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Wu F, Liu J, Zheng L, Chen C, Basnet D, Zhang J, Shen C, Feng X, Sun Y, Du X, Zheng JC, Liu J. Preoperative pain sensitivity and its correlation with postoperative acute and chronic pain: a systematic review and meta-analysis. Br J Anaesth 2024; 133:591-604. [PMID: 38879440 DOI: 10.1016/j.bja.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/24/2024] [Accepted: 05/21/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Preoperative pain sensitivity (PPS) can be associated with postsurgical pain. However, estimates of this association are scarce. Confirming this correlation is essential to identifying patients at high risk for severe postoperative pain and for developing analgesic strategy. This systematic review and meta-analysis summarises PPS and assessed its correlation with postoperative pain. METHODS PubMed, Scopus, Cochrane Library, and PsycINFO were searched up to October 1, 2023, for studies reporting the association between PPS and postsurgical pain. Two authors abstracted estimates of the effect of each method independently. A random-effects model was used to combine data. Subgroup analyses were performed to investigate the effect of pain types and surgical procedures on outcomes. RESULTS A total of 70 prospective observational studies were included. A meta-analysis of 50 studies was performed. Postoperative pain was negatively associated with pressure pain threshold (PPT; r=-0.15, 95% confidence interval [CI] -0.23 to -0.07]) and electrical pain threshold (EPT; r=-0.28, 95% CI -0.42 to -0.14), but positively correlated with temporal summation of pain (TSP; r=0.21, 95% CI 0.12-0.30) and Pain Sensitivity Questionnaire (PSQ; r=0.25, 95% CI 0.13-0.37). Subgroup analysis showed that only TSP was associated with acute and chronic postoperative pain, whereas PPT, EPT, and PSQ were only associated with acute pain. A multilevel (three-level) meta-analysis showed that PSQ was not associated with postoperative pain. CONCLUSIONS Lower PPT and EPT, and higher TSP are associated with acute postoperative pain while only TSP is associated with chronic postoperative pain. Patients with abnormal preoperative pain sensitivity should be identified by clinicians to adopt early interventions for effective analgesia. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42023465727).
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Affiliation(s)
- Fan Wu
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jiehui Liu
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Liang Zheng
- Research Center for Translation Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changqi Chen
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Diksha Basnet
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jingya Zhang
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Chaonan Shen
- Research Center for Translation Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuanran Feng
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Yiyan Sun
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Xue Du
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jialin C Zheng
- Center for Translational Neurodegeneration and Regenerative Therapy, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China; Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Jianhui Liu
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China.
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Zhang J, Sun D, Wang J, Chen J, Chen Y, Shu B, Huang H, Duan G. Exploring the Analgesic Efficacy and mechanisms of low-dose esketamine in pregnant women undergoing cesarean section: A randomized controlled trial. Heliyon 2024; 10:e35434. [PMID: 39170110 PMCID: PMC11336589 DOI: 10.1016/j.heliyon.2024.e35434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/28/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024] Open
Abstract
Background Postoperative pain is a prevalent concern following a cesarean section. This study aimed to investigate the effect and mechanism of low-dose (0.1 mg/kg) esketamine on postoperative pain management in pregnant women undergoing cesarean sections, specifically in cases where both patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) were employed. Methods Pregnant women intending to undergo elective cesarean section were divided into four subgroups based on the intravenous administration of esketamine and the specific analgesia methods employed: E1 (0.1 mg/kg esketamine + PCEA), E2 (0.1 mg/kg esketamine + PCIA), C1 (saline + PCEA), and C2 (saline + PCIA). The primary outcome was the maximum pain score within 24 h postoperatively. Secondary outcomes included the pressure pain threshold and tolerance at 30 min and 24 h postoperatively, along with the inflammation and adverse event index scores. Results A total of 118 pregnant women were assigned to the four groups: E1 (n = 29), E2 (n = 29), C1 (n = 30), and C2 (n = 30). Compared with those in the control groups (C1 + C2), the maximum postoperative pain scores within 24 h in the esketamine groups (E1 + E2) were significantly lower (4 [2-5] vs. 4 [4-6], P = 0.002), and the E1 group exhibited superior analgesic effects compared with other groups. No significant differences were observed in postoperative hyperalgesia or inflammation across the four groups. Notably, esketamine combined with PCIA increased the incidence of postoperative nausea and vomiting (7 [25 %] vs. 0 [0 %]; P = 0.005). Conclusion The administration of low-dose (0.1 mg/kg) esketamine effectively alleviates pain following cesarean section, and the analgesic effect is notably enhanced in combination with PCEA. Importantly, these effects do not appear to be mediated through anti-inflammatory mechanisms or the inhibition of hyperalgesia. Clinical trial registration number NCT05414006.
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Affiliation(s)
- Junhua Zhang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Dina Sun
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jing Wang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jie Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuanjing Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bin Shu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - He Huang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Liu XY, Chen XB, Wen YL, Guo XP, Zhou XB. Effect of psychological nursing intervention combined with acupressure on postoperative recovery of women after cesarean section. World J Clin Cases 2024; 12:4527-4535. [PMID: 39070839 PMCID: PMC11235511 DOI: 10.12998/wjcc.v12.i21.4527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/09/2024] [Accepted: 06/13/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Psychological intervention nursing (PIN) has been considered to have a curative effect on cesarean section (CS) postoperative recovery. However, the therapeutic mechanisms remain obscure. AIM To explore the effects of PIN combined with acupressure massage on CS postoperative recovery. METHODS A retrospective study was conducted on 150 pregnant women admitted to an obstetrics department between January 2020 and January 2023. The control group (CG) received acupressure therapy (n = 73), and the intervention group (IG) received acupressure therapy and PIN therapy (n = 77). Postoperative recovery time was assessed by anal-exhausting, defecation, bed activity, breastfeeding, and hospital stay times. Adverse effects, including infection, bleeding, limb numbness, intrauterine hematoma, urinary retention, and venous thromboembolism, were recorded. the pain visual analogue scale (VAS) was used to evaluate the degree of pain. Anxiety and depression status were qualitatively assessed using the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Edinburgh postpartum depression scale (EPDS). The Pittsburgh sleep quality index (PSQI) was used to compare sleep quality between the groups. RESULTS The baseline data and SAS, SDS, EPDS, and PSQI scores did not significantly differ before CS (P > 0.05) and neither did complication rates between the two groups after CS (P > 0.05). However, anal-exhausting, defecation, waking up, breastfeeding, and hospitalization times were significantly shorter for participants in the IG than those for participants in the CG (P < 0.05). The VAS, SAS, SDS, EPDS, and PSQI scores of the IG were significantly lower than those of the CG (P < 0.05). CONCLUSION PIN, combined with acupressure massage, effectively promotes maternal recovery, reduces post-CS pain, and improves postoperative negative emotions and sleeping quality.
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Affiliation(s)
- Xing-Ying Liu
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Xiao-Bo Chen
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - You-Liang Wen
- Rehabilitation Therapy Teaching and Research Office, Rehabilitation College of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Xiao-Ping Guo
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Xiao-Bin Zhou
- Dermatology and Plastic Surgery Department, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
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Qin PP, Zou BY, Liu D, Li MX, Liu XN, Wei K. Lateral quadratus lumborum block vs acupuncture for postcesarean analgesia: a randomized clinical trial. Am J Obstet Gynecol MFM 2024; 6:101433. [PMID: 39019211 DOI: 10.1016/j.ajogmf.2024.101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Improved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head. OBJECTIVE This study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section. STUDY DESIGN In this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function. RESULTS Median (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2-4] vs 3 [2-4], respectively; P=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (P<.001), as well as shortened the time to first flatus (P=.03) and first drinking (P<.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0-19.0] hours vs 15.3 [13.3-17.0] hours, estimated median difference, 1.5; 95% CI, 1-2; P<.001). CONCLUSION As a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.
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Affiliation(s)
- Pei-Pei Qin
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bing-Yu Zou
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Liu
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming-Xi Li
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Nan Liu
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Wei
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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White TD, Matthew SK, Tubog TD. Postoperative Cesarean Section Pain Management Using Transversus Abdominis Plane Block Versus Intrathecal Morphine: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024:S1089-9472(24)00123-0. [PMID: 39001740 DOI: 10.1016/j.jopan.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Compare and evaluate the effectiveness of transversus abdominis plane (TAP) block versus intrathecal morphine (ITM) on elective postcesarean section pain, opioid consumption, and related side effects. DESIGN Systematic review and meta-analysis. METHODS A search for evidence was conducted in PubMed, Google Scholar, CINAHL, Cochrane Collaboration Database, UpToDate, Health Source, and gray literature. Only randomized controlled trials (RCTs) were included in the study. The methodological quality of evidence assessment was conducted using the Risk of Bias and Grades of Recommendation, Assessment, Development, and Evaluation system. The meta-analysis used Review Manager (RevMan 5.4, The Cochrane Collaboration). FINDINGS A total of 11 RCTs involving 1,129 patients were analyzed. Compared to ITM, TAP has a similar effect on static (mean difference [MD]; 0.37; 95% confidence interval [CI], -0.04 to 0.79; P = .08) and dynamic pain scores (MD, 0.43; 95% CI, -0.06 to 0.92; P = .09) within the first 48 hours after surgery. Additionally, the TAP block had a lower incidence of postoperative nausea and vomiting (risk ratio, 0.45; 95% CI, 0.31 to 0.66; P < .0001) and increased opioid consumption (MD, 6.78; 95% CI, 3.79 to 9.77; P < .00001). Overall, TAP block and ITM did not differ in the time to first to rescue analgesia, incidence of sedation, and pruritus. CONCLUSIONS Evidence suggests that TAP blocks are equivalent to ITM in pain scores and more effective at lowering the incidence of postoperative nausea and vomiting, yet ITM has been shown to be more effective in reducing postoperative opioid consumption.
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Affiliation(s)
- Tyler D White
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Shilpa K Matthew
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX.
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Cheng J, Wan M, Yu X, Yan R, Lin Z, Liu H, Chen L. Pharmacologic Analgesia for Cesarean Section: An Update in 2024. Curr Pain Headache Rep 2024:10.1007/s11916-024-01278-8. [PMID: 38951467 DOI: 10.1007/s11916-024-01278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE OF THE REVIEW With the increasing prevalence of cesarean section globally, the importance of perioperative analgesia for cesarean section is becoming increasingly evident. This article provides an overview and update on the current status of cesarean section worldwide and associated analgesic regimens. RECENT FINDINGS Some recent studies unveiled potential association of neuraxial analgesia might be associated with children's autism, pharmacologic analgesia in obstetric will potentially gain some more attention. Various commonly used techniques and medications for analgesia in cesarean section are highlighted. While neuraxial administration of opioid remains the most classic method, the use of multimodal analgesia, particularly integration of nonsteroidal anti-inflammatory drugs, acetaminophen, peripheral nerve blocks has provided additional and better options for patients who are not suitable for intrathecal and neuraxial techniques and those experiencing severe pain postoperatively. Optimal pain management is crucial for achieving better clinical outcomes and optimal recovery, and with the continuous development of medications, more and better pharmacologic regimen will be available in the future.
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Affiliation(s)
- Jing Cheng
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Mengjiao Wan
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Xiaoyan Yu
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Rongrong Yan
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Zirui Lin
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Henry Liu
- Department of Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Lin Chen
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070.
