Nalmefene relieves epidural morphine-caused pruritus following caesarean section: a randomized and placebo-controlled clinical trial

Abstract Background. Epidural morphine has an effective analgesic effect in cesarean section patients; however, a very common adverse effect caused by epidural morphine is pruritus, which is difficult to treat or prevent. Here, we aimed to investigate whether a μ-opioid antagonist with central and peripheral effects reduces morphine-induced pruritus. Methods. In this prospective randomized trial, eighty patients scheduled for an elective cesarean section under spinal aesthesia with 3 mg of epidural morphine were assigned into the nalmefene group (n=40) or placebo group (n=40). After delivery, either 50 μg of intravenous nalmefene hydrochloride (Nalmefene group) or an equivalent amount of normal saline (Placebo group) was administered to the patients. In the meantime, an assessment of a series of side effects such as pruritus, nausea, and pain was conducted at 2, 4, 8, 12, and 24h after epidural morphine administration. Results. All eighty participants completed this trial. The total incidence of pruritus in the first 24 hours following the section was reduced in IV nalmefene group compared with the placebo group (37.5% vs 65%, P=0.003). Moreover, IV nalmefene administration relieved the pruritus intensity, whereas the difference in the incidence of nausea and vomiting between the two groups was not significant. Besides, the nalmefene group displayed significantly higher pain scores at 8, 12 and 24h than the placebo group (all P<0.05). However, no significant difference in the percentage of patients with an analgesic treatment was found between the two groups (P=0.37). Conclusion. In this study, a single dose of 50 μg of IV nalmefene was found to decrease the overall severity and incidence of epidural morphine-induced pruritus, but cause no adverse effect on postoperative analgesia.

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Efficacy of Intravenous Ondansetron on Hemodynamic Complications in Women Undergoing Spinal Anesthesia for Cesarean Section: A Randomized Placebo Controlled Clinical Trial

Galen Medical Journal ◽

10.31661/gmj.v5i1.475 ◽

2016 ◽

Vol 5 (1) ◽

pp. 13-18

Author(s):

Pouran Hajian ◽

Bita Malekianzadeh ◽

Maryam Davoudi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Placebo Group ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Nausea And Vomiting ◽

Elective Cesarean Section ◽

Controlled Clinical Trial ◽

Sterile Water ◽

Elective Cesarean

Background: Several methods are used for the prevention or decreasing the incidence of spinal anesthesia hemodynamic complications. Ondansetron is a 5HT3 receptor antagonist with known efficacy on preventing nausea and vomiting and probably on intrathecal opioid-induced pruritus. The present study aims to evaluate the effects of intravenous Ondansetron on the attenuation of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on Bezold Jarish reflex. Material and Methods: One hundred and two candidates for elective cesarean section were randomized into 2 groups of 51 cases, the Ondansetron group received 4mg Ondansetron intravenously before performing spinal anesthesia, and placebo group received 2cc sterile water. Hypotension was defined: Systolic blood pressure less than 100 MmHg or fall more than 20% from primary BP which was treated by administration of Ephedrine in case of any. In both groups, Ondansetron effect was studied on hypotension occurrence, bradycardia, consumed Ephedrine amount, pruritus, nausea and vomiting. Results: There were no statistically significant differences in systolic/diastolic blood pressure, Mean Arterial Pressure, heart rate and pruritus in both groups (P=0.081).Nausea and vomiting in the first 10 minutes after spinal anesthesia were lesser in Ondansetron group (P= 0.001). Mean consumed Ephedrine was significantly lesser in Ondansetron group (5.8 mg in Ondansetron and 10.7 mg in placebo group, P=0.009). Conclusion: Ondansetron given intravenously with antiemetic dose (4 mg) decreases mean consumed Ephedrine and nausea and vomiting after spinal anesthesia, but does not have an influence on blood pressure, heart rate and pruritus.[GMJ. 2016;5(1):13-18]

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Breed-specific ecobiometry and ultrasound factors predictive of fetal maturity in healthy English Bulldog bitches subjected to elective cesarean section

Research Society and Development ◽

10.33448/rsd-v10i10.19091 ◽

2021 ◽

Vol 10 (10) ◽

pp. e555101019091

Author(s):

Luana Azevedo de Freitas ◽

Paula Priscila Correia Costa ◽

Stefanie Bressan Waller ◽

Thaissa Gomes Pellegrin ◽

Eduardo Gonçalves da Silva ◽

...

Keyword(s):

Cesarean Section ◽

Elective Cesarean Section ◽

Significant Difference ◽

Fetal Maturity ◽

Intestinal Peristalsis ◽

Elective Cesarean ◽

Ultrasound Assessment ◽

Student’S T ◽

Ultrasound Parameters ◽

English Bulldog

The aims of the current study are to build an equation to predict gestational age (GA) and to compare ultrasound parameters indicative of delivery in healthy English Bulldog bitches subjected to elective cesarean section. Sixteen pregnant female dogs were included in the study. Inner chorionic cavity (ICCDD) and biparietal (BPD) diameters were measured at 30 and 50 days after artificial insemination, respectively, to estimate GA at embryonic and fetal stages. BPD, heart rate (HR), and intestinal peristalsis were measured at 48 h, 24 h, and 6 hours before delivery to compare fetal development. ICCD and BPD values were subjected to linear regression and parameters predictive of elective cesarean section were compared through Student’s t-test before delivery. The number of conceptuses did not influence pregnancy duration. Both ICCD and BPD were significantly correlated to GA; their formulas presented accuracy of ± 1 and ± 2 days, respectively, in comparison to that of progesterone dosage. Based on the comparative ultrasound assessment, BPD has significantly increased from 48 h to 6 h before delivery (≥3 cm), regardless of the number of pups, whereas HR has significantly decreased within 6 h before delivery (HR <200 bpm). There was not statistically significant difference in parameter “intestinal peristalsis” among measurement times. The current study is pioneer in highlighting that measuring ICCD and BPD in the formula is a useful tool to predict GA in the herein investigated breed and that fetal parameters such as BPD and HR are fetal maturity predictors.

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Influence of type of birth on child development: a comparison by Bayley- III Scale

Journal of Human Growth and Development ◽

10.7322/jhgd.v30.10382 ◽

2020 ◽

Vol 30 (2) ◽

pp. 301-310

Author(s):

Ana Paula Magosso Cavaggioni ◽

Maria do Carmo Fernandes Martins ◽

Miria Benincasa

Keyword(s):

Cesarean Section ◽

Adaptive Behavior ◽

Motor Development ◽

Reference Sample ◽

Psychological Development ◽

Elective Cesarean Section ◽

Fine Motor ◽

Gastrointestinal Problems ◽

Significant Difference ◽

Elective Cesarean

Introduction: Elective cesarean section is associated with several damages to the newborn's health, such as respiratory and gastrointestinal problems and diabetes that last throughout life. However, few studies discuss aspects related to psychological development. Objective: To investigate the development of Brazilian children according to the type of birth and gestational age in the cognitive, language, motor, socio-emotional and adaptive behavior domains. Methods: This is an exploratory and descriptive cross-sectional study conducted in the city of São Bernardo de Campo, São Paulo, Brazil, between June 2016 and March 2017. The final sample consisted of 263 children up to 42 months of age. For data collection were applied a socio demographic questionnaire and the Bayley-III Scale. The statistical analysis was based on both a North American reference sample and a local sample using the SPSS version 21, through Pearson's Chi-square statistical test and significance criteria p <0.05. Results: A significant difference (p<0.005) was observed, with a higher risk of problems in fine motor development and expressive language in children born at pre-term between 37- 39 weeks compared to those born at term between 39 - 41 weeks. Significant difference (p<0.005) was also observed in sensory processing and adaptive behavior, with greater impairment in children born via elective cesarean section compared to those born vaginally. Conclusion: Despite its limitations and discrepancies, this research indicates potential impairments in the psychological development of children born at early term via elective cesarean.

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Low Dose Hyperbaric Bupivacaine with Fentanyl in Spinal Anesthesia in Elective Cesarean Section

Journal of Chitwan Medical College ◽

10.3126/jcmc.v9i2.24560 ◽

2019 ◽

Vol 9 (2) ◽

pp. 79-82

Author(s):

Bharati Devi Sharma Regmi ◽

Gopendra Prasad Deo ◽

Subin Shrestha ◽

Sabita Shrestha ◽

Renuka Tamrakar Mishra

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Low Dose ◽

Nausea And Vomiting ◽

Elective Cesarean Section ◽

Hyperbaric Bupivacaine ◽

Significant Difference ◽

Elective Cesarean

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the incidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section. Methods: Seventy-four pregnant women aged 20-35 years old which underwent elective cesarean section at Chitwan Medical College were randomized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group received 12mg 0.5% bupivacaine. Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypotension (24.31% vs. 62.16%, p<0.05) and Nausea and vomiting (16.20% vs. 27%, p<0.05) were found in bupivacaine-fentanyl group versus a conventional dose of spinal bupivacaine group. Conclusions: Low dose of bupivacaine with Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomiting in comparison to bupivacaine alone.

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Comparison of Two Breastfeeding Positions on Maternal Comfort and Infant Feeding Behaviors through Video Teaching among Postnatal Mothers

Journal of Health and Allied Sciences NU ◽

10.1055/s-0039-3401966 ◽

2019 ◽

Vol 09 (03) ◽

pp. 104-115

Author(s):

Smitha D'Souza ◽

Timi Thomas ◽

Shynee Paul

Keyword(s):

Cesarean Section ◽

Infant Feeding ◽

Rating Scale ◽

Sampling Technique ◽

Posttest Score ◽

Elective Cesarean Section ◽

Research Approach ◽

Feeding Behaviors ◽

Significant Difference ◽

Elective Cesarean

Abstract Introduction Breastfeeding is not a choice but it is a responsibility. While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby. Antenatal education motivates the mothers who are undergoing Cesarean section to prepare themselves, so as to establish a wonderful efficient latch. The aim of this study was to conclude which breastfeeding position may be the best choice for the mother with Caesarean section. The objectives of the study were (1) to identify the maternal comfort and infant feeding behaviors in groups 1 and 2, (2) to compare the maternal comfort and infant feeding behaviors between the groups, and (3) to find the association between maternal comforts with selected demographic characteristics. The literature also very well supports that especially the mothers with Cesarean section achieve very good maternal comfort, greater satisfaction, and favorable infant feeding behaviors in side-lying position. Thus, the researcher attempts to compare the cradle hold and side-lying breastfeeding position in terms of maternal comfort and efficient latch. Materials and Methods An evaluative research approach was used and the design selected for the study was quasiexperimental for two groups posttest only. Sample comprised of 70 antenatal mothers with elective Cesarean section (35 in each group) admitted at K.S. Hegde Hospital in Deralakatte, Mangalore. Purposive sampling technique was used to select the samples. Data were collected by using demographic proforma, maternal comfort rating scale, and infant behavior checklist. Results The results of the study shows that there was significant difference in the mean posttest scores between cradle hold and side-lying breastfeeding position. Mothers from the side-lying breastfeeding position group showed higher maternal comfort, mean posttest score, and favorable infant feeding behaviors than the cradle hold breastfeeding position. The independent sample t test revealed that the calculated t value for maternal comfort and infant feeding behaviors within the group and between the group less than the table value t (0.05, 68 = −2.042). Conclusion This study explores that mothers with Cesarean section show greater maternal comfort and favorable infant feeding behaviors in side-lying breastfeeding position between the groups and within the groups than the cradle hold.

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Nalmefene to prevent Epidural morphine-induced pruritus after Caesarean delivery: a randomized, placebo-controlled clinical trail

10.21203/rs.2.17436/v1 ◽

2019 ◽

Author(s):

Chaochao Zhong ◽

Xingguo Xu ◽

Xiang Zhu ◽

Yibin Qin ◽

Haihang Miao ◽

...

Keyword(s):

Epidural Morphine ◽

Randomized Study ◽

Opioid Antagonist ◽

Common Side Effect ◽

Total Incidence ◽

Morphine Administration ◽

Number Of Patients ◽

Significant Difference ◽

Elective Cesarean ◽

Clinical Trail

Abstract Background. Epidural morphine provides an effective analgesic effect on cesarean section patients, while epidural morphine-induced pruritus is a very common side-effect that is difficult to prevent or treat. The aim of this study was to determine whether a μ-opioid antagonist with central and peripheral effects could reduce morphine-induced pruritus. Methods. Eighty patients who underwent elective cesarean delivery under spinal aesthesia with epidural morphine 3mg were divided into two groups of 40 each in this prospective, randomized study. After delivery, participants received either intravenous nalmefene hydrochloride 50μg( Nalmefene group, n=40) or saline(Placebo group, n=40). Pruritus, nausea, pain, and side-effects were assessed at 2, 4, 8, 12, 24h after epidural morphine administration. Results. Eighty women completed the study. Compared to IV saline , the total incidence of pruritus within the first 24 hours was reduced in IV nalmefene group (37.5% vs 65%, P=0.003). IV nalmefene also reduced the severity of pruritus. There was no significant difference in the incidence of nausea and vomiting. Remarkably, although the pain scores were significantly higher at 8, 12 and 24h(all P<0.05) in the nalmefene groups, but there was no difference between two groups in the number of patients who needed analgesic treatment(P=0.37). Conclusions. A single dose of IV nalmefene 50μg can reduce the overall severity and incidence of epidural morphine-related pruritus without adversely affecting the quality of postoperative analgesia. TRIAL REGISTRY: ChiCTR1900022268. Registered on 2 April 2019

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Phenylephrine Effectiveness in Handling Hypotensive Issues During Spinal Anesthesia Conductance for Cesarean Section Deliveries

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm.04.03.02 ◽

2019 ◽

Vol 4 (3) ◽

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Research Group ◽

Elective Cesarean Section ◽

Control Group ◽

P Values ◽

Management Protocol ◽

Significant Difference ◽

Elective Cesarean ◽

The Impact

Background: Hypotension is frequent clinical challenge during spinal mode of anesthetic induction for cesarean delivery. Requiring an effective and prompt management mode since it has unfavorable clinical outcomes such as hemodynamic cardiovascular instability issues besides reduced uteroplacental perfusion. Aim: Investigating the impact and effectiveness of different prophylacticdosages of Phenylephrine on hypotensive issues during spinal anesthesia for cesarean section deliveries. Methodology:A prospective, randomized, clinical research study involved 184 cases That are classified as American Society of Anesthesiologists physical status I and II with term singleton pregnancies scheduled for elective cesarean section under spinal anesthesia randomized to receive 0.9% saline 2 mL (Control Group) or phenylephrine1.0 ug/kg (PHE1 research Group), 1.5 ug/kg (PHE1.5 research Group), or 2.0 ug/kg (PHE2 research Group) immediately after induction of spinal anesthesia. Results: The adverse effects of prophylactic bolus ofPhenylephrine among the research groups control, Phenylephrine 1, 1.5,2 in which there was statistically significant difference as regards hypotension, rescue Phenylephrine,lowest SBP,highest SBP,early highest SBP,mean SBP, occurrence of hypertension (p values= <0.001, <0.001, 0.002, <0.001, <0.001, <0.001, <0.001consecutively) there was no statistical significant difference as regards nausea and bradycardia (p values=0.929, 0.823consecutively). Conclusions: The research findings obtained denote and imply that a prophylactic Phenylephrine 1.5 ug/kg bolus followed by additional boluses when necessary could be an alternative management protocol to decrease the frequency of hypotensive issues occurrence during spinal anesthetic mode for cesarean deliveries.

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Maternal and Fetal Outcome in Elective versus Emergency Cesarean Section

Journal of Nepal Medical Association ◽

10.31729/jnma.2426 ◽

2013 ◽

Vol 52 (192) ◽

Cited By ~ 4

Author(s):

Anupama Suwal ◽

Veena R Shrivastava ◽

Amrita Giri

Keyword(s):

Cesarean Section ◽

Teaching Hospital ◽

College Teaching ◽

Fetal Outcome ◽

Elective Cesarean Section ◽

Emergency Cesarean Section ◽

Medical College ◽

Emergency Cesarean ◽

Significant Difference ◽

Elective Cesarean

Introduction: The complications of cesarean section are seen more commonly in emergency than in elective cases. The aim of this study was to find out the incidence of cesarean section in Nepal Medical College Teaching Hospital and to compare the maternal and fetal outcome in elective and emergency cesarean section. Methods: A prospective study of all the cases undergoing cesarean section in Nepal Medical College Teaching Hospital was carried out during the period of six months from Asar 2069 to Mangsir 2069. Results: The incidence of cesarean section was 254 (22.30%) out of which emergency cesarean section accounted for 167 (65.7%) and elective cesarean section for 87 (34.3%). The usual indications of emergency cesarean section were fetal distress, previous cesarean section in labour, non progress of labour and prolonged second stage of labour. The usual indications of elective cesarean section were previous cesarean section, breech, cephalopelvic disproportion and cesarean section on demand. There was found to be no significant difference in age, period of gestation, blood loss and blood transfusion in emergency vs. elective cesarean section. There was significant difference seen in the length of hospital stay, fever, urinary tract infection, wound infection and low APGAR in five minutes indicating that these were more common in emergency cesarean section. Significant difference was also seen in the incidence of postpartum haemorrhage indicating that it was seen more in elective cesarean section. Conclusions: The incidence of cesarean section in Nepal Medical College Teaching Hospital is high and the overall complication rate is higher in emergency cesarean section than in elective cesarean section.Keywords: cesarean section; fetal and maternal outcome.

