scholarly journals A Clinical Trial on the Effects of Different Regimens of Phenylephrine on Maternal Hemodynamic After Spinal Anesthesia for Cesarean Section

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Mahshid Nikooseresht ◽  
Mohammad Ali Seifrabiei ◽  
Pouran Hajian ◽  
Shadab Khamooshi
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Saline Control ◽  
Control Group ◽  
Significant Difference ◽  
The Mean ◽  
Phenylephrine Infusion

Background: Phenylephrine is used to prevent and treat hypotension during spinal anesthesia for cesarean delivery. Objectives: The present study aims to investigate the effects of different regimens of phenylephrine on blood pressure of candidates for the cesarean section. Methods: In this double-blind, randomized clinical trial, a total of 120 candidates of elective cesarean delivery under spinal anesthesia was randomly categorized into three groups. Groups 1, 2, and 3 received bolus and prophylactic saline (control group), prophylactic bolus phenylephrine (100 µg), and prophylactic phenylephrine infusion (50 µg/min), respectively. The incidence of hypotension, maternal hemodynamics, hypertension, rescue phenylephrine dose, nausea, and vomit were compared between the groups. Results: In all the three groups, the incidence of nausea and vomit, bradycardia, hypertension, and neonatal Apgar score were not statistically different (P > 0.05). However, the adjuvant phenylephrine dose requirement was remarkably different. Moreover, the mean systolic blood pressure differed significantly in the second and 7th minutes after the spinal block (P < 0.05). 35% in the first group, 15% in the second group, and 2.5% in the third group had hypotension (P = 0.001). Apart from the first measurement after spinal anesthesia, the mean heart rate showed no significant difference between the groups. Conclusions: The use of prophylactic phenylephrine infusion is recommended to control the optimal blood pressure in parturients undergoing cesarean section after spinal anesthesia.

scholarly journals Norepinephrine versus phenylephrine infusion for preventing postspinal hypotension during cesarean section for twin pregnancy: a double-blinded randomized controlled clinical trial

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Zijun Chen ◽  
Jieshu Zhou ◽  
Li Wan ◽  
Han Huang
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Heart Rate ◽  
Cardiac Output ◽  
Cesarean Section ◽  
Area Under The Curve ◽  
Neonatal Outcomes ◽  
The Mean ◽  
Phenylephrine Infusion ◽  
Double Blinded

Abstract Background Compared with singleton pregnancy, twin gestation is featured by a greater increase in cardiac output. Therefore, norepinephrine might be more suitable than phenylephrine for maintaining blood pressure during cesarean section for twins, as phenylephrine causes reflex bradycardia and a resultant decrease in cardiac output. This study was to determine whether norepinephrine was superior to phenylephrine in maintaining maternal hemodynamics during cesarean section for twins. Methods Informed consent was obtained from all the patients before enrollment. In this double-blinded, randomized clinical trial, 100 parturients with twin gestation undergoing cesarean section with spinal anesthesia were randomized to receive prophylactic norepinephrine (3.2 μg/min) or phenylephrine infusion (40 μg/min). The primary outcome was the change of heart rate and blood pressure during the study period. The secondary outcomes were to compare maternal complications, neonatal outcomes, Apgar scores and umbilical blood acid-base status between the two vasopressors. Results There was no significant difference observed for the change of heart rate between two vasopressors. The mean standardized area under the curve of heart rate was 78 ± 12 with norepinephrine vs. 74 ± 11 beats/min with phenylephrine (mean difference 4.4, 95%CI − 0.1 to 9.0; P = .0567). The mean standardized area under the curve of systolic blood pressure (SBP) was significantly lower in parturients with norepinephrine, as the mean of differences in standardized AUC of SBP was 6 mmHg, with a 95% CI from 2 to 9 mmHg (P = .0013). However, requirements of physician interventions for correcting maternal hemodynamical abnormalities (temporary cessation of vasopressor infusion for reactive hypertension, rescuing vasopressor bolus for hypotension and atropine for heart rate less < 50 beats/min) and neonatal outcomes were also not significantly different between two vasopressors. Conclusion Infusion of norepinephrine was not associated with less overall decrease in heart rate during cesarean section for twins, compared with phenylephrine. Trial registration Chinese Clinical Trial Registry (ChiCTR1900021281).