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Crandon R, Storr N, Padhy S, Parker P, Lun S, Hughes I, Pietrobuono M, Carter P. Enhanced recovery after caesarean section: Implementation of an ERAC protocol in a tertiary obstetric hospital. J Perioper Pract 2024:17504589241256458. [PMID: 38867421 DOI: 10.1177/17504589241256458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Assess safety and efficacy of an Enhanced Recovery After Caesarean protocol. BACKGROUND Caesarean sections are among the most commonly performed surgeries worldwide, but have been associated with postoperative chronic pain and opioid abuse. METHODS ASA 2 females, over 18 years, non-primiparous, repeat elective LSCS. Primary outcomes were length of stay and opioid consumption. Secondary outcomes were pain scores, functional assessment scores, pruritus, nausea and vomiting. RESULTS A total of 579 women divided into standard care (389 patients) and enhanced recovery after caesarean groups (190 patients). Enhanced recovery after caesarean associated with reduced length of stay, 50.8 hours (interquartile range 48.6, 53.6) versus 72.2 hours (interquartile range 53.2, 75.7) in standard care. Enhanced recovery after caesarean associated with reduced opioid consumption, median 10 (interquartile range 0, 27.5mg) versus 120mg (interquartile range 90, 145mg) in standard care at 24 hours and 30 (interquartile range 7.7, 67.5mg) versus 177.5mg (interquartile range 132.5, 222.5 mg) at 48 hours. Pain scores reduced from moderate to mild in the enhanced recovery after caesarean. functional assessment scores trend towards improved function in the enhanced recovery after caesarean group (Functional assessment scores B 8.9% in enhanced recovery after caesarean versus 147% in standard care). Increased pruritus in the enhanced recovery after caesarean with 41.6% compared with 9.3% in standard care. Nausea and vomiting increased in enhanced recovery after caesarean group 48.9% versus 11.6% in standard care. CONCLUSION Enhanced recovery after caesarean associated with a reduction in length of stay, opioid consumption and improved pain scores with an increase in side effects.
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Affiliation(s)
- Rian Crandon
- Townsville Hospital and Health Service, Douglas, QLD, Australia
| | - Nicholas Storr
- Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
| | - Sofia Padhy
- Gold Coast University Hospital, Southport, QLD, Australia
| | - Paula Parker
- Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
| | - Stacey Lun
- Gold Coast University Hospital, Southport, QLD, Australia
| | - Ian Hughes
- Gold Coast University Hospital, Southport, QLD, Australia
| | | | - Paula Carter
- Gold Coast University Hospital, Southport, QLD, Australia
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Salazar-Flórez JE, Arenas-Cardona LT, Marhx N, López-Guerrero E, Echeverri-Rendón ÁP, Giraldo-Cardona LS. Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study. Local Reg Anesth 2024; 17:39-47. [PMID: 38650746 PMCID: PMC11033210 DOI: 10.2147/lra.s444947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/16/2024] [Indexed: 04/25/2024] Open
Abstract
Background Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects. Objective To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia. Methods Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square ([Formula: see text]), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant. Results Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size. Conclusion The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.
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Affiliation(s)
| | - Leidy Tatiana Arenas-Cardona
- Department of Medicine, Hospital General de Occidente, University Health Sciences Center of University of Guadalajara, Jalisco, Mexico
| | - Ninemy Marhx
- Department of Medicine, Hospital General de Occidente, University Health Sciences Center of University of Guadalajara, Jalisco, Mexico
| | - Eduardo López-Guerrero
- Department of Medicine, Hospital General de Occidente, University Health Sciences Center of University of Guadalajara, Jalisco, Mexico
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He J, Wilson JM, Fields KG, Mikayla Flowers Zachos K, Franqueiro AR, Reale SC, Farber MK, Bateman BT, Edwards RR, Rathmell JP, Soens M, Schreiber KL. Brief Assessment of Patient Phenotype to Explain Variability in Postsurgical Pain and Opioid Consumption after Cesarean Delivery: Performance of a Novel Brief Questionnaire Compared to Long Questionnaires. Anesthesiology 2024; 140:701-714. [PMID: 38207329 PMCID: PMC10939890 DOI: 10.1097/aln.0000000000004900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Understanding factors that explain why some women experience greater postoperative pain and consume more opioids after cesarean delivery is crucial to building an evidence base for personalized prevention. Comprehensive psychosocial assessment with validated questionnaires in the preoperative period can be time-consuming. A three-item questionnaire has shown promise as a simpler tool to be integrated into clinical practice, but its brevity may limit the ability to explain heterogeneity in psychosocial pain modulators among individuals. This study compared the explanatory ability of three models: (1) the 3-item questionnaire, (2) a 58-item questionnaire (long) including validated questionnaires (e.g., Brief Pain Inventory, Patient Reported Outcome Measurement Information System [PROMIS]) plus the 3-item questionnaire, and (3) a novel 19-item questionnaire (brief) assessing several psychosocial factors plus the 3-item questionnaire. Additionally, this study explored the utility of adding a pragmatic quantitative sensory test to models. METHODS In this prospective, observational study, 545 women undergoing cesarean delivery completed questionnaires presurgery. Pain during local anesthetic skin wheal before spinal placement served as a pragmatic quantitative sensory test. Postoperatively, pain and opioid consumption were assessed. Linear regression analysis assessed model fit and the association of model items with pain and opioid consumption during the 48 h after surgery. RESULTS A modest amount of variability was explained by each of the three models for postoperative pain and opioid consumption. Both the brief and long questionnaire models performed better than the three-item questionnaire but were themselves statistically indistinguishable. Items that were independently associated with pain and opioid consumption included anticipated postsurgical pain medication requirement, surgical anxiety, poor sleep, pre-existing pain, and catastrophic thinking about pain. The quantitative sensory test was itself independently associated with pain across models but only modestly improved models for postoperative pain. CONCLUSIONS The brief questionnaire may be more clinically feasible than longer validated questionnaires, while still performing better and integrating a more comprehensive psychosocial assessment than the three-item questionnaire. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Jingui He
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Jenna M. Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Kara G. Fields
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - K. Mikayla Flowers Zachos
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Angelina R. Franqueiro
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Sharon C. Reale
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Michaela K. Farber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - James P. Rathmell
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Mieke Soens
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
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Fowler C, Stockert E, Hoang D, Guo N, Riley E, Sultan P, Carvalho B. Continuous wound infusion catheter as part of a multimodal analgesia regimen for post-Caesarean delivery pain: a quality improvement impact study. BJA OPEN 2024; 9:100242. [PMID: 38179106 PMCID: PMC10761342 DOI: 10.1016/j.bjao.2023.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
Background The role of continuous wound infusion catheters as part of a multimodal analgesia strategy after Caesarean delivery is unclear. We introduced continuous wound infusion catheters to our multimodal analgesia regimen to evaluate the impact on analgesic outcomes after Caesarean delivery. Methods After institutional review board (IRB) approval, a 4-month practice change was instituted as a quality improvement initiative. In addition to multimodal analgesia, continuous wound infusion catheters for up to 3 days were offered on alternate weeks for all women undergoing Caesarean deliveries. The primary outcome was postoperative in-hospital opioid consumption. Secondary outcomes were static and dynamic pain scores at 24 and 72 h, time until first analgesic request, opioid-related side-effects, length of stay, satisfaction (0-100%), and continuous wound infusion catheter-related complications. Results All women scheduled for Caesarean delivery (n=139) in the 4-month period were included in the analysis, with 70 women receiving continuous wound infusion catheters, and 69 in the control group. Opioid consumption (continuous wound infusion catheter group 11.3 [7.5-61.9] mg morphine equivalents vs control group 30.0 [11.3-48.8] mg morphine equivalents), pain scores (except 24 h resting pain scores which were higher in the control group 2 [1-3] vs 1.5 [0-3] in the continous wound infusion catheters group; P=0.05), side-effects, length of stay, and complications were similar between groups. Satisfaction scores at 24 h were higher with continuous wound infusion catheters (100% [91-100%] vs 90% [86-100%]; P=0.003) with no differences at 72 h. One patient demonstrated symptoms of systemic local anaesthetic toxicity which resolved without significant harm. Conclusions The addition of continuous wound infusion catheters to a multimodal analgesia regimen for post-Caesarean delivery pain management demonstrated minimal clinically significant analgesic benefits. Future studies are needed to explore the use of continuous wound infusion catheters in populations that may benefit most from this intervention.
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Affiliation(s)
- Cedar Fowler
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Emily Stockert
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dan Hoang
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA
| | - Nan Guo
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward Riley
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Pervez Sultan
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Brendan Carvalho
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Ren Y, Guo Y, Tang J, He L, Li M, Huang X, Lu Q, Sun B, Feng H, Liu H, Du J, Li J. Effect of Personality and Pain Catastrophizing on Postoperative Analgesia Following Cesarean Section: A Prospective Cohort Study. J Pain Res 2024; 17:11-19. [PMID: 38192365 PMCID: PMC10771724 DOI: 10.2147/jpr.s443230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose This study aimed to investigate the effects of different psychological personalities and pain catastrophizing levels on postoperative analgesia in patients undergoing cesarean section. Patients and Methods Puerperas who underwent cesarean section at our hospital between January and August 2023 were recruited into the study and assessed using the Eysenck Personality Questionnaire-Revised Short Scale (EPQRSC) and Pain Catastrophizing Scale (PCS). Data on the numerical pain intensity at rest and during activity 24 h after surgery, number and dosage of analgesia pumps, and satisfaction with analgesia were recorded. According to the numerical pain score during activity 24 h post-operation, the patients were divided into the analgesia incomplete group (≥4) and control group (<4). Univariate analysis, Spearman correlation analysis, and binary logistic regression analysis were used to evaluate the influence of personality characteristics and PCS on postoperative analgesia. Results A total of 778 women were included in the study. The incidence of inadequate analgesia was 89.8%. The satisfaction rate of analgesia was 66.8%. Univariate analysis showed that extraversion; neuroticism; PCS; numbers of previous cesarean delivery; ASA; analgesic satisfaction; and 24-h analgesia pump compressions and dosage were associated with postoperative analgesia after cesarean section (P<0.05). Using binary logistic regression analysis, the first cesarean section (odds ratio [OR]=0.056, 95% confidence interval [CI]=1.913-19.174), the number of 24-h analgesic pump compressions (OR=8.464, 95% CI=0.356-0.604), extraversion (OR=0.667, 95% CI=0.513-0.866), neuroticism (OR=1.427, 95% CI=1.104-1.844), and PCS (OR=7.718, 95% CI=0.657-0.783) were factors affecting postoperative analgesia. Conclusion The incidence of inadequate analgesia after a cesarean section was high (89.8% on the first day after surgery). Formulating accurate analgesia programs for women undergoing cesarean section with extraversion, neuroticism personality characteristics, and pain catastrophizing behaviors is necessary for improving their postoperative analgesia effects and satisfaction and promoting postpartum comfort.
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Affiliation(s)
- Yunhong Ren
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Yinhao Guo
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, Sichuan, 637000, People’s Republic of China
| | - Jing Tang
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, Sichuan, 637000, People’s Republic of China
| | - Ling He
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Meiling Li
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Xuemei Huang
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Qin Lu
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Baoxia Sun
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Haixia Feng
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Huan Liu
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Juan Du
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Jun Li
- Mianyang Key Laboratory of Anesthesia and Neuroregulation, Department of Anesthesiology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
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Zanfini BA, Di Muro M, Biancone M, Catarci S, Piersanti A, Frassanito L, Ciancia M, Toni F, Santantonio MT, Draisci G. Ultrasound-Guided Bilateral Erector Spinae Plane Block vs. Ultrasound-Guided Bilateral Posterior Quadratus Lumborum Block for Postoperative Analgesia after Caesarean Section: An Observational Closed Mixed Cohort Study. J Clin Med 2023; 12:7720. [PMID: 38137789 PMCID: PMC10744071 DOI: 10.3390/jcm12247720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
ESP block (ESPB) and posterior Quadratus Lumborum Block (pQLB) have been proposed as opioid-sparing techniques for the management of pain after abdominal surgery. Between December 2021 and October 2022, we conducted a retrospective comparative study at the delivery suite of Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, to compare the efficacy of ESPB and pQLB in preventing postoperative pain after an elective caesarean section (CS). The primary outcome was total morphine consumption in the first 24 h. Secondary outcomes were time to first opioid request; Numerical Pain Rating Scale (NPRS) at 0, 2, 6, 12 and 24 h; vital signs; adverse events. Fifty-two women were included. The total cumulative dose of morphine was not significantly different between the two groups of patients (p = 0.897). Time to first dose of morphine, NPRS values and haemodynamic parameters were not statistically different between the two groups. NPRS values significantly increased (p < 0.001) at the different time intervals considered. The need for rescue doses of morphine was lower in the ESPB group compared to the pQLB group (hazard ratio of 0.51, 95% CI (0.27 to 0.95), p = 0.030). No adverse event was reported. ESPB seems to be as effective as pQLB in providing analgesia after CS.
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Affiliation(s)
- Bruno A. Zanfini
- Department of Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
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13
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Connery S, Tanner JP, Odibo L, Raitano O, Nikolic-Dorschel D, Louis JM. Effect of Using Silver Nylon Dressings on Postoperative Pain after Cesarean Delivery. Am J Perinatol 2023; 40:1811-1819. [PMID: 34839470 DOI: 10.1055/s-0041-1739521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Silver dressings have been associated with a decrease in postoperative pain in selected populations, but it is unknown if the benefit can be observed after cesarean deliveries. We sought to evaluate the impact of silver nylon dressings in reducing postoperative pain after cesarean delivery. STUDY DESIGN A secondary analysis of data from a blinded randomized clinical trial of women undergoing cesarean delivery scheduled and unscheduled at a single site was conducted. Women were recruited for participation from a single site and randomized to a silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient clinic at 1 and 6 weeks after delivery and patient responded to the modified patient scar assessment scale. The primary outcome of this analysis was inpatient opioid and nonopioid analgesic dispensed. The secondary outcome was patient-reported pain at the 1- and 6-week postpartum visits. Data were analyzed using chi-square test, Student's t-test, Fisher's exact test, Wilcoxon-Mann-Whitney's test, and logistic regression where appropriate. A p-value of < 0.05 was considered significant. RESULTS Among the 649 participants, women allocated to the silver nylon dressing group, when compared with the gauze group, were similar in the amount of dispensed opioid and nonopioid analgesic medications (morphine equivalent milligrams of opioids dispensed [82.5 vs. 90 mg, p = 0.74], intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) [120 vs. 120 mg, p = 0.55], and oral NSAIDs [4,800 vs. 5,600 mg in the gauze group, p = 0.65]). After adjusting for confounding variables, postoperative wound infection (adjusted odds ratio [aOR]: 11.70; 95% confidence interval [CI]: 4.51-30.31) at 1-week postoperative and again at 6-week postoperative (aOR: 5.59; 95% CI: 1.03-30.31) but not gauze dressing was associated with patient-reported postoperative pain. CONCLUSION Among women undergoing cesarean delivery, silver nylon dressing was not associated with a reduction in postoperative pain. KEY POINTS · Silver dressings showed no decrease in pain medications.. · Wound infection is associated with pain postoperatively.. · Silver dressings did not reduce postoperative pain..
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Affiliation(s)
- Sheila Connery
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jean Paul Tanner
- College of Public Health, University of South Florida, Tampa, Florida
| | - Linda Odibo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Olivia Raitano
- Creighton University School of Medicine, Omaha, Nebraska
| | | | - Judette M Louis
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
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14
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Yurashevich M, Cooter Wright M, Sims SC, Tan HS, Berger M, Ji RR, Habib AS. Inflammatory changes in the plasma and cerebrospinal fluid of patients with persistent pain and postpartum depression after elective Cesarean delivery: an exploratory prospective cohort study. Can J Anaesth 2023; 70:1917-1927. [PMID: 37932648 PMCID: PMC10842683 DOI: 10.1007/s12630-023-02603-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/16/2023] [Accepted: 05/03/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Severe acute pain after Cesarean delivery increases the risk of developing persistent pain (~20% incidence) and postpartum depression (PPD) (~15% incidence). Both conditions contribute to maternal morbidity and mortality, yet early risk stratification remains challenging. Neuroinflammation has emerged as a key mechanism of persistent pain and depression in nonobstetric populations. Nevertheless, most studies focus on plasma cytokines, and the relationship between plasma and cerebrospinal fluid (CSF) cytokine levels is unclear. Our primary aim was to compare inflammatory marker levels between patients who developed the composite outcome of persistent pain and/or PPD vs those who did not. METHODS We recruited term patients with singleton pregnancies undergoing elective Cesarean delivery under neuraxial anesthesia into an exploratory prospective cohort study. We collected baseline demographic, obstetric, and Edinburgh Postnatal Depression Scale information, and performed quantitative sensory tests. Plasma was collected preoperatively and 48 hr postoperatively. In the operating room, 10 mL of CSF was collected, followed by a standardized anesthetic. Intra- and postoperative management were according to standard practice. We obtained Edinburgh Postnatal Depression Scale and pain scores at six weeks and three months after delivery. The primary outcome was persistent pain and/or PPD at three months. We analyzed the difference in inflammatory marker levels between the groups (primary aim) using two-sided Mann-Whitney tests. RESULTS Eighty participants were enrolled, and 63 patients completed the study; 23 (37%) experienced the primary outcome at three months. Preoperative plasma transforming growth factor beta 1 (TGF-β1) concentration was higher in patients who developed the primary outcome compared with those who did not (median [interquartile range (IQR)], 2,879 [2,241-5,494] vs 2,292 [1,676-2,960] pg·mL-1; P = 0.04), while CSF IL-1β concentration was higher in patients who developed the primary outcome than in those who did not (median [IQR], 0.36 [0.29-0.39] vs 0.30 [0.25-0.35] pg·mL-1; P = 0.03). CONCLUSIONS We observed differential levels of plasma and CSF inflammatory biomarkers in patients who developed persistent pain and PPD compared with those who did not. We showed the feasibility of collecting plasma and CSF samples at Cesarean delivery, which may prove useful for future risk-stratification. STUDY REGISTRATION ClinicalTrials.gov (NCT04271072); registered 17 February 2020.
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Affiliation(s)
- Mary Yurashevich
- Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Mary Cooter Wright
- Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Sierra C Sims
- Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Hon Sen Tan
- Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Ru-Rong Ji
- Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University Medical Center, Duke University, Box 3094, Durham, NC, 27710, USA.
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15
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Aksoy M, Aksoy AN, Yilmaz EPT, Senocak GNC, Dostbil A, Ozkan H. The effectiveness of erector spina plane, quadratus lumborum blocks, and intrathecal morphine for analgesia after cesarean: a randomized study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230867. [PMID: 37971133 PMCID: PMC10645188 DOI: 10.1590/1806-9282.20230867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE This prospective randomized study was conducted at Ataturk University Medical Faculty Hospital, Department of Anesthesia and Reanimation, from June 2022 to May 2023. The aim of this study was to compare the effectiveness of ultrasound-guided erector spinae plane block, quadratus lumborum block, and intrathecal morphine to decrease postoperative pain after cesarean section. METHODS Sixty-term pregnant women who were scheduled for elective cesarean sections with spinal anesthesia were included. Patients were randomly divided into three groups (n=20 for each group): Group 1: Patients were administered intrathecal morphine during spinal anesthesia; Group 2: Patients performed bilateral erector spinae plane block postoperatively; and Group 3: Patients performed bilateral quadratus lumborum block postoperatively. In the postpartum care unit, patients received intravenous Patient-Controlled Analgesia. The Patient-Controlled Analgesia devices were set to administer an intravenous bolus of 25 μg fentanyl, with a lockout interval of 10 min. Opioid consumption and maximum pain score in the 24 postoperative hours were recorded. RESULTS Patients in Group 1 had a longer time to first analgesic requirement compared to Group 2 (p=0.017). Opioid consumption and resting and moving visual analog score scores in the first 24 h postoperatively were similar between groups. CONCLUSION All three methods, including intrathecal morphine, erector spinae plane block, and quadratus lumborum block, are efficacious and comparable in providing postoperative analgesia after cesarean under spinal anesthesia.
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Affiliation(s)
- Mehmet Aksoy
- Atatürk University, Faculty of Medicine, Department of Anesthesiology and Reanimation – Erzurum, Turkey
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
| | - Ayse Nur Aksoy
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
- University of Health Sciences, Erzurum City Hospital, Department of Obstetrics and Gynecology – Erzurum, Turkey
| | - Emsal Pınar Topdagi Yilmaz
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
- Atatürk University, Faculty of Medicine, Department of Obstetrics and Gynecology – Erzurum, Turkey
| | - Gamze Nur Cimilli Senocak
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
- Atatürk University, Faculty of Medicine, Department of Obstetrics and Gynecology – Erzurum, Turkey
| | - Aysenur Dostbil
- Atatürk University, Faculty of Medicine, Department of Anesthesiology and Reanimation – Erzurum, Turkey
- Atatürk University, Anesthesiology Clinical Research Office – Erzurum, Turkey
| | - Hava Ozkan
- Atatürk University, Faculty of Health Science, Department of Midwifery – Erzurum, Turkey
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Sangkum L, Tangjitbampenbun A, Chalacheewa T, Brennan K, Liu H. Peripheral Nerve Blocks for Cesarean Delivery Analgesia: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1951. [PMID: 38004000 PMCID: PMC10673165 DOI: 10.3390/medicina59111951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Effective postoperative analgesia using multimodal approach improves maternal and neonatal outcomes after cesarean delivery. The use of neuraxial approach (local anesthetic and opioids) and intravenous adjunctive drugs, such as nonsteroidal anti-inflammatory drugs and acetaminophen, currently represents the standard regimen for post-cesarean delivery analgesia. Peripheral nerve blocks may be considered in patients who are unable to receive neuraxial techniques; these blocks may also be used as a rescue technique in selected patients. This review discusses the relevant anatomy, current evidence, and advantages and disadvantages of the various peripheral nerve block techniques. Further research is warranted to compare the analgesic efficacy of these techniques, especially newer blocks (e.g., quadratus lumborum blocks and erector spinae plane blocks). Moreover, future studies should determine the safety profile of these blocks (e.g., fascial plane blocks) in the obstetric population because of its increased susceptibility to local anesthetic toxicity.
