Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

Abstract Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: A prospective cohort study was carried out, and only women who underwent cesarean deliveries under spinal anesthesia were included. Postoperative patient-controlled intravenous analgesia was performed for all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen, and the pump was programmed as 2.0 mL/h background infusion, and loading dose of 1 mL with a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using visual analogue scale, and inadequate analgesia was defined as visual analogue scale ≥40 during the postoperative 48 hours. Additionally, the patients’ pain statuses on 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 primipara and 101 multipara) were included. The relative risk for multipara to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primipara. In patients under 30 years old, inadequate analgesia on visceral pain in the multipara was higher than that on the primipara (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 multipara and primipara (33.7%vs.40.2%, P=0.381). No difference was found in PCIA consumption between two groups. (111.1 ± 36.0mL vs. 110.9 ± 37.3mL, P=0.979) Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (62.2%vs.37.7%, P=0.011). Conclusions: Multipara who underwent first repeat cesarean section have lower risk to experience inadequate analgesia on incision pain during the first 48 hours after surgery compared to primipara. While multipara under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain.

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

BMC Anesthesiology ◽

10.1186/s12871-019-0865-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Guangyou Duan ◽

Guiying Yang ◽

Jing Peng ◽

Zhenxin Duan ◽

Jie Li ◽

...

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Visual Analogue Scale ◽

Cesarean Section ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Analogue Scale ◽

Visceral Pain ◽

Significant Difference ◽

Repeat Cesarean Section

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.

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Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

10.21203/rs.2.169/v6 ◽

2019 ◽

Author(s):

Guangyou Duan ◽

Guiying Yang ◽

Jing Peng ◽

Zhenxin Duan ◽

Jie Li ◽

...

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Visual Analogue Scale ◽

Cesarean Section ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Analogue Scale ◽

Visceral Pain ◽

Significant Difference ◽

Repeat Cesarean Section

Abstract Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: A prospective cohort study was carried out, and only women who underwent cesarean deliveries under spinal anesthesia were included. Postoperative patient-controlled intravenous analgesia was performed for all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen, and the pump was programmed as 2.0 mL/h background infusion, and loading dose of 1 mL with a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using visual analogue scale, and inadequate analgesia was defined as visual analogue scale ≥40 during the postoperative 48 hours. Additionally, the patients’ pain statuses on 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 primipara and 101 multipara) were included. The relative risk for multipara to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primipara. In patients under 30 years old, inadequate analgesia on visceral pain in the multipara was higher than that on the primipara (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 multipara and primipara (33.7%vs.40.2%, P=0.381). No difference was found in PCIA consumption between two groups. (111.1 ± 36.0mL vs. 110.9 ± 37.3mL, P=0.979) Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (62.2%vs.37.7%, P=0.011). Conclusions: Multipara who underwent first repeat cesarean section have lower risk to experience inadequate analgesia on incision pain during the first 48 hours after surgery compared to primipara. While multipara 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.

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Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

10.21203/rs.2.169/v3 ◽

2019 ◽

Author(s):

Guangyou Duan ◽

Guiying Yang ◽

Jing Peng ◽

Zhenxin Duan ◽

Jie Li ◽

...

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Visual Analogue Scale ◽

Cesarean Section ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Analogue Scale ◽

Visceral Pain ◽

Significant Difference ◽

Repeat Cesarean Section

Abstract Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: A prospective cohort study was carried out, and only women who underwent cesarean deliveries under spinal anesthesia were included. Postoperative patient-controlled intravenous analgesia was performed for all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen, and the pump was programmed as 2.0 mL/h background infusion, and loading dose of 1 mL with a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using visual analogue scale, and inadequate analgesia was defined as visual analogue scale ≥40 during the postoperative 48 hours. Additionally, the patients’ pain statuses on 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 primipara and 101 multipara) were included. The relative risk for multipara to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primipara. In patients under 30 years old, inadequate analgesia on visceral pain in the multipara was higher than that on the primipara (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 multipara and primipara (33.7%vs.40.2%, P=0.381). No difference was found in PCIA consumption between two groups. (111.1 ± 36.0mL vs. 110.9 ± 37.3mL, P=0.979) Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (62.2%vs.37.7%, P=0.011). Conclusions: Multipara who underwent first repeat cesarean section have lower risk to experience inadequate analgesia on incision pain during the first 48 hours after surgery compared to primipara. While multipara under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain.

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Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

10.21203/rs.2.169/v5 ◽

2019 ◽

Author(s):

Guangyou Duan ◽

Guiying Yang ◽

Jing Peng ◽

Zhenxin Duan ◽

Jie Li ◽

...

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Visual Analogue Scale ◽

Cesarean Section ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Analogue Scale ◽

Visceral Pain ◽

Significant Difference ◽

Repeat Cesarean Section

Abstract Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: A prospective cohort study was carried out, and only women who underwent cesarean deliveries under spinal anesthesia were included. Postoperative patient-controlled intravenous analgesia was performed for all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen, and the pump was programmed as 2.0 mL/h background infusion, and loading dose of 1 mL with a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using visual analogue scale, and inadequate analgesia was defined as visual analogue scale ≥40 during the postoperative 48 hours. Additionally, the patients’ pain statuses on 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 primipara and 101 multipara) were included. The relative risk for multipara to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primipara. In patients under 30 years old, inadequate analgesia on visceral pain in the multipara was higher than that on the primipara (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 multipara and primipara (33.7%vs.40.2%, P=0.381). No difference was found in PCIA consumption between two groups. (111.1 ± 36.0mL vs. 110.9 ± 37.3mL, P=0.979) Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (62.2%vs.37.7%, P=0.011). Conclusions: Multipara who underwent first repeat cesarean section have lower risk to experience inadequate analgesia on incision pain during the first 48 hours after surgery compared to primipara. While multipara 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.