scholarly journals Analgesic effect of preoperative intravenous administration of paracetamol on post-cesarean pain: A randomized clinical trial

2019 ◽  
Author(s):  
Seyyed Hamid Pakzad Moghadam ◽  
Masoud Pourparizi ◽  
Reza Goujani ◽  
Tayyebeh Mirzaei Khalilabadi ◽  
Ali Ravari ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Intravenous Administration ◽  
Normal Saline ◽  
Analgesic Effect ◽  
Pain Control ◽  
Opioid Analgesic ◽  
Saline Control ◽  
Control Group ◽  
Significant Difference

Abstract Background Pain control after every surgery, especially cesarean is highly important, and physicians are striving to discover pain control methods using the least amount of opioid and Paracetamol is a non-opioid analgesic with few complications. The present study was aimed to investigate the analgesic effect of preoperative intravenous administration of paracetamol on post-cesarean pain.Methods This randomized double-blind clinical trial was conducted on 240 pregnant women under spinal anesthesia who were candidate for elective cesarean. The patients’ weight, height, age and body mass index (BMI) were recorded, and patients were randomly divided into two equal groups (n=120). In the first group, 10 mg/kg paracetamol in 100cc normal saline (paracetamol group) and in the second group 100cc normal saline (control group) administered 15 minutes before surgery intravenously. Blood pressure, pulse rate, chills and nausea were recorded during and 1 hour after surgery, and pain visual analogue scale (VAS) and need for additional analgesic were recorded 1, 2, 4, 6, 12 and 24 hours after surgery.Results No significant difference was found between the two groups in frequency of chills and nausea (p>0.05). Mean pethidine consumed was lower in paracetamol group than control group but not significantly. Systolic blood pressure of both groups during surgery and one hour after surgery did not show a significant difference, but diastolic blood pressure was significantly lower in paracetamol group 15 minutes (p=0.046) and 60 minutes after surgery (p=0.042) than control group. The mean scores of pain were significantly lower in paracetamol group than control group 6 hours (0.008) and 24 hours (p=0.038) after surgery.Conclusions Within the limitations of the current study, preoperative intravenous administration of paracetamol significantly reduced post-cesarean pain within 24 hours.

Effectiveness of Preload Verses Coload of Crystalloid during Spinal Anesthesia for Cesarean Delivery

2021 ◽  
Vol 15 (5) ◽  
pp. 1139-1141
Author(s):  
R. Ansari ◽  
A. Jamil ◽  
H. A. Khan ◽  
N. Zahoor ◽  
Z. Ahmad ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Gestational Age ◽  
Controlled Trial ◽  
Physical Status ◽  
Randomized Controlled ◽  
The Mean

Objective: To compare the effectiveness of preload verses coload of crystalloid during spinal anesthesia for cesarean delivery Study design: Randomized controlled trial Place and Duration of Study: Department of Anaesthesia, Civil Hospital Karachi from 1st November 2017 to 30th April 2018. Methodology: Sixty patients with age in between 18 to 35 years irrespective of parity having ASA physical status I and II and gestational age 37 completed weeks underwent cesarean section under spinal anesthesia were enrolled. Patients were randomized into one of two groups (P or C). A decrease of systolic blood pressure by 20% or more from the baseline value was taken as hypotension. Results: The mean age, weight, height, BMI and gestational age of the patients was 29.5±4.83 years, 60.16±5.17 kg, 1.54±0.60 m, 27.04±5.07 kg/m2 and 38.13±1.07 weeks respectively. Efficacy was significantly higher 25 (83.3%) among patients in preload group as compared to coload group 17 (56.7%) [P=0.024]. Conclusion: Effectiveness of preload was found to be less than coload of crystalloid during spinal anesthesia for cesarean delivery Keywords: Crystalloid, Preload, Coload, Spinal anesthesia, Cesarean delivery

Investigation of the Effect of Operating Room Environment and Cesarean Section Orientation on Physiological Parameters (BP, heart rate, respiration) in Mothers of Candidate for Cesarean Section in Shiraz, a Clinical Trial Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Jamshid Eslami ◽  
Neda Hatami ◽  
Aazadeh Amiri ◽  
Marzieh Akbarzadeh
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Heart Rate ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Operating Room ◽  
Intervention Group ◽  
Physiological Parameters ◽  
Control Group ◽  
The Mean

Background: : Changes in physiological parameters in pregnant women are important factors in mothers who are candidates for cesarean section. Objective:: The aim of present study was to investigate the effect of operating room and cesarean section orientation on the physiological parameters (BP, heart rate, respiration) of pregnant women undergoing cesarean section. Materials and Methods:: This clinical trial study was performed on 80 pregnant women referring to cesarean section in hospitals affiliated to Shiraz University of Medical Sciences in 2019. The samples were randomly divided into two control (n = 40) and intervention groups (n = 40). The intervention group participated in 4 sessions of training classes. The control group used routine hospital trainings. The parameters were measured before and after the intervention in two groups. Data were analyzed using SPSS software (version 21), independent t-test and analysis of covariance. Results: The mean of post-training blood pressure in the intervention group 82.78(7.86) and in the control group 84.08 (7.44) was not statistically significant (p < .487). After intervention, the mean of heart rate in the intervention group 82.15 (8.10) and in the control group 83.43 (8.54) was statistically significant (p <0.0001). After intervention, the mean of respiratory rate in the intervention group was 94.28 (0.96) and in the control group was 75.96 (1.08) (P <0.0001). Conclusions: Although the patient's operating room and cesarean section orientation did not affect mothers' mean blood pressure; it reduced the mean of their heart rate and respiratory rate. It is important for medical staff to play an important role in identifying important strategies in managing the anxiety of pregnant women in order to improve their physiological indicators.

scholarly journals Norepinephrine Versus Phenylephrine Infusion for Preventing Postspinal Hypotension During Cesarean Section for Twin Pregnancy: A Double-Blinded Randomized Controlled Clinical Trial

2021 ◽  
Author(s):  
Zijun Chen ◽  
Jieshu Zhou ◽  
Li Wan ◽  
Han Huang
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Heart Rate ◽  
Cardiac Output ◽  
Cesarean Section ◽  
Area Under The Curve ◽  
Neonatal Outcomes ◽  
The Mean ◽  
Phenylephrine Infusion ◽  
Double Blinded

Abstract BackgroundCompared with singleton pregnancy, twin gestation is featured by a greater increase in cardiac output. Therefore, norepinephrine might be more suitable than phenylephrine for maintaining blood pressure during cesarean section for twins, as phenylephrine causes reflex bradycardia and resultant a decrease in cardiac output. This study was to determine whether norepinephrine was superior to phenylephrine in maintaining maternal hemodynamics during cesarean section for twins.MethodsInformed consent was obtained from all the patients before enrollment. In this double-blinded, randomized clinical trial, 100 parturients with twin gestation undergoing cesarean section with spinal anesthesia were randomized to receive prophylactic norepinephrine (3.2 μg/min) or phenylephrine infusion (40 μg/min). The primary outcome was the change of heart rate and blood pressure during the study period. The secondary outcomes were to compare maternal complications, neonatal outcomes, Apgar scores and umbilical blood acid-base status between the two vasopressors.Results: There was no significant difference was observed for the change of heart rate between two vasopressors. The mean standardized area under the curve of heart rate was 78 ± 12 with norepinephrine vs. 74 ± 11 beats/min with phenylephrine (mean difference 4.4, 95%CI -0.1 to 9.0; P =.0567). The mean standardized area under the curve of systolic blood pressure (SBP) was significantly lower in parturients with norepinephrine, as the mean of differences in standardized AUC of SBP is 6 mmHg, with a 95% CI from 2 to 9 mmHg (P = .0013). However, requirements of physician interventions for correcting maternal hemodynamical abnormalities (temporary cessation of vasopressor infusion for reactive hypertension, rescuing vasopressor bolus for hypotension and atropine for heart rate less < 50 beats/min) and neonatal outcomes were also not significantly different between two vasopressors.Conclusion: Infusion of norepinephrine was not associated with less decrease in heart rate during cesarean section for twins, compared with phenylephrine. Clinical trial number: Chinese Clinical Trial Registry (ChiCTR1900021281) Clinical trial registry URL: http://www.chictr.org.cn/showproj.aspx?proj=35234

scholarly journals Efficacy and safety of intrathecal morphine for post cesarean section analgesia