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COMPARISON OF NEONATAL APGAR SCORES AND PATIENT SATISFACTION LEVELS IN SPINAL VERSUS GENERAL ANESTHESIA IN ELECTIVE CESAREAN SECTIONS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i4.3296 ◽

2021 ◽

Vol 71 (4) ◽

pp. 1183-87

Author(s):

Syed Khurram Naseer ◽

Aijaz Ali ◽

Shizan Hamid Feroz ◽

Dr Danish ◽

Amir Sohail

Keyword(s):

Patient Satisfaction ◽

Cesarean Section ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Elective Cesarean Section ◽

Military Hospital ◽

P Value ◽

Apgar Scores ◽

Significant Difference ◽

Elective Cesarean

Objective: To compare patients undergoing cesarean section under spinal and general anesthesia in terms of neonatal APGAR scores and patient satisfaction. Study Design: Comparative cross-sectional study. Place and Duration of Study: Departments of Anesthesia and Gynecology and Obstetrics, Combined Military Hospital Peshawar, for six months from Mar to Aug 2019. Methodology: In this study, 120 females with a singleton pregnancy of 36-40 weeks, and requiring a non-emergency elective cesarean section were enrolled through consecutive sampling in the study. The patients were randomly allocated into two equal groups of 60 women each through random table numbers. Group A received spinal anesthesia and group B general anesthesia. APGAR score was assessed at 5 minutes after delivery, and score of ≥7 was taken as satisfactory. Patient's satisfaction level regarding anesthesia was recorded on a visual analogue scale of 0 (extremely unsatisfied) to 10 (completely satisfied), and score of ≥7 was taken as satisfactory. Results: Women receiving general anesthesia were more satisfied as compared to receiving spinal anesthesia (95% vs. 78.3%; p-value 0.007). There was no significant difference in terms of APGAR scores in general anesthesia and spinal anesthesia (83.33% versus 90%; p-value 0.283). Conclusion: After an elective caesarean section, more mothers were satisfied after receiving general anesthesia as compared to spinal anesthesia. However, both types of anaesthesia were found to be equally safe for babies born in terms of APGAR scores at 5 minutes.

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Assessment of compliance with a color coded protocol for non-elective cesarean section in a maternity ward in France.

10.22541/au.161969569.90990035/v1 ◽

2021 ◽

Author(s):

Oriane Vetier ◽

Marie-Alice Yanni ◽

Linda Lassel ◽

Helene Isly ◽

Alain Beuchée ◽

...

Keyword(s):

Cesarean Section ◽

Statistical Tests ◽

Neonatal Outcomes ◽

University Hospital ◽

Elective Cesarean Section ◽

Maternity Ward ◽

Color Code ◽

Significant Difference ◽

Elective Cesarean ◽

Maternal And Neonatal Outcomes

Purpose: The aim of a color coded protocol for non-elective cesarean-sections is to improve decision-delivery interval by better organization of care in a maternity unit. We set out to assess compliance of a color coded protocol and its impact on maternal and neonatal outcomes since its implementation in our maternity ward. Materials and methods: This was a retrospective study including a sample of 200 patients per year who underwent an non-elective cesarean section delivery in Rennes University Hospital from January 1, 2015 to December 31, 2018. Patients were grouped by year and by color code (red, orange or green). The main outcome was compliance with the protocol (color code in accordance with indication for cesarean section) and compliance with the corresponding decision-delivery interval. Secondary outcomes were maternal and neonatal outcomes. The statistical tests performed were Fisher’s test for qualitative parameters and Kruskal-Wallis test for quantitative parameters. Results: Eight hundred patients were included during the study period. There was no significant difference in patient characteristics over the years. There was a significant improvement in protocol compliance: full compliance increased from 22.4% in 2015 to 76.5% in 2018 (p<0.0001). No difference was observed in the decision-delivery interval overall but compliance with the 15-minute decision-delivery interval imposed by a red coded protocol increased between 2015 and 2018 (p=0.0020). Conclusion: We observed a significant improvement in compliance with the color coded protocol between 2015 and 2018 and in the 15-minute decision-delivery deadline for the red code.

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