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A novel intraoral neuromuscular stimulation device for treating sleep-disordered breathing

Sleep And Breathing ◽

10.1007/s11325-021-02355-7 ◽

2021 ◽

Cited By ~ 1

Author(s):

Bhik Kotecha ◽

Phui Yee Wong ◽

Henry Zhang ◽

Amro Hassaan

Keyword(s):

Cohort Study ◽

Electrical Stimulation ◽

Visual Analogue Scale ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Analogue Scale ◽

Sleep Disordered Breathing ◽

Neuromuscular Electrical Stimulation ◽

Neuromuscular Stimulation ◽

Sleep Studies

Abstract Purpose To ascertain the usefulness of a novel intraoral neuromuscular stimulation device in treating patients with primary snoring and mild obstructive sleep apnoea (OSA). This device uses daytime awake neuromuscular electrical stimulation (NMES) as an application to induce toning of the tongue muscles. Methods A prospective cohort study of 70 patients with sleep-disordered breathing was conducted. Objective snoring and respiratory parameters were recorded with 2 consecutive night WatchPat sleep studies before and after treatment. The device was used for 20 min once daily for a 6-week period. Secondary outcome measures using visual analogue scale reporting of snoring by patient and Epworth Sleepiness Score (ESS) were recorded. Quality of life parameters were also noted. Results Objective reduction of snoring was noted on the sleep studies in 95% of participants, with an average snoring time reduction of 48%. Subjectively, the visual analogue scale reported by partners’ similarly demonstrated reduction in 95% of the patients with an average reduction of 40%. In a subset of 38 patients with mild OSA, AHI reduced from 9.8 to 4.7/h (52% reduction), ODI 7.8 to 4.3/h (45% reduction), and ESS from 9.0 to 5.1. Adverse effects encountered were minimal. Conclusion This prospective cohort study demonstrates a notable improvement in both objective and subjective parameters of snoring and mild OSA in both simple snorers and patients with mild OSA. This device offers a safe and novel approach to reduce snoring and mild OSA by utilising intraoral neuromuscular electrical stimulation. This could be a preferred option for patients as it alleviates the need of using an oral device during sleep. Trial registration clinicaltrials.gov identifier NCT03829956

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Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

10.21203/rs.2.169/v1 ◽

2019 ◽

Author(s):

Guangyou Duan ◽

Guiying Yang ◽

Jing Peng ◽

Zhenxin Duan ◽

Jie Li ◽

...

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Cesarean Section ◽

Visceral Pain ◽

Postoperative Patient ◽

Cesarean Deliveries ◽

Post Operative Pain ◽

Significant Difference ◽

Intravenous Analgesia

Abstract Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: Women who underwent cesarean deliveries under spinal anesthesia were included, and postoperative patient-controlled intravenous analgesia was performed. Postoperative incision and visceral pain within 48 hours after the surgery were evaluated. Serum leukocyte and neutrophil counts before and 24 hours after the surgery were retrospective collected. Additionally, the patients’ pain statuses on postoperative week 1 and week 4 were also assessed during follow-up via telephone. Results: A total of 168 patients (67 primipara and 101 multipara) were included. The multipara showed less risk for experiencing moderate to severe incision pain during the 48 hours after the surgery than the primipara (15.8%vs.37.3%; P=0.001). In patients under 30 years old, inadequate treatment of the visceral pain in the multipara was higher than that of the primipara (22.7%vs.6.4%; P=0.026). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multipara and primipara (33.7%vs.40.2%, P=0.381). Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (55.4%vs.36.1%, P=0.015). Conclusions: Individual differences between the primipara and multipara should be considered in the management of postoperative analgesia for those who have undergone Cesarean deliveries.

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0642 A Novel Daytime Intra-Oral Neuromuscular Stimulation Therapy in Simple Snorers: Objective Improvement in Snoring

SLEEP ◽

10.1093/sleep/zsaa056.638 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A245-A245

Author(s):

B Kotecha

Keyword(s):

Cohort Study ◽

Electrical Stimulation ◽

Visual Analogue Scale ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Analogue Scale ◽

Neuromuscular Electrical Stimulation ◽

Secondary Outcome ◽

Sleep Studies ◽

Respiratory Parameters

Abstract Introduction The reduction in pharyngeal muscle tone in the upper airway is a pivotal factor in snoring and obstructive sleep apnoea (OSA).There is accumulative evidence that pharyngeal exercises can reduce snoring and OSA. We present a novel device SnooZeal® that uses daytime awake neuromuscular electrical stimulation (NEMS) as an application to induce toning of the tongue muscles. This study investigates objective changes in snoring and respiratory parameters with this device. Methods Prospective cohort study of 100 simple snorers was conducted. Objective snoring and respiratory parameters were recorded with 2 consecutive WatchPat sleep studies before and after treatment. SnooZeal® device was used for 20 minutes once a day for a 6 week period. Secondary outcome measures using visual analogue scale reporting of snoring by patient and Epworth Sleepiness Score (ESS) were recorded. Results Objective reduction of snoring was noted on the sleep studies in 95% with an average reduction of 48%. Subjectively, the visual analogue scale reported by partners similarly demonstrated reduction in 95% of the patients with an average reduction of 40%. Conclusion This prospective cohort study demonstrates a notable improvement in both objective and subjective parameters of snoring and respiratory indices. SnooZeal® offers a novel approach to reduce snoring by utilising intra-oral neuromuscular electrical stimulation. This could be a preferred option for patients as it alleviates the need of using an oral device during sleep. Support

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