martes, 24 de junio de 2014

Anestesia para cesárea/Spinal anaesthesia for C-section

Encuesta nacional sobre control del dolor después de cesárea

National survey of postoperative pain control after cesarean delivery.
Orbach-Zinger S, Ioscovich A, Aviram A, Babytz S, Fein S, Reuveni A, Eidelman LA.
Isr Med Assoc J. 2014 Mar;16(3):153-6.
BACKGROUND:Postoperative pain is a common problem after cesarean deliveries. OBJECTIVES:To characterize common obstetric anesthesia practices after cesarean deliveries in Israel in order to standardize postoperative pain relief protