Effect of preoperative education about spinal anesthesia on anxiety and postoperative pain in parturients undergoing elective cesarean section: A randomized controlled trial

Abstract Background: Pain is one of the most common compliant and cause of distress in the perioperative period. The postoperative pain after cesarean section is believed to be of mild to moderate intensity lasting for up to 72 hours. Apart from patient preferences, number of factors affect choices of analgesia in a resource limited setting like Ethiopia. Availability of resources, a trained man power and inter-individual variation in pain threshold were among a factor affecting analgesia choices. Thus, this study aims to compare TAP block versus II/IH block for post cesarean delivery analgesia in resource limited areas where ultrasound guided block is not practiced.Method: A randomized controlled trial study were conducted in Dilla University teaching and referral Hospital found in southern Ethiopia. A pregnant women scheduled for elective cesarean section was randomized to either TAP block (n = 36) or II/IH block (n = 36) for postoperative pain management. Sample size were calculated using a G-power version 3.1.9.2 getting a total of 72 participants. Pain severity, total tramadol consumption and time to first analgesia request were asses’ during the first 72 hour postoperatively. Many Whitney U-test and independent t-test were used based on distribution of data. A Kaplan Meier analysis was to asses’ proportion of patients who did not require analgesia for 48hour follow up period.Result: The cumulative median tramadol consumption over 48hour were 100 mg for TAP group and 150 mg for II/IH (p = 0.018). The median tramadol consumption at 24hr. and 36 hr. were also lower in TAP group compared to II-IH (P < 0.05). There is no statistically significant difference between groups regarding time to first analgesia request (p > 0.05). The median pain score at 36hr. and 48hr. were lower in TAP group (3 and 4) compared to II-IH group (4 and 6) respectively (p < 0.05). There is no statistically significant difference between groups regarding the postoperative side effects and complication.Conclusion: Both II-IH and TAP block has comparable analgesic efficacy during the first 24hr. TAP block has a longer analgesic effectiveness compared to II-IH with an effect lasting for 48hr.

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Effectiveness of Leg Elevation to Prevent Spinal Anesthesia-Induced Hypotension during Cesarean Delivery in the Resource-Limited Area: Open Randomized Controlled Trial

Anesthesiology Research and Practice ◽

10.1155/2020/5014916 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Sofia Assen ◽

Bedru Jemal ◽

Adane Tesfaye

Keyword(s):

Randomized Controlled Trial ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Controlled Trial ◽

Elective Cesarean Section ◽

Control Group ◽

Limited Area ◽

Randomized Controlled ◽

Severe Hypotension ◽

Elective Cesarean

Background. Postspinal hypotension is the most common complication after spinal anesthesia for cesarean section (CS). Hypotension mainly occurs due to the reductions of vascular tone leading to decreased systemic vascular resistance and decreased venous return. The aim of this study was to assess the effectiveness of leg elevation (LE) as a method of prevention of postspinal hypotension in patients who undergo cesarean section under spinal anesthesia. Methods. This is a single-center parallel-randomized controlled trial study, and 52 full-term parturients scheduled for elective cesarean section who meets inclusion criteria were included in the study. The randomization sequence was created by a researcher not participating in patient management using a computer random generator. The participant was randomly assigned to the leg elevation group (n = 26) or to the control group (n = 26) of usual perioperative care. Results. The proportions of patients who develop hypotension are lower (8 (33.3%)) in the leg elevation group than the control group (15 (62.5%)) with an X2 (1, N = 48) = 4.09, P=0.043. The relative risk of developing postspinal hypotension in the leg elevation group compared to the control group was 0.47 (95% CI, 0.28–1.00). The proportion of severe hypotension was significantly decreased in the leg elevation group at a P value of 0.02. Conclusion. Performing leg elevation immediately after spinal anesthesia reduced the incidence of hypotension. The trial is registered with PACTR201908713181850.

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