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Affiliation(s)
- Lisa Sangkum
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Amornrat Tangjitbampenbun
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Theerawat Chalacheewa
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Kristin Brennan
- Department of Anesthesiology, Penn Medicine Lancaster General Hospital, 555 N Duke St., Lancaster, PA 17602, USA;
| | - Henry Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Badreldin N, Ditosto JD, Grobman WA, Yee LM. Maternal psychosocial factors associated with postpartum pain. Am J Obstet Gynecol MFM 2023; 5:100908. [PMID: 36809840 PMCID: PMC10121962 DOI: 10.1016/j.ajogmf.2023.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND The experience of pain is shaped by a host of psychological, cultural, and social factors. Although pain is the most common postpartum complaint, data on its relationship with psychosocial factors and postpartum pain are limited. OBJECTIVE This study aimed to examine the relationship between self-reported postpartum pain scores and patient-level psychosocial factors, including relationship status, pregnancy intendedness, employment, education, and psychiatric diagnosis. STUDY DESIGN This was a secondary analysis of data from a prospective observational study of postpartum patients at 1 institution (May 2017 to July 2019) who used an oral opioid at least once during their postpartum hospitalization. Enrolled participants completed a survey, which included questions regarding their social situation (including relationship status), psychiatric diagnoses, and perceptions of their pain control during their postpartum hospitalization. The primary outcome was self-reported overall pain during the postpartum hospitalization (score of 0-100). Multivariable analyses accounted for age, body mass index, nulliparity, and mode of delivery. RESULTS In this cohort of 494 postpartum patients, most patients (84.0%) underwent cesarean delivery, and 41.3% of patients were nulliparous. In a pain score of 0 to 100, participants reported a median pain score of 47. On bivariable analyses, there was no significant difference in pain score between patients with and without an unplanned pregnancy or a psychiatric diagnosis. Patients who were unpartnered, those without a college education, and those who were unemployed reported significantly higher pain scores (57.5 vs 44.8 [P<.01], 52.6 vs 44.6 [P<.01], and 53.6 vs 44.6 [P<.01], respectively). In multivariable analyses, patients who were unpartnered and unemployed reported significantly higher adjusted pain scores than patients who were partnered and employed (adjusted beta coefficients: 7.93 [95% confidence interval, 2.29-13.57] vs 6.67 [95% confidence interval, 2.28-11.05]). CONCLUSION Psychosocial factors, such as relationship and employment statuses, which are indicators of social support, are associated with the experience of pain postpartum. These findings suggest that addressing social support, such as via enhanced support from the health care team, warrants exploration as a nonpharmacologic means of improving the postpartum pain experience.
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Affiliation(s)
- Nevert Badreldin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Badreldin, Ms Ditosto, and Dr Yee).
| | - Julia D Ditosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Badreldin, Ms Ditosto, and Dr Yee)
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH (Dr Grobman)
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Badreldin, Ms Ditosto, and Dr Yee)
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18
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Ulfa Y, Maruyama N, Igarashi Y, Horiuchi S. Women's experiences of breastfeeding after a cesarean section: A meta-synthesis. Jpn J Nurs Sci 2023:e12534. [PMID: 37186368 DOI: 10.1111/jjns.12534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 05/17/2023]
Abstract
AIM The World Health Organization and United Nations Children's Fund recommend the early initiation of breastfeeding within the first hour postpartum for successful exclusive breastfeeding. However, cesarean section is a risk factor for unsuccessful early initiation of breastfeeding. Herein, we aim to explore women's experiences of breastfeeding after a cesarean section. METHODS We used the Joanna Briggs Institute framework in this meta-synthesis. We searched articles published from 1990 to 2022 on PubMed, CINAHL, Cochrane library, PsycInfo, and EMBASE to identify qualitative studies on women's experiences of breastfeeding after a cesarean section. We used the Critical Appraisal Skills Programme checklist for qualitative studies to assess the quality of the included studies. RESULTS Seven qualitative studies from five countries met the inclusion criteria, representing the views of 194 women who underwent cesarean sections. Six new categories were integrated into the women's experiences of breastfeeding after a cesarean section as follows: (i) Perceived values of breastfeeding, (ii) Emotional vulnerability in breastfeeding, (iii) Physical difficulties in breastfeeding, (iv) Inconvenient conditions in breastfeeding, (v) Inadequate resources for breastfeeding, and (vi) Support systems to enable breastfeeding. CONCLUSIONS We provide evidence showing that knowledge of the specific breastfeeding mechanism and provision of the most appropriate postsurgical care by healthcare providers just after a cesarean section can reduce the barriers to post-cesarean breastfeeding. Moreover, effective hospital policies and family support can result in the initiation of positive breastfeeding outcomes. Future studies that consider the cultural aspects of breastfeeding practice may generate additional insights into providing optimal postpartum care.
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Affiliation(s)
- Yunefit Ulfa
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- National Research and Innovation Agency, Central Jakarta, Indonesia
| | - Naoko Maruyama
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Yumiko Igarashi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
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Gupta D, Kerai S, Saxena KN, Gaur S. Clinical evaluation of preoperative three -item questionnaire and pain experienced on infiltration of local anesthetics to predict severity of acute pain after caesarean section. J Anaesthesiol Clin Pharmacol 2023; 39:273-278. [PMID: 37564838 PMCID: PMC10410050 DOI: 10.4103/joacp.joacp_378_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/10/2021] [Accepted: 12/22/2021] [Indexed: 08/12/2023] Open
Abstract
Background and Aims Several studies have attempted to identify patients at risk of developing severe pain after caesarean section (CS) by utilizing preoperative experimental pain application and clinical tests. The three-item questionnaire and reported pain intensity on infiltration of local anesthetic (LA) on the back of patient just before administration of spinal anesthesia, are two simple tests previously shown to be promising. We aimed to study utility of these two tools in Indian patients undergoing CS and find their correlation with postoperative pain and analgesic consumption. Material and Methods A total of 150 parturients undergoing elective CS were enrolled. Preoperatively patients were asked to rate their level of anxiety, anticipated postoperative pain and analgesic need after surgery (three-item questionnaire). The pain intensity reported by patient upon LA injection for spinal anesthesia were recorded. In the postoperative period, pain intensity at rest, evoked pain and need for rescue analgesics were recorded. The correlation between three item questionnaire and pain on LA infiltration to postoperative pain were evaluated. To see relationship between the predictor variables to outcome, a multiple regression analysis was performed. Results The predictors variables and postoperative pain were found to have mild correlation (r = 0.124 to 0.239). The predictor variables were significantly correlated with postoperative pain at rest but their association was not significant to evoked pain intensity. Multiple regression analysis showed that change in the predictors explains only 7-8% variance in postoperative pain outcomes. Conclusion The three -item questionnaire and pain intensity reported upon LA infiltration for spinal anesthesia have mild correlation to postoperative pain in Indian parturients undergoing CS. As these variables predicts only 8% variance in pain experienced after CS, further studies are required for accurate prediction and targeted treatment of post CS pain.
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Affiliation(s)
- Divya Gupta
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Sukhyanti Kerai
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Kirti N. Saxena
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Saurabh Gaur
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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Kamimura Y, Kamijo K, Banno M, Tsuji T, Aoki Y, Ito H, Tanaka M, Sobue K. Efficacy of intravenous dexamethasone on postoperative pain after caesarean delivery under spinal anaesthesia with an intrathecal long-acting opioid: a systematic review and meta-analysis. J Anesth 2023; 37:416-425. [PMID: 36964795 DOI: 10.1007/s00540-023-03183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Intravenous dexamethasone is recommended in elective caesarean delivery to decrease postoperative pain. However, the efficacy of spinal anaesthesia with an intrathecal long-acting opioid such as morphine or diamorphine for caesarean delivery has not been systematically investigated. METHODS We searched all randomized controlled trials (RCTs) of pregnant women undergoing caesarean delivery under spinal anaesthesia with an intrathecal morphine or diamorphine via MEDLINE, CENTRAL, EMBASE, ICTRP, and ClinicalTrials.gov on May 18, 2022. Primary outcomes were time to first rescue analgesia, consumption of oral morphine equivalents, and incidence of drug-related adverse reactions. We evaluated the risk of bias for each outcome using the Risk of Bias 2. We conducted a meta-analysis using a random effects model. We evaluated the certainty of evidence with the GRADE approach. RESULTS Five RCTs (455 patients) were included. The results of intravenous dexamethasone were as follows: time to first rescue analgesia (mean difference [MD] 0.99 h, 95% confidence interval [CI] - 0.86 to 2.84; very low certainty) and consumption of oral morphine equivalents (MD - 6.55 mg, 95% CI - 17.13 to 4.02; moderate certainty). No incidence of drug-related adverse reactions was reported (very low certainty). CONCLUSION The evidence was very uncertain about the efficacy of intravenous dexamethasone on time to first rescue analgesia and the incidence of drug-related adverse reactions. Intravenous dexamethasone probably reduces the consumption of oral morphine equivalents. Anaesthesiologists might want to consider intravenous dexamethasone for postoperative pain after caesarean delivery under spinal anaesthesia with an intrathecal long-acting opioid.
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Affiliation(s)
- Yuji Kamimura
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan.
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Kyosuke Kamijo
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Gynecology, Nagano Municipal Hospital, Nagano, Japan
| | - Masahiro Banno
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuya Tsuji
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Yusuke Aoki
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Hidekazu Ito
- Department of Anesthesiology, Toyokawa City Hospital, Toyokawa, Japan
| | - Motoshi Tanaka
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
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Jin Y, Yu X, Hu S, Liu L, Wang B, Feng Y, Li Y, Xiong B, Wang L. Efficacy of electroacupuncture combined with intravenous patient-controlled analgesia after cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol MFM 2023; 5:100826. [PMID: 36464237 DOI: 10.1016/j.ajogmf.2022.100826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Electroacupuncture is a nonpharmacologic intervention for analgesia that is widely recognized as therapy for pain. However, the clinical efficacy of electroacupuncture combined with patient-controlled intravenous analgesia for postoperative analgesia after cesarean delivery remains unclear. OBJECTIVE This study aimed to assess the efficacy of electroacupuncture + patient-controlled intravenous analgesia for postoperative analgesia after cesarean delivery, determine the optimal frequency for the best analgesic effect, and explore the underlying mechanism of action. STUDY DESIGN This single-center, randomized, single-blinded, sham acupuncture controlled clinical trial was conducted at a tertiary university hospital in China. Female patients who underwent cesarean delivery and received fentanyl as patient-controlled intravenous analgesia for postoperative analgesia were enrolled. Patients were after surgery randomized to receive 2 Hz electroacupuncture treatment (n=53), 20/100 Hz electroacupuncture treatment (n=53), or sham electroacupuncture treatment (n=52) (controls). The 2 electroacupuncture groups received electroacupuncture treatment at 2 or 20/100 Hz at the ST36 and SP6 points, whereas, in the sham electroacupuncture group, sham electroacupuncture was performed at nonmeridian points with nonenergized electroacupuncture instruments. Of note, 4 electroacupuncture treatments were performed in all groups at 6, 12, 24, and 48 hours after surgery. The primary outcome was the number of analgesic pump compressions at 48 hours after surgery. The secondary outcomes included number of analgesic pump compressions at 6, 12, and 24 hours after surgery; pain scores at 6, 12, 24, and 48 hours after surgery; fentanyl consumption at 48 hours after surgery; interleukin 6 and procalcitonin levels at 12 and 48 hours after surgery; and time to first exhaust. RESULTS Overall, 174 primigravida women were included in the intention-to-treat analysis. The number of analgesic pump compressions and pain scores at all 4 time points and fentanyl consumption at 48 hours after surgery were significantly lower in the electroacupuncture treatment groups than in the sham electroacupuncture group (P<.001). CONCLUSION Electroacupuncture + patient-controlled intravenous analgesia had a significantly better analgesic effect than sham electroacupuncture + patient-controlled intravenous analgesia within 48 hours after surgery. Thus, electroacupuncture can be considered safe and effective and may improve the efficacy of patient-controlled intravenous analgesia for pain management after cesarean delivery. Electroacupuncture can be recommended as a routine complementary therapy for pain control after cesarean delivery.