2015 ◽  
Vol 1 (1) ◽  
pp. 13-17
Author(s):  
Rupesh Kumar Gami ◽  
Kumar Jahan ◽  
Chandra Bhushan Jha
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Visual Analog Scale ◽  
Intrathecal Morphine ◽  
Safe Motherhood ◽  
Control Group ◽  
Efficacy And Safety ◽  
Analog Scale ◽  
Morphine Group ◽  
Significant Difference

Background: Government of Nepal has been conducting Cesarean section under “Safe Motherhood” program all over country. The purpose of this study was to evaluate the efficacy and safety of intrathecal morphine for post cesarean analgesia under spinal anesthesia.  Methods: A total of 300 parturients posted for Cesarean section under spinal anesthesia were divided into two groups of 150 each in this prospective randomized case-control study. Morphine group received 0.15 mg of intrathecal morphine mixed in 12 mg of 0.5% bupivacaine heavy while control group received 12 mg of 0.5% bupivacaine heavy alone, after proper preparation of spinal anesthesia. The parturients were assessed for first request of analgesic as per Visual Analog Scale, frequency of analgesics required within 24 hr, nausea, vomiting, pruritus, sedation and respiratory depression.Results: Postoperative analgesia was significantly greater in morphine group as compare to control group (12.1 ± 7.6 vs 3.7 ± 2.9 hr). Frequency of analgesics requirements was also significantly lower in morphine group (1.7 ± 2.0 vs 3.4 ± 8.1). Visual Analog Scale was below 4 at most of time in morphine group. The incidence of nausea, vomiting and pruritus were more in morphine group as compare to control group but without any respiratory depression. There was no significant difference in APGAR score among fetus.  Conclusion: Mixing low dose of intrathecal morphine in standard dose of spinal anesthesia effectively prolongs the duration of post cesarean analgesia and decreases the frequency of analgesics requirement without any major complication in parturients or fetus.Journal of Society of Anesthesiologists 2014 1(1): 13-17

Compare the effect of aromatherapy using lavender and Damask rose essential oils on the level of anxiety and severity of pain following C-section: A double-blinded randomized clinical trial

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Ali Abbasijahromi ◽  
Hamed Hojati ◽  
Saeid Nikooei ◽  
Hossein Kargar Jahromi ◽  
Hamid Reza Dowlatkhah ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Essential Oil ◽  
Essential Oils ◽  
Randomized Clinical Trial ◽  
Control Group ◽  
Content Type ◽  
Gate Control Theory ◽  
Significant Difference ◽  
The Mean ◽  
Damask Rose

AbstractBackgroundAnxiety is the most common psychological reaction in women during labor. Similar to numerous other surgeries, postoperative pain is also reported following cesarean section (C-section). According to the (Gate) Control Theory, there is a relationship between pain and psychological problems such as anxiety. Accordingly, the present study aimed to compare the effect of aromatherapy using lavender and Damask rose essential oils on the level of anxiety and severity of pain following C-section.MethodsThis triple-group randomized clinical trial was performed on 90 mothers who visited Motahari Hospital of Jahrom, Iran, for C-section in 2017. The incidence and severity of pain and anxiety were measured and recorded for all three groups prior to intervention. The intervention groups underwent aromatherapy with lavender and Damask rose essential oils. Patients were asked to inhale cotton balls, separately stained with three drops of each essential oil at a distance of 10 cm for 30 mins. The severity of pain and anxiety was measured using the visual analogue scale (VAS) and the Spielberger State-Trait Anxiety Inventory (STAI) 5 min after the specified process, respectively. The control group underwent aromatherapy in a similar fashion with normal saline. Finally, data were analyzed using descriptive statistical indices and ANOVA and Kruskal–Wallis tests in SPSS 21.ResultsThere was no significant difference between the three groups in the mean severity of pain and anxiety before the intervention (p>0.05). The mean severity of pain and overt anxiety in the lavender and Damask rose aromatherapy groups was significantly different than the control group after the intervention (p<0.001). In addition, no significant difference was observed between the overt and overall anxiety levels of the two intervention groups after the intervention (p>0.05).ConclusionsThe findings suggested that inhalation aromatherapy can reduce the severity of overt anxiety and pain after C-section, with Damask rose essential oil showing a larger effect than lavender.

