Dataset Information

Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study.

ABSTRACT:

Background

The differences in post-operative pain are unclear between the primiparas who underwent a primary cesarean section and multiparas who underwent their first repeat cesarean section. The study aimed to explore the possible differences in postoperative pain between primiparas and multiparas.

Methods

A prospective cohort study was performed only including women who underwent cesarean deliveries under spinal anesthesia. Postoperative patient-controlled intravenous analgesia (PCIA) was administered to all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen; the pump was programmed as 2.0 mL/h background infusion with a loading dose of 1 mL and a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using the visual analogue scale, and inadequate analgesia was defined as a visual analogue scale score ≥ 40 during 48 h post-operation. Additionally, the patients' pain statuses in postoperative week 1 and week 4 were also assessed during follow-up via telephone.

Results

From January to May 2017, a total of 168 patients (67 primiparas and 101 multiparas) were included. The relative risk for multiparas to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primiparas. In patients aged < 30 years, inadequate analgesia on visceral pain was higher in multiparas than in primiparas (RR, 3.56 [1.05 to 12.04], P = 0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multiparas and primiparas (33.7% vs. 40.2%, P = 0.381). No difference was found in PCIA use between the two groups (111.1 ± 36.0 mL vs. 110.9 ± 37.3 mL, P = 0.979). In addition, a significantly higher incidence of pain was noted 4 weeks post-surgery in primiparas than that in multiparas (62.2% vs. 37.7%, P = 0.011).

Conclusion

Multiparas who underwent their first repeat cesarean section have a lower for inadequate analgesia on incision pain during the first 48 h after surgery than primiparas. Multiparas aged under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain.

Trail registration

ClinicalTrial.gov: NCT03009955 , Date registered: December 30, 2016.

SUBMITTER: Duan G

PROVIDER: S-EPMC6806491 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Publications

Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study.

Duan Guangyou G Yang Guiying G Peng Jing J Duan Zhenxin Z Li Jie J Tang Xianglong X Li Hong H

BMC anesthesiology 20191022 1

<h4>Background</h4>The differences in post-operative pain are unclear between the primiparas who underwent a primary cesarean section and multiparas who underwent their first repeat cesarean section. The study aimed to explore the possible differences in postoperative pain between primiparas and multiparas.<h4>Methods</h4>A prospective cohort study was performed only including women who underwent cesarean deliveries under spinal anesthesia. Postoperative patient-controlled intravenous analgesia ...[more]

PMID: 31640565

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Project description:BackgroundCesarean section rates is often used as an indicator of quality of care in maternity hospitals. The assumption is that lower rates reflect in developed countries more appropriate clinical practice and general better performances. Hospitals are thus often ranked on the basis of caesarean section rates. The aim of this study is to assess whether the adjustment for clinical and sociodemographic variables of the mother and the fetus is necessary for inter-hospital comparisons of cesarean section (c-section) rates and to assess whether a risk adjustment model based on a limited number of variables could be identified and used.MethodsDischarge abstracts of labouring women without prior cesarean were linked with abstracts of newborns discharged from 29 hospitals of the Emilia-Romagna Region (Italy) from 2003 to 2004. Adjusted ORs of cesarean by hospital were estimated by using two logistic regression models: 1) a full model including the potential confounders selected by a backward procedure; 2) a parsimonious model including only actual confounders identified by the "change-in-estimate" procedure. Hospital rankings, based on ORs were examined.Results24 risk factors for c-section were included in the full model and 7 (marital status, maternal age, infant weight, fetopelvic disproportion, eclampsia or pre-eclampsia, placenta previa/abruptio placentae, malposition/malpresentation) in the parsimonious model. Hospital ranking using the adjusted ORs from both models was different from that obtained using the crude ORs. The correlation between the rankings of the two models was 0.92. The crude ORs were smaller than ORs adjusted by both models, with the parsimonious ones producing more precise estimates.ConclusionRisk adjustment is necessary to compare hospital c-section rates, it shows differences in rankings and highlights inappropriateness of some hospitals. By adjusting for only actual confounders valid and more precise estimates could be obtained.

