Comparing the effects of general and spinal anesthesia on the postoperative pain intensity in patients undergoing emergent or elective cesarean section

Abstract Background Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia. Objectives The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives. Methods and material After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg) Results The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups. Conclusions We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine.

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Effect of Spinal Anesthesia for Elective Cesarean Section on Cerebral Blood Oxygenation Changes: Comparison of Hyperbaric and Isobaric Bupivacaine

Advances in Experimental Medicine and Biology - Oxygen Transport to Tissue XXXIV ◽

10.1007/978-1-4614-4989-8_16 ◽

2012 ◽

pp. 109-114 ◽

Cited By ~ 7

Author(s):

Yuko Kondo ◽

Kaoru Sakatani ◽

Noriya Hirose ◽

Takeshi Maeda ◽

Jitsu Kato ◽

...

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Blood Oxygenation ◽

Elective Cesarean Section ◽

Elective Cesarean ◽

Cerebral Blood Oxygenation

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Effect of Anesthesia Techniques on Pain Severity, Hemodynamic Changes, and Patients’ Satisfaction in Elective Cesarean Section

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i7.2328 ◽

2020 ◽

Author(s):

Abdollah Jafarzadeh ◽

Maryam Hadavi ◽

Gholamhossein Hasanshahi ◽

Mohsen Rezaeian ◽

Reza Vazirinejad ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Postoperative Pain ◽

Cesarean Section ◽

Diastolic Blood Pressure ◽

Elective Cesarean Section ◽

Hemodynamic Changes ◽

Apgar Scores ◽

Patients Satisfaction ◽

Elective Cesarean

The severity of postoperative pain and hemodynamic changes during and post-cesarean section have a direct effect on the neonatal and maternal condition. This study aimed to compare pain severity, hemodynamic changes, and patient satisfaction following two anesthesia techniques in elective cesarean section. In this blinded study, 60 women who were candidate for cesarean section were allocated into two equal groups of general anesthesia (GA) and spinal anesthesia (SA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and O2 Saturation at pre cesarean (T0), the uterine incision time (T1), end of surgery (T2), 6h (T3), 12h (T4), and 24 hours post-cesarean (T5) were measured. A Visual Analog Scale assessed post-cesarean pain, 6, 12, and 24 hours post-cesarean. Gender, birth weight, first- and fifth- minutes’ apgar score was recorded in the checklists. The VAS score was significantly higher in the GA group at 6h, 12h, and 24 hours post-cesarean (P=0.014, P=0.002, P=0.017, respectively). SBP and DBP at T1 in the GA group were significantly higher than in the S.A group (P<0.001). The heart rate at T0 and T1 in the GA group was lower than the SA group (P=0.001, P=0.045 respectively). The difference between the apgar scores of the two groups was not significant. SA for cesarean section was associated with lower postoperative pain, systolic and diastolic blood pressure. However, the two groups had no significant difference in terms of patients’ satisfaction and apgar scores. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):424-429.

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Effects of Adusted Dose of Local Anesthetic Considered Patient's Characteristics for Spinal Anesthesia for Elective Cesarean Section

Korean Journal of Anesthesiology ◽

10.4097/kjae.2005.49.5.641 ◽

2005 ◽

Vol 49 (5) ◽

pp. 641 ◽

Cited By ~ 1

Author(s):

Cheol Lee ◽

Yong Son ◽

Jae Seong Yoon ◽

Yong Kwan Cheong ◽

Min Soo Kim

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Local Anesthetic ◽

Elective Cesarean Section ◽

Elective Cesarean

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Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i2.23394 ◽

2018 ◽

Vol 1 (2) ◽

pp. 70-74

Author(s):

Rohini Sigdel ◽

Maya Lama ◽

Sanish Gurung ◽

Bishal Gurung ◽

Anil Prasad Neupane ◽

...

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Elective Cesarean Section ◽

Controlled Study ◽

Control Group ◽

Operating Table ◽

Hemodynamic Effects ◽

Elective Cesarean ◽

Spinal Hypotension ◽

The Right

Background: Several methods have been used to prevent post spinal hypotension including preloading, co-loading, use of vasopressors, placement of pelvic wedge, lumbar wedge and tilting of operating table in parturients undergoing cesarean section. We conducted a randomized controlled study to determine the hemodynamic effects of a standard pelvic wedge placed below the right hip immediately after the spinal block till the delivery of baby. Methods: One hundred consenting women undergoing elective cesarean section under spinal anesthesia were randomly allocated to wedge group (N=50) and control group (N=50). A standard wedge was placed under the right pelvis soon after spinal anesthesia till the delivery of baby in wedge group whereas the control group remained supine. Hemodynamic parameters including blood pressure, heart rate, vasopressor consumption, other side effects like nausea, vomiting and neonatal outcome were also recorded. Results: The incidence of hypotension and bradycardia was similar between groups (Wedge group 60% vs Control group 75.51%, p=0.125) before the birth of baby. The use of vasopressors (p=0.212), incidence of nausea (p=0.346) and Apgar score at 1 and 5 minutes (p=0.629, p=0.442) were also not statistically significant. None of the patients had vomiting. Conclusion: In our study, the use of right pelvic wedge immediately after spinal anesthesia was not effective in preventing post spinal hypotension in elective cesarean section.

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