scholarly journals Investigation of the effect of the virtual reality application on experimental pain severity in healthy

2019 ◽  
Vol 65 (3) ◽  
pp. 446-451
Author(s):  
Dilek Karaman ◽  
Funda Erol ◽  
Dilek Yılmaz ◽  
Yurdanur Dikmen
Keyword(s):  
Blood Pressure ◽  
Virtual Reality ◽  
Control Group ◽  
Control Groups ◽  
Adult Type ◽  
Significant Difference ◽  
The Mean ◽  
And Control ◽  
Experimental Group ◽  
Virtual Reality Application

SUMMARY OBJECTIVE: This study aimed to investigate the effect of virtual reality application on experimental ischemic pain created with a blood pressure instrument in healthy volunteers. METHODS: The research sample consisted of 172 volunteer adult students who conformed to the inclusion criteria. These individuals were assigned into an experimental (n=86) and a control group (n=86) by a simple randomization method. All individuals in the experimental and control groups wereexperimentally subjected to pain for two minutes by applying 260 mmHg of pressure 3-4 cm above the antecubital region of the left arm with an aneroid adult-type blood pressure instrument. During the procedure, the volunteers in the experimental group watched virtual reality images, while those in the control group received no intervention. Immediately after the procedure, the pain levels of the individuals in both groups were assessed with a Visual Analog Scale (VAS). RESULTS: We found that the mean pain score of the individuals in the experimental group was 2.62±1.82, and that of individuals in the control group was 5.75±1.65. Results of the statistical analysis showed a statistically significant difference between the mean pain scores of the individuals in the experimental and control groups (p<0.001). CONCLUSION: This study found that the use of virtual reality was effective in reducing the level of pain in healthy individuals. This method used a smartphone with widespread availability and ease of transportation, which can be used by health professionals as a non-pharmacological method in the management of pain.

scholarly journals Post Dural Puncture Headache in Fibromyalgia after Cesarean Section: A Comparative Cohort Study

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E871-E876
Author(s):  
Khalid M. Morsy
Keyword(s):  
Chronic Pain ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Dural Puncture ◽  
Control Group ◽  
Elective Cesarean Delivery ◽  
Post Dural Puncture Headache ◽  
Elective Cesarean ◽  
Control Study

Background: Patients of chronic pain syndromes like fibromyalgia (FMS) when subjected to spinal anesthesia are theoretically more liable to post dural puncture headache (PDPH) as they have enhanced central nervous system sensitization and decreased descending inhibition. Objective: The current study aims to verify the incidence and chronicity of PDPH in FMS patients. Study Design: Case control study. Methods: In a comparative control study, 70 fibromyalgia patients were scheduled for an elective cesarean delivery fibromyalgia group or Group 1. Group 2 included 70 women scheduled for elective cesarean delivery who had no history of chronic pain and is used as a control group. Both groups were compared regarding the incidence of development of PDPH in the first postoperative 48 hours and the persistence of PDPH for 7 days or more. Settings: Women’s Health Hospital, Assiut University, antenatal Clinic. Results: The fibromyalgia group reported more PDPH (18 patients, 25.7%) as compared to the control group (10 patients, 14.3%), P < 0.01. PDPH persisted for 7 or more days in 8 patients in the fibromyalgia group (11.4%) while, it persisted in 2.86% of the control patients. PDPH continued for more than 3 months in 2 patients in the fibromyalgia group (2.86%) Limitations: Difficulty in calculating the dose of analgesics as patients with fibromyalgia may use other analgesics due to musculoskeletal pain. Conclusion: Dural puncture increases the incidence of PDPH in fibromyalgia patients in comparison with normal controls without increasing other postoperative side effects. Key Words: Fibromyalgia, cesarean section, post dural puncture headache, spinal anesthesia

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