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Affiliation(s)
- Ying Jin
- Department of Rehabilitation in Traditional Chinese Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Jin and Xiong); Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Jiangsu, China (Drs Jin and Liu); Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China (Drs Jin and Li)
| | - Xiaoshuai Yu
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (Dr Yu)
| | - Shen Hu
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Hu, Feng, and L Wang)
| | - Lanying Liu
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Jiangsu, China (Drs Jin and Liu)
| | - Bin Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Dr B Wang)
| | - Yuanling Feng
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Hu, Feng, and L Wang)
| | - Yubo Li
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, China (Dr Li); Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China (Drs Jin and Li)
| | - Bing Xiong
- Department of Rehabilitation in Traditional Chinese Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Jin and Xiong).
| | - Liquan Wang
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Hu, Feng, and L Wang).
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Fu Q, Han M, Mu Y, Hao L, Lu L, Huang X, Li J, Kang F. Does the pain sensitivity questionnaire correlate with tourniquet pain in patients undergoing ankle surgery? Front Surg 2023; 10:1102319. [PMID: 36923376 PMCID: PMC10009183 DOI: 10.3389/fsurg.2023.1102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/06/2023] [Indexed: 03/02/2023] Open
Abstract
Background Tourniquet pain is the most prominent problem in ankle surgery, and there is no proper method to predict it. It was reported that pain sensitivity questionnaires could evaluate the pain sensitivity of subjects. Its potential to predict tourniquet pain in ankle surgery is constructive and meaningful. Methods One hundred and twenty patients undergoing ankle surgery were included in this study. The pain sensitivity questionnaire (PSQ) and self-rating anxiety scale (SAS) were completed before the operation. The methods included an ultrasound-guided popliteal sciatic, a femoral nerve block, and a proximal thigh tourniquet. The pressure of the tourniquet was set according to the systolic blood pressure (SBP + 100 mmHg). A visual analogue scale (VAS) was used to assess the tourniquet pain. Also, the onset time of tourniquet pain ≥4 VAS units was recorded. Results The PSQ-total and PSQ-minor scores were significantly correlated with the onset time when the tourniquet pain ≥4 VAS units (r = -0.763, r = -0.731, P < 0.001). The PSQ-total score <6.5 group gave significantly lower ratings for items 3, 4, 14, and 16 in the PSQ survey compared to the PSQ-total score ≥6.5 group (P < 0.05). Patients with high pain sensitivity have a higher need for analgesic drugs (P < 0.001). PSQ-total score ≥6.5 (OR = 185.8, 95% CI = 39.8-1,437.6, P < 0.001), sex (male, OR = 0.11, 95% CI = 0.018-0.488, P < 0.05), and age (OR = 0.92, 95% CI = 0.842-0.995, P < 0.05) were risk factors for reporting a tourniquet pain ≥4 VAS units within 30 min. Conclusion The PSQ score is found to be correlated with intraoperative tourniquet pain. In addition, sex and age also affect the time of having intraoperative tourniquet pain.
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Affiliation(s)
- Qiuyue Fu
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Mingming Han
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Yuyang Mu
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Lina Hao
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Liang Lu
- Department of Hand and Foot Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Xiang Huang
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Juan Li
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
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23
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Prokopowicz A, Stańczykiewicz B, Uchmanowicz I. Anxiety and Psychological Flexibility in Women After Childbirth in the Rooming-in Unit during the COVID-19 Pandemic. J Midwifery Womens Health 2023; 68:107-116. [PMID: 36565212 PMCID: PMC9880685 DOI: 10.1111/jmwh.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/15/2022] [Accepted: 10/13/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has intensified perinatal anxiety disorders. Psychological flexibility (PF), considered a specific mental toughness, has not been examined with regard to its relationship with anxiety in women after childbirth. We aimed to compare levels of anxiety, PF, and pain in women depending on the mode of birth, parity, and the magnitude of risk of developing an anxiety disorder. We also investigated the association of anxiety with PF and pain. METHODS A total of 187 women after childbirth completed validated questionnaires for anxiety (State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale-Anxiety, Numerical Rating Scale for anxiety [NRS-A]), PF, and pain (Numerical Rating Scale for pain). Specific postpartum anxieties were assessed with a numerical scale from 0 to 10. The relationship of anxiety with PF and pain was examined. Women at low and high risk of developing anxiety disorder were compared in terms of PF, anxiety, and pain. RESULTS On the second postpartum day, women after cesarean birth demonstrated significantly greater anxiety on NRS-A and pain than those after vaginal birth. Primiparous women experienced significantly greater anxieties and pain compared to multiparous women. The higher the PF patients demonstrated, the less anxiety and pain they had. Patients at high risk of developing an anxiety disorder had a lower level of PF (P < .001) and higher levels of anxiety (P < .001) and pain (P < .01) than patients at low risk of developing an anxiety disorder. No difference in the anxiety of getting COVID-19 was observed between the groups (P > .05). CONCLUSIONS PF is an important psychological construct related to the mental and physical condition of women after childbirth. Increasing PF in women after childbirth may be considered as an important goal of preventive and intervention measures.
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Affiliation(s)
- Anna Prokopowicz
- Division of Midwifery and Gynaecological Nursing, Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
| | - Bartłomiej Stańczykiewicz
- Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Izabella Uchmanowicz
- Division of Internal Medicine Nursing, Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
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Comparison of Post-Cesarean Pain Perception of General Versus Regional Anesthesia, a Single-Center Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010044. [PMID: 36676668 PMCID: PMC9866267 DOI: 10.3390/medicina59010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
Background and Objectives: Pain during and after the procedure remains the leading concern among women undergoing cesarean section. Numerous studies have concluded that the type of anesthesia used during a cesarean section undoubtedly affects the intensity and experience of pain after the operation. Materials and Methods: This prospective cohort study was conducted at the Clinic for Gynecology and Obstetrics, Clinical Center "Dragisa Misovic-Dedinje", Belgrade, Serbia. Patients at term pregnancy (37-42 weeks of gestation) with an ASA I score who delivered under general (GEA) or regional anesthesia (RA) by cesarean section were included in the study. Following the procedure, we assessed pain using the Serbian McGill questionnaire (SF-MPQ), Visual Analogue Scale (VAS) and the pain attributes questionnaire at pre-established time intervals of 2, 12, and 24 h after the procedure. Additionally, time to patient's functional recovery was noted. We also recorded the time to the first independent mobilization, first oral intake, and lactation establishment. Results: GEA was performed for 284 deliveries while RA was performed for 249. GEA had significantly higher postoperative sensory and affective pain levels within intervals of 2, 12, and 24 h after cesarean section. GEA had significantly higher postoperative VAS pain levels. On pain attribute scale intensity, GEA had significantly higher postoperative pain levels within all intervals. Patients who received RA had a shorter time to first oral food intake, first independent mobilization, and faster lactation onset in contrast to GEA. Conclusions: The application of RA presented superior postoperative pain relief, resulting in earlier mobilization, shorter time to first oral food intake, and faster lactation onset in contrast to GEA.
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Marznaki ZH, Hosseinnataj A, Darvishi-Khezri H, Azarnivand M, Oleson T, Griffiths MD, Alimoradi Z. The effect of auricular acupressure on short-term postoperative pain intensity after cesarean section: A three-arm randomized controlled trial. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bimrew D, Misganaw A, Samuel H, Daniel Desta T, Bayable SD. Incidence and associated factors of acute postoperative pain within the first 24 h in women undergoing cesarean delivery at a resource-limited setting in Addis Ababa, Ethiopia: A prospective observational study. SAGE Open Med 2022; 10:20503121221133190. [PMID: 36312327 PMCID: PMC9608192 DOI: 10.1177/20503121221133190] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: This study aimed to assess the incidence and associated factors of acute postoperative pain after cesarean section within the first 24 h of postoperative period. Methods: An institutional-based prospective observational study was conducted on parturients who had undergone cesarean section in Gandhi Memorial Hospital from 1 December 2019 to 28 February 2020. A numerical rating scale was used to evaluate the incidence of acute postoperative pain. Patients having a pain score of >4 were considered having moderate-to-severe pain on numerical rating scale. Data were analyzed using SPSS version 20. Bivariable and multivariable logistic regression were used to assess the association of variables. A p value of less than 0.05 was taken as significant association with dependent variables. Result: In total, 290 parturients participated in the study with a response rate of 98%. Moderate-to-severe acute postoperative pain after cesarean section was 76.2% (95% confidence interval: 71%, 81%) in the first 24 h postoperatively. On multivariable analysis, previous cesarean section history (adjusted odds ratio: 2.80, 95% confidence interval: 1.40, 5.55; p = 0.003), preoperative anxiety (adjusted odds ratio: 2.70, 95% confidence interval: 1.45, 5.05; p = 0.003), transverse incision type (adjusted odds ratio: 3.35, 95% confidence interval: 1.67, 6.72; p = 0.002), and incision length (adjusted odds ratio: 2.46, 95% confidence interval: 1.24, 4.85; p = 0.009) were identified as risk factors for postoperative moderate-to-severe acute pain. Conclusion: The incidence of moderate-to-severe postoperative pain was high in the first 24-h postoperative period; this indicates that pain management after cesarean section was treated inadequately. History of previous cesarean section, preoperative anxiety, transverse incision, and incision length >10 cm were the factors of postoperative acute pain after cesarean section. Therefore, we suggest the study institution develop a protocol for pain management.
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Affiliation(s)
- Dagim Bimrew
- Department of Anesthesia, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Abebaw Misganaw
- Department of Anesthesia, School of Medicine, Debre Markos University, Debre Markose, Ethiopia,Abebaw Misganaw, Department of Anesthesia, School of Medicine, Debre Markos University, Debre Markose, P.O. Box 269, Ethiopia.
| | - Hirbo Samuel
- School of Anesthesia, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tenbite Daniel Desta
- School of Anesthesia, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Samuel Debas Bayable
- Department of Anesthesia, School of Medicine, Debre Markos University, Debre Markose, Ethiopia
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Lin R, Lu Y, Luo W, Zhang B, Liu Z, Xu Z. Risk factors for postpartum depression in women undergoing elective cesarean section: A prospective cohort study. Front Med (Lausanne) 2022; 9:1001855. [PMID: 36250100 PMCID: PMC9553994 DOI: 10.3389/fmed.2022.1001855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPostpartum depression (PPD) has adverse effects on maternal and child health. Cesarean section (CS) is suggested to be associated with PPD, but no study has examined the risk factors for PPD in women who underwent CS. Therefore, this study aimed to investigate this association.MethodsA prospective observational study was conducted between December 2020 and September 2021. In total, 590 women who underwent elective CS participated in this study. Data were collected using a questionnaire through a face-to-face interview at three time points: 32nd week of gestation, 2 days postpartum, and 6 weeks postpartum. PPD was defined by an Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 11 at 6 weeks postpartum. Multivariate logistic regression analysis was performed to identify the risk factors for PPD.ResultsAmong the 590 women, 25.4% had PPD (142/590). After adjustment for the confounding factors, high antenatal self-rating anxiety scale score (OR = 1.10, 95% CI = 1.04–1.16), PPD symptoms (EPDS ≥ 11) at 2 days postpartum (OR = 6.17, 95% CI = 1.35–28.31), and pain at 6 weeks postpartum (OR = 2.14, 95% CI = 1.24–3.69) were independently associated with PPD.ConclusionPrenatal anxiety, PPD symptoms occurring at an early postoperative stage, and pain at 6 weeks postpartum may be associated with an increased risk of PPD among women who undergo CS.