Project description:Background Spinal anesthesia is an anesthesia technique suitable for cesarean section to avoid respiratory complications. However, the management of spinal anesthesia is very important because spinal anesthesia may fail and the patient may be exposed to pain and discomfort. Objective To assess the type, management, and related factors of failure of spinal anesthesia at cesarean section. Methods Multicenter prospective cohort study was conducted at a public hospital in Addis Ababa on 794 mothers who met the criteria for cesarean section under spinal anesthesia. Data collection methods were adopted, including chart reviews and observations of spinal anesthesia procedures. The data collected was entered in Epi info version 7 and analyzed in SPSS version 20. Independent variables with dependent variables were analyzed using logistic regression. A p-value of 0.05 for & it; was considered a statistically significant test cutoff. Result Of 121 failed spinal anesthesia 35 were complete and 86 were partial failed spinal anesthesia from those complete failed spinal anesthesia were managed by repeating spinal and converting to general anesthesia and partial failed spinal anesthesia were managed by the supplementary drug. Experience of the anesthetist <1 (AOR = 4.12, 95% CI, 2.47–6.90), patient position (AOR = 14.43,95%CL, 2.65–78.61), number of attempts>1 (AOR = 9.26, 95% CI, 5.69–15.01), bloody CSF (AOR = 6.37, 95%CI, 2.90–13.96), BMI ≥30kgm2 (AOR = 2.03, 95%CI, 1.12–3.68) and dose of bupivacaine <10 mg (AOR = 2.72, 95% CI, 1.33–5.53) were found to be statistically significant associated with failed spinal anesthesia. Conclusion and recommendation Experience of anesthetists (<1 year), obesity, bupivacaine dose <10 mg, bloody appearance of CSF, number of attempts> 1 were associated factors for failed spinal anesthesia in cesarean section. Our failed spinal management is not the same among hospitals and does not follow recommended failed spinal management. Up-skilling of anesthesia professionals should be considered on identified associated factors of failed spinal anesthesia and management of failed spinal anesthesia should be based on the recommended guidelines. Highlights • Failed spinal anesthesia may lead to maternal discomfort.• In our study failed spinal managements were not along with recommended guidelines.• Experience of the anesthetist, bloody CSF others were associated factors for FSA.

Project description:BackgroundUp to 40% of women gain excessive weight during pregnancy. Obesity complications and risks in parturient women undergoing cesarean section (CS) with different anesthetic methods remain unknown. This study aimed to assess the safety and risk of obese women undergoing CS delivery with various perioperative anesthetic methods.MethodsSeven hundred ninety parturient women underwent CS under general anesthesia (GA), intraspinal anesthesia including epidural anesthesia (EA) and combined spinal-epidural anesthesia (CSEA). They were divided into morbid (n = 255), severe (n = 274), and non-obesity (n = 261) groups. This study is registered with ClinicalTrials.gov (number NCT03002636).ResultBetween 2013 and 2016, 790 pregnant were assessed. Compared with the non-obesity group, there were significantly more fetal distress and higher body mass index (BMI) in the morbid obesity group (P = .0001 and P = .001, respectively). Significantly more patients showed preeclampsia, multifetation, amniotic fluid abnormality, and high bleeding amounts in the morbid obesity group compared with the non-obesity group (P = .0001, P = .048, P = .017, and P = .018, respectively); more patients were administered EA and GA compared with the non-obesity group (P = .0001 and P = .0001, respectively). More post-anesthesia care unit (PACU) patients were found in the severe obesity group no more than the non-obesity group. Significantly increased anesthesia puncture times for 5 > n ≥ 3 and n ≥ 5 were obtained in the morbid obesity group (P = .0001 and P = .0001, respectively), with more patients in the puncture sitting position, compared with the non-obesity group (P = .0001).ConclusionGA, EA, and CSEA are safe and effective in severely or morbidly obese patients. Morbidly obese parturient show increased likelihood for fetal distress, PACU, sitting position puncture, puncture difficulty, and other pregnancy complications. There were more anesthesia puncture times in morbidly obese patients.

Dataset Information

Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study.

Background

Methods

Results

Conclusion

Trail registration

Publications

Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study.

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