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Affiliation(s)
- Rong Lin
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Lu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Luo
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bing Zhang
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Zhiqiang Liu,
| | - Zhendong Xu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Zhendong Xu,
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Traditional Chinese Acupressure Massage of the Quadriceps Femoris Can Relieve Flexion Pain after Undergoing Total Knee Arthroplasty. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1091174. [PMID: 35310022 PMCID: PMC8930215 DOI: 10.1155/2022/1091174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/27/2022] [Accepted: 02/05/2022] [Indexed: 11/17/2022]
Abstract
Objective To reduce the pain of quadriceps during knee flexion after total knee arthroplasty and increase range motion of knee flexion. Design Three-month prospective before/after quality improvement project. Setting. Department of Bone and Joint Surgery. Participants. A total of 80 patients who met the surgical indications were admitted to the outpatient department for surgery. They were randomly grouped by computer in advance, and the patients were divided into two groups according to the time of admission, each with 40 cases. Intervention. The intervention group performed routine rehabilitation exercises and received quadriceps acupoint massages for 20 minutes twice a day for two consecutive weeks. The control group performed routine rehabilitation exercises, such as gentle quadriceps massage for 20 minutes twice a day for two consecutive weeks. Main Outcome Measures. PPT (pressure pain threshold) of quadriceps femoris/VAS (visual analog scale) of knee flexion and motion of knee flexion. Results The VAS score, range of motion, and tenderness threshold during flexion were significantly better in the intervention group than in the control group at 1, 2, and 4 weeks after surgery. But the VAS score, range of motion, and tenderness threshold did not significantly differ between groups at 12 weeks after surgery. Conclusion Acupoint massage of the quadriceps femoris can relieve early flexion pain in patients after total knee arthroplasty. The trial was registered at clinical trials.gov.
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Demelash G, Berhe YW, Gebregzi AH, Chekol WB. Prevalence and Factors Associated with Postoperative Pain After Cesarean Section at a Comprehensive Specialized Hospital in Northwest Ethiopia: Prospective Observational Study. OPEN ACCESS SURGERY 2022. [DOI: 10.2147/oas.s347920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Predicting pain after Cesarean delivery: pressure algometry, temporal summation, three-item questionnaire. Can J Anaesth 2021; 68:1802-1810. [PMID: 34585366 DOI: 10.1007/s12630-021-02105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Approximately one in five women will experience severe postoperative pain after Cesarean delivery (CD). Previously, a bedside three-item questionnaire (3-IQ) has shown to predict women experiencing higher evoked pain intensity after CD, with an area under the receiver operator characteristics (ROC) curve of 0.72. We hypothesized that the addition of psychophysical pain tests to the existing 3-IQ would improve the ability to predict severe pain in women undergoing elective CD under spinal anesthesia METHODS: This was a prospective cohort study on women undergoing elective CD under spinal anesthesia. Women were assessed preoperatively using the 3-IQ, pressure algometry (PA) and mechanical temporal summation (TS) response. All women received standard perioperative care, including a multimodal analgesia regimen that included intrathecal fentanyl and morphine. A 0-100 mm visual analogue scale (VAS) was used to assess the severity of pain at rest (VASr) and on movement (VASm) at 24 and 48 hr after surgery. Patient satisfaction and opioid consumption were also recorded. We performed ROC curve analyses to assess whether we could improve the ability to predict our primary outcome of severe pain on movement at 24 hr (VASm24 ≥ 70). RESULTS We studied 195 women. Median [interquartile range] VASm24 was 53 [32-72] and 28% of patients experienced a VASm24 ≥ 70. The ability to predict a VASm24 ≥ 70 assessed by the area under the ROC curve was 0.64 using the 3-IQ and 0.67 using the 3-IQ combined with TS and PA. CONCLUSION The addition of PA and TS to the 3-IQ model resulted in a predictive model that performed similarly to the 3-IQ model alone. Further research is warranted in this area to better predict women at risk of severe pain post CD.
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Alemu WM, Ashagrie HE, Agegnehu AF, Admass BA. Comparing the analgesic efficacy of transversus abdominis plane block versus wound infiltration for post cesarean section pain management: A prospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Akgün M, Boz İ. The effects of acupressure on post-cesarean pain and analgesic consumption: a randomized single-blinded placebo-controlled study. Int J Qual Health Care 2021; 32:609-617. [PMID: 32877509 DOI: 10.1093/intqhc/mzaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/14/2020] [Accepted: 08/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the effects of P6 and LI4 acupressure on post-caesarean pain and analgesic consumption. DESIGN This was a randomized, single-blinded, placebo-controlled study conducted in a university-affiliated obstetrics clinic between July 2017 and July 2018. PARTICIPANTS Women (n = 132) were randomly assigned to acupressure (n = 44), placebo (n = 44) and control (n = 44) groups. SETTING All groups received routine nursing care and analgesia protocol for post-cesarean pain. Acupressure was performed in two sessions, the postpartum second and fourth hours, with the following protocol: bilaterally to P6 (point on wrist) and LI4 (point on hand) points (for 3 minutes on each point). In the placebo group, it was just touched without the pressure on acupressure points, but the main difference was that touching was too superficial to have a therapeutic effect. The control group received only routine nursing care and analgesia protocol for post-cesarean pain. MAIN OUTCOME MEASURES The post-caesarean pain was evaluated four times before and after each session using Visual Analog Scale for pain. Also, the analgesia protocol for post-cesarean pain was recorded for all women. RESULTS The acupressure group experienced the lowest level of post-cesarean pain compared with the placebo and control groups (P = 0.000). The consumption of pethidine hydrochloride and paracetamol was statistically lower in the acupressure group compared with the placebo and control groups (respectively, P = 0.002 and P = 0.040). CONCLUSION Acupressure is an effective method for reducing post-cesarean pain and analgesic consumption. Clinical trial registration: ClinicalTrials.gov: NCT04337801.
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Affiliation(s)
- Mehtap Akgün
- Nursing Faculty, Akdeniz University, Antalya, Turkey
| | - İlkay Boz
- Nursing Faculty, Akdeniz University, Antalya, Turkey
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Kahn KM, Demarco K, Pavsic J, Sangillo J. A Quality Improvement Project to Reduce Postcesarean Opioid Consumption. MCN Am J Matern Child Nurs 2021; 46:190-197. [PMID: 34016836 DOI: 10.1097/nmc.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The opioid epidemic is a public health emergency in the United States, stemming in part from widespread misuse and overprescribing of opioids following surgery. Approximately 1 in 300 women with no prior exposure to opioids develops an opioid use disorder following cesarean birth. Effective management of postcesarean pain requires individualized treatment and a balance of the woman's goals for optimal recovery and ability to safely care for her newborn. The American College of Obstetricians and Gynecologists recommends a multimodal approach to pain management after cesarean birth. METHODS In April 2019, a multidisciplinary team was formed at New York University Langone Health to study opioid use postcesarean. The team used the Plan, Do, Study, Act process model for continuous quality improvement to launch a postcesarean pathway called "Your Plan After Cesarean," a standardized visual tool with quantifiable milestones. It facilitates integration of women's preferences in their postcesarean care, and emphasizes providers' routine use of nonpharmacological interventions to manage pain. RESULTS During the pilot period of the project, postcesarean high consumption of 55 to 120 mg of opioids was reduced from 25% to 8%. By January 2020, 75% of women postoperative cesarean took little-to-no opioids during their hospital stay. By February 2021, the total number of opioids consumed by women after cesarean birth in-hospital was reduced by 79%. Satisfaction among women with pain management after cesarean continued to be high. CLINICAL IMPLICATIONS Reduction in postcesarean opioid administration and the number of opioids prescribed at hospital discharge can be accomplished without having a negative effect on women's perceptions of post-op pain relief. These changes can potentially be a factor in helping to avoid an opioid-naive woman who has a cesarean birth from developing an opioid use disorder.
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Wang J, Zhao G, Song G, Liu J. The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. J Pain Res 2021; 14:1559-1572. [PMID: 34103981 PMCID: PMC8180269 DOI: 10.2147/jpr.s313972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Cesarean section (CS) is one of the most frequently performed major surgical interventions. Local anesthetic techniques, a universal component of perioperative multimodal analgesia, are reportedly effective in reducing pain scores and opioid requirements. However, the optimal local anesthetic technique for postoperative CS pain remains unclear. Methods Six databases were searched, and a Bayesian network meta-analysis was performed. The outcomes included cumulative morphine consumption and pain scores at four time points, time to first analgesic request, postoperative nausea and vomiting, pruritus, and sedation. Results Sixty-eight studies with 5039 pregnant women were included. Six local anesthetic techniques were involved, including transversus abdominis plane block (TAPB), ilioinguinal and iliohypogastric nerve block, quadratus lumborum blocks, transversalis fascia plane block, erector spinae block, and wound infiltration. Compared to inactive controls, TAPB reduced cumulative morphine consumption at 6, 12, 24, and 48 h, pain scores at 6, 12, and 24 h (with the exception of 24 h at rest), the risk of postoperative nausea and vomiting, and sedation. Compared with inactive controls, ilioinguinal and iliohypogastric nerve block reduced cumulative morphine consumption at 6 and 24 h and pain scores at 6, 12, and 24 h during movement. Compared with inactive controls, quadratus lumborum blocks reduced cumulative morphine consumption at 24 and 48 h and pain scores at 6 and 12 h and lengthened the time to first analgesic request. Compared with inactive controls, wound infiltration reduced cumulative morphine consumption at 12 and 24 h, pain scores at 12 and 24 h during movement, and risk of sedation. Compared with inactive controls, erector spinae block reduced pain scores at 6 and 12 h. Transversalis fascia plane block was found to have similar outcomes to inactive controls. Conclusion TAPB is the most comprehensive local anesthetic technique for postoperative CS analgesia in the absence of intrathecal morphine.
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Affiliation(s)
- Jian Wang
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Ge Zhao
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jing Liu
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
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Vogel TM. Unique Pain Management Needs for Pregnant Women with Pre-existing PTSD and Other Mental Health Disorders. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-020-00430-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abd-ElGawad M, Said Ali A, Abdelmonem M, Elshamy NH, Abdeltawab AK, Abd El-Shafea M, Rund NMA, Fadlalmola HA, Ashour ASA, Almohamady M. The effectiveness of the abdominal binder in relieving pain after cesarean delivery: A systematic review and meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2021; 154:7-16. [PMID: 33471362 DOI: 10.1002/ijgo.13607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/19/2020] [Accepted: 01/18/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Abdominal binder is a non-pharmacological method of relieving pain after surgical procedures. OBJECTIVES To evaluate the effectiveness of the abdominal binder in relieving pain and distress scores after cesarean delivery (CD). SEARCH STRATEGY The following terms were searched: cesarean section, cesarean, caesarean, abdominal deliveries, C-section, abdominal delivery, abdominal binding, binder, and abdominal binder. SELECTION CRITERIA Randomized controlled trials (RCTs) with patients undergoing CD receiving an abdominal binder compared with non-users of the abdominal binder. DATA COLLECTION AND ANALYSIS Five electronic databases were searched until November 2019. Records were screened for eligibility. Data were extracted independently and analyzed. The main outcomes were pain and distress scores. RESULTS The final analysis included six RCTs. Overall effect estimate favored the abdominal binder group over the control group in the following outcomes: VAS pain scores after 24 h (mean difference [MD] -1.76; 95% confidence interval [CI] -3.14 to -0.39; P = 0.01), VAS scores after 48 h (MD -1.21; 95% CI -1.51 to -0.90; P < 0.001), distress score after 24 h (MD -1.87; 95% CI -3.01 to -0.73; P = 0.001), and distress score after 48 h (MD -1.87; 95% CI -3.07 to -0.67; P = 0.002). CONCLUSION The abdominal binder could be an effective, simple, non-pharmacological option of relieving pain and distress after CD.
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Affiliation(s)
| | | | | | | | | | | | - Nancy M A Rund
- Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ahmed S A Ashour
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maged Almohamady
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Park SK, Kim H, Yoo S, Kim WH, Lim YJ, Kim JT. Predicted Versus Non-Predicted Opioid Administration Using Preoperative Pain Sensitivity in Patients Undergoing Gynecological Surgery: A Randomized-Controlled Trial. J Clin Med 2021; 10:jcm10040585. [PMID: 33557259 PMCID: PMC7914520 DOI: 10.3390/jcm10040585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/03/2022] Open
Abstract
Individualized administration of opioids based on preoperative pain sensitivity may improve postoperative pain profiles. This study aimed to examine whether a predicted administration of opioids could reduce opioid-related adverse effects after gynecological surgery. Patients were randomized to the predicted group or control group. Participants received a preoperative sensory test to measure pressure pain thresholds. Patients were treated with a higher or lower (15 or 10 μg/mL) dose of fentanyl via intravenous patient-controlled analgesia. The opioid dose was determined according to pain sensitivity in the predicted group, while it was determined regardless of pain sensitivity in the control group. The primary outcome was the incidence of nausea over the first 48 h postoperative period. Secondary outcomes included postoperative pain scores and opioid requirements. There was no difference in the incidence of nausea (40.0% vs. 52.5% in predicted and control groups, respectively; p = 0.191) and postoperative pain scores (3.3 vs. 3.5 in predicted and control groups, respectively; p = 0.691). However, opioid consumptions were lower in the predicted group compared to the control group (median 406.0 vs. 526.5 μg; p = 0.042). This study showed that offering a predicted dose of opioids according to pain sensitivity did not affect the incidence of nausea and pain scores.
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Roofthooft E, Joshi GP, Rawal N, Van de Velde M. PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020; 76:665-680. [PMID: 33370462 PMCID: PMC8048441 DOI: 10.1111/anae.15339] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
Caesarean section is associated with moderate‐to‐severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother‐child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50–100 µg or diamorphine 300 µg administered pre‐operatively; paracetamol; non‐steroidal anti‐inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single‐injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non‐steroidal anti‐inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel‐Cohen incision; non‐closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.
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Affiliation(s)
- E Roofthooft
- Department of Anesthesiology, GZA Sint-Augustinus Hospital, Antwerp, Belgium.,Department of Cardiovascular Sciences, KULeuven and UZLeuven, Leuven, Belgium
| | - G P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - N Rawal
- Department of Anesthesiology, Orebro University, Orebro, Sweden
| | - M Van de Velde
- Department of Cardiovascular Sciences, KULeuven and UZLeuven, Leuven, Belgium
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Simonelli MC, Gennaro S, O'Connor C, Doyle LT. Women Construct Their Birth Narratives and Process Unplanned Cesarean Births Through Storytelling. J Obstet Gynecol Neonatal Nurs 2020; 50:30-39. [PMID: 33197433 DOI: 10.1016/j.jogn.2020.09.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine birth narratives of primiparous women who experienced unplanned cesarean births to improve nursing care. DESIGN Descriptive, qualitative. SETTING The family/newborn units of a large teaching hospital in the Northeast United States. PARTICIPANTS Fourteen women who experienced unplanned cesarean births of singleton infants at term. METHODS We used semistructured interviews to analyze the participants' birth narratives. Within 48 hours of birth, participants answered the prompt: "Tell us your birth story." Four perinatal nurse experts in consultation with a qualitative research expert ordered, analyzed, and coded data into themes and subthemes. RESULTS We identified the following four themes: Changing Reality: Transition to Labor, Expectations Meeting Reality: Navigating the Unknown, Transition to Motherhood: The Cesarean Birth Experience, and Accepting the New Reality. CONCLUSION Childbearing women need time immediately after birth to process their experiences. Our findings highlight avenues for changes in clinical care to optimize women's experiences of unplanned cesarean births. Participants wanted clearer communication with the maternity care team, voices in the decision-making process, and inclusion of support persons to optimize their birth experiences. Because negative birth experiences affect maternal and child well-being, it is important to understand women's perceptions and develop strategies to assist them in the construction of their birth narratives.
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Nimmaanrat S, Wongwiwattananon W, Siripreukpong S, Chongsuvivatwong V, Jensen MP. A prospective observational study to investigate the relationship between local anesthetic infiltration pain before spinal anesthesia and acute and chronic postsurgical pain in women undergoing elective cesarean delivery. Int J Obstet Anesth 2020; 45:56-60. [PMID: 33293186 DOI: 10.1016/j.ijoa.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cesarean delivery is one of the most common procedures performed worldwide. We conducted this prospective cohort study to evaluate the association between local anesthetic infiltration (LAI) pain prior to spinal anesthesia and pain and morphine consumption within 24 h after cesarean delivery (primary outcomes). A secondary objective was to assess the association between LAI pain and pain at one month postoperatively. METHODS Recruitment of 216 eligible women scheduled for elective cesarean delivery. Local infiltration before spinal anesthesia was performed using a 24-gauge needle and 3 mL 2% plain lidocaine. All subjects received 2.2 mL 0.5% hyperbaric bupivacaine with 200 µg morphine for spinal anesthesia. A 0-10 verbal numerical rating scale was used to assess LAI pain severity, and subsequent pain at 24 h, 1, 3 and 12 months. RESULTS We found a moderate correlation between LAI pain intensity and severity of acute pain at rest (rho=0.56, P <0.001) and with movement (rho=0.58, P <0.001) and a weak correlation with morphine consumption (rho=0.17, P=0.01) within 24 h postoperatively. We also found a positive correlation between LAI pain and the severity of persistent wound pain at rest (rho=0.30, P <0.001) and with movement (rho=0.52, P <0.001) at 1 month. The incidence of wound pain at 1, 3 and 12 months postoperatively was 37.1%, 7.0% and 1.4%, respectively. CONCLUSIONS Pain from LAI prior to spinal anesthesia is significantly associated with subsequent postoperative pain both acutely and at one month in women scheduled for elective cesarean delivery under spinal anesthesia.
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Affiliation(s)
- S Nimmaanrat
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
| | - W Wongwiwattananon
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - S Siripreukpong
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - V Chongsuvivatwong
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - M P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Patient and procedural risk factors for increased postoperative pain after cesarean delivery under neuraxial anesthesia: a retrospective study. Int J Obstet Anesth 2020; 44:60-67. [DOI: 10.1016/j.ijoa.2020.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/17/2022]
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Patient anxiety of verticalization on day 0 after a Cesarean section. Arch Gynecol Obstet 2020; 303:391-399. [PMID: 32856137 PMCID: PMC7858551 DOI: 10.1007/s00404-020-05748-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
Purpose The ERAS protocol recommends fast mobilization of a patient along with providing psychological comfort; however, early verticalization can generate mental discomfort. In the post-operative period after Caesarean section (CC), a patient may experience pain, anxiety and negative affect. The main aim of the study was to investigate levels of patient anxiety concerning verticalization on day 0 after CC using. Also, the dependence between anxiety of verticalization and the following: pain, anxiety as a permanent disposition, resistance to pain, negative and positive emotions, and positive orientation was described. Methods The study included 150 women on day 0 after their CC. The measurement of anxiety concerning verticalization, pain, and also negative and positive emotions was conducted twice. During the first measurement, variables such as anxiety levels as a constant disposition, level of pain resistance and positive orientation were also monitored.
Results Patients upon arrival at the post-operative room declared a higher level of anxiety of verticalization (p < 0.05) (Median = 4; IQR = 5) when compared to 6 h after surgery (Median = 3; IQR = 4). A weak correlation of anxiety and pain was noted (r = 0.264; p < 0.01) in the second measurement. In both measurements, negative emotions and pain resistance proved to be the strongest variables explaining anxiety concerning verticalization. Conclusions Low levels of pain experienced by a patient after CC do not explain the variance in anxiety of verticalization. The use of the Numerical Rating Scale (NRS) of anxiety allows care givers to gain patients' psychological perspective in different moments after CC.
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Hawkins NN, Lamon AM, Li YJ, Grotegut C, Habib AS. Analgesic use after vaginal delivery in women with perineal lacerations: a retrospective cohort study. Curr Med Res Opin 2020; 36:1009-1013. [PMID: 32268793 DOI: 10.1080/03007995.2020.1754185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To evaluate opioid consumption among parturients with varying degrees of perineal lacerations.Methods: This was a retrospective analysis of women who delivered vaginally at our institution from 1 January 2014 to 12 April 2015. We collected information regarding the degree of perineal lacerations (no lacerations, first-/second-degree, third-/fourth-degree), analgesic consumption, and postpartum pain scores. The primary outcome was opioid use from 0-48 h postpartum. Univariate and multivariable regression analyses were performed to test for the association of laceration severity with opioid use.Results: We included 5598 women in the analysis; 1948 had no lacerations, 3434 had first-/second-degree lacerations, and 216 had third-/fourth-degree lacerations. In univariate analysis, parturients with third-/fourth-degree lacerations had significantly higher use of opioids within 48 h postpartum (53.2%) compared to women with no lacerations (30.03%) or first-/second-degree lacerations (28.6%) (p < .001). In the multivariable analysis, women with third-/fourth-degree lacerations had higher odds of opioid use than those without laceration [OR (95% CI) = 2.61 (1.75-3.85), p < .001]. In pairwise comparisons, those with third-/fourth-degree lacerations had higher odds of opioid use than those without lacerations [OR (95% CI) = 3.55 (2.20-5.74)], and those with first-/second-degree lacerations [OR (95% CI) = 2.15 (1.49-3.10)] (p < .001). Oxycodone equivalent consumption was significantly different among groups with a median (IQR) of 5.00 mg (0.00-27.50), 0.00 mg (0.00-5.00) and 0.00 mg (0.00-5.00) in women with third-/fourth-degree, first-/second-degree, and no lacerations, respectively, during the 0-48 h postpartum (p < .001).Conclusion: The use of opioids and opioid doses are higher in women with third-/fourth-degree perineal lacerations compared to those with first-/second-degree or no lacerations.
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Affiliation(s)
| | - Agnes M Lamon
- Department of Anesthesiology, Penn Medicine Princeton Health, Plainsboro, NJ, USA
| | - Yi-Ju Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Chad Grotegut
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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Peng F, Li Y, Ai Y, Yang J, Wang Y. Application of preoperative assessment of pain induced by venous cannulation in predicting postoperative pain in patients under laparoscopic nephrectomy: a prospective observational study. BMC Anesthesiol 2020; 20:86. [PMID: 32305062 PMCID: PMC7165404 DOI: 10.1186/s12871-020-01003-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative pain is the most prominent concern among surgical patients. It has previously been reported that venous cannulation-induced pain (VCP) can be used to predict postoperative pain after laparoscopic cholecystectomy within 90 mins in the recovery room. Its potential in predicting postoperative pain in patients with patient-controlled intravenous analgesia (PCIA) is worth establishing. The purpose of this prospective observational study was to investigate the application of VCP in predicting postoperative pain in patients with PCIA during the first 24 h after laparoscopic nephrectomy. METHODS One hundred twenty patients scheduled for laparoscopic nephrectomy were included in this study. A superficial vein on the back of the hand was cannulated with a standard-size peripheral venous catheter (1.1 × 3.2 mm) by a nurse in the preoperative areas. Then the nurse recorded the VAS score associated with this procedure estimated by patients, and dichotomized the patients into low response group (VAS scores < 2.0) or high response group (VAS scores ≥2.0). After general anesthesia and surgery, all the patients received the patient-controlled intravenous analgesia (PCIA) with sufentanil. The VAS scores at rest and on coughing at 2 h, 4 h, 8 h, 12 h, 24 h, the effective number of presses and the number of needed rescue analgesia within 24 h after surgery were recorded. RESULTS Peripheral venous cannulation-induced pain score was significantly correlated with postoperative pain intensity at rest (rs = 0.64) and during coughing (rs = 0.65), effective times of pressing (rs = 0.59), additional consumption of sufentanil (rs = 0.58). Patients with venous cannulation-induced pain intensity ≥2.0 VAS units reported higher levels of postoperative pain intensity at rest (P < 0.0005) and during coughing (P < 0.0005), needed more effective times of pressing (P < 0.0005) and additional consumption of sufentanil (P < 0.0005), and also needed more rescue analgesia (P = 0.01) during the first 24 h. The odds of risk for moderate or severe postoperative pain (OR 3.5, 95% CI 1.3-9.3) was significantly higher in patients with venous cannulation-induced pain intensity ≥2.0 VAS units compared to those <2.0 VAS units. CONCLUSIONS Preoperative assessment of pain induced by venous cannulation can be used to predict postoperative pain intensity in patients with PCIA during the first 24 h after laparoscopic nephrectomy. TRIAL REGISTRATION We registered this study in a Chinese Clinical Trial Registry (ChiCTR) center on July 6 2019 and received the registration number: ChiCTR1900024352.
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Affiliation(s)
- Fei Peng
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yanshuang Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yanqiu Ai
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jianjun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yanping Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China.
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Carrico JA, Mahoney K, Raymond KM, McWilliams SK, Mayes LM, Mikulich-Gilbertson SK, Bartels K. Predicting Opioid Use Following Discharge After Cesarean Delivery. Ann Fam Med 2020; 18:118-126. [PMID: 32152015 PMCID: PMC7062496 DOI: 10.1370/afm.2493] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/23/2019] [Accepted: 08/14/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although cesarean delivery is the most common surgical procedure in the United States, postoperative opioid prescribing varies greatly. We hypothesized that patient characteristics, procedural characteristics, or both would be associated with high vs low opioid use after discharge. This information could help individualize prescriptions. METHODS In this prospective cohort study, we quantified opioid use for 4 weeks following hospital discharge after cesarean delivery. Predischarge characteristics were obtained from health records, and patients self-reported total opioid use postdischarge on weekly questionnaires. Opioid use was quantified in milligram morphine equivalents (MMEs). Binomial and Poisson regression analyses were performed to assess predictors of opioid use after discharge. RESULTS Of the 233 patients starting the study, 203 (87.1%) completed at least 1 questionnaire and were included in analyses (86.3% completed all 4 questionnaires). A total of 113 patients were high users (>75 MMEs) and 90 patients were low users (≤75 MMEs) of opioids postdischarge. The group reporting low opioid use received on average 44% fewer opioids in the 24 hours before discharge compared with the group reporting high opioid use (mean = 33.0 vs 59.3 MMEs, P <.001). Only a minority of patients (11.4% to 15.8%) stored leftover opioids in a locked location, and just 31 patients disposed of leftover opioids. CONCLUSIONS Knowledge of predischarge opioid use can be useful as a tool to inform individualized opioid prescriptions, help optimize nonopioid analgesia, and reduce opioid use. Additional studies are needed to evaluate the impact of implementing such measures on prescribing practices, pain, and functional outcomes.
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Affiliation(s)
- Jacqueline A Carrico
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Katharine Mahoney
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Kristen M Raymond
- Department of Psychiatry, Division of Substance Dependence, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Shannon K McWilliams
- Department of Psychiatry, Division of Substance Dependence, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Lena M Mayes
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Susan K Mikulich-Gilbertson
- Department of Psychiatry, Division of Substance Dependence, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Department of Biostatistics & Informatics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Karsten Bartels
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado .,Department of Psychiatry, Division of Substance Dependence, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Chao A, Pasca I, Alschuler M, Lee J, Woodfin M, Pugh J, Austin B, Ringer M, Ramsingh D. Comparison of Postoperative Opioid Consumption and Pain Scores in Primary Versus Repeat Cesarean Delivery in Opioid Naïve Patients. J Clin Med 2019; 8:E2221. [PMID: 31888170 PMCID: PMC6947434 DOI: 10.3390/jcm8122221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/05/2019] [Accepted: 12/13/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cesarean deliveries represent a large percentage of deliveries worldwide. Patients undergoing repeat cesarean deliveries are known to have increased risks for surgical complications. However, little is known regarding potential differences in pain. We sought to compare postoperative opioid consumption and pain scores in opioid naïve patients undergoing primary versus repeat non-emergent cesarean delivery. METHODS This was a retrospective cohort study. Patient inclusion criteria included: having a non-emergent cesarean delivery, receiving a spinal procedure for surgical anesthesia without general anesthesia, and following the same postoperative pain management protocols. Exclusion criteria included: history of opioid tolerance, illicit drug use, or prior, non-obstetric, major abdominal surgery. The primary outcome marker was total morphine equivalents consumed 0-72 h post-procedure compared between the primary versus repeat cesarean delivery groups. Secondary outcome markers were opioid consumption and pain scores in 24-h period increments for the first 72 h postoperatively. RESULTS 1617 patients were screened. 217 primary and 377 repeat cesarean deliveries met criteria for comparison. Reduced opioid consumption was demonstrated for the total opioid consumption 0-72 h for the repeat cesarean delivery group (median = 35) compared to the primary cesarean delivery group (median = 58), p = 0.0005. When divided into 24-h periods, differences were demonstrated for the 24-48 and 48-72 h periods but not the 0-24 h period. Pain scores did not differ statistically. CONCLUSION Opioid naïve obstetric patients who undergo non-emergent repeat cesarean delivery demonstrate lower opioid consumption in the postoperative period. Providers should be aware of this potential difference in order to better educate patients and provide adequate pain management. HIGHLIGHTS The study reviewed differences in opioid consumption between primary and repeat cesarean deliveries. All patients received the same protocol for spinal dosage and pain management. Repeat cesarean deliveries were associated with lower opioid consumption.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Davinder Ramsingh
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA; (A.C.); (I.P.); (M.A.); (J.L.); (M.W.); (J.P.); (B.A.); (M.R.)
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Personalized analgesic management for cesarean delivery. Int J Obstet Anesth 2019; 40:91-100. [DOI: 10.1016/j.ijoa.2019.02.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/04/2019] [Accepted: 02/27/2019] [Indexed: 02/01/2023]
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Bishop DG, Gibbs MW, Dyer RA. Post-caesarean delivery analgesia in resource-limited settings: a narrative review. Int J Obstet Anesth 2019; 40:119-127. [PMID: 31230992 DOI: 10.1016/j.ijoa.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 04/02/2019] [Accepted: 05/10/2019] [Indexed: 01/26/2023]
Abstract
Post-caesarean pain is an important and often neglected outcome. It causes suffering, affects breastfeeding and is associated with postpartum depression and the development of chronic pain syndromes. Pain control is often difficult even in resource-rich environments; it is likely far worse in resource-limited settings, where emphasis is on reducing the high maternal mortality rate. Lack of adequate staffing, education, and postoperative monitoring severely limit the options in resource-limited settings. Resource-limited settings are further compromised by limited access to essential analgesic drugs and equipment for their administration. Solutions using affordable and accessible medications as part of a multimodal analgesic strategy are possible, supplemented by education and training programmes. More research is required, both to establish current practice and to test methods for improving maternal pain control. While government involvement is necessary to improve infrastructure and resources in individual countries, other solutions should also be sought, empowering local institutions and harnessing individual cultural characteristics.
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Affiliation(s)
- D G Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
| | - M W Gibbs
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - R A Dyer
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
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Abstract
Clinicians encounter an ever increasing and frequently overwhelming amount of information, even in a narrow scope or area of interest. Given this enormous amount of scientific information published every year, systematic reviews and meta-analyses have become indispensable methods for the evaluation of medical treatments and the delivery of evidence-based best practice. The present basic statistical tutorial thus focuses on the fundamentals of a systematic review and meta-analysis, against the backdrop of practicing evidence-based medicine. Even if properly performed, a single study is no more than tentative evidence, which needs to be confirmed by additional, independent research. A systematic review summarizes the existing, published research on a particular topic, in a well-described, methodical, rigorous, and reproducible (hence "systematic") manner. A systematic review typically includes a greater range of patients than any single study, thus strengthening the external validity or generalizability of its findings and the utility to the clinician seeking to practice evidence-based medicine. A systematic review often forms the basis for a concomitant meta-analysis, in which the results from the identified series of separate studies are aggregated and statistical pooling is performed. This allows for a single best estimate of the effect or association. A conjoint systematic review and meta-analysis can provide an estimate of therapeutic efficacy, prognosis, or diagnostic test accuracy. By aggregating and pooling the data derived from a systemic review, a well-done meta-analysis essentially increases the precision and the certainty of the statistical inference. The resulting single best estimate of effect or association facilitates clinical decision making and practicing evidence-based medicine. A well-designed systematic review and meta-analysis can provide valuable information for researchers, policymakers, and clinicians. However, there are many critical caveats in performing and interpreting them, and thus, like the individual research studies on which they are based, there are many ways in which meta-analyses can yield misleading information. Creators, reviewers, and consumers alike of systematic reviews and meta-analyses would thus be well-served to observe and mitigate their associated caveats and potential pitfalls.
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Affiliation(s)
- Thomas R Vetter
- From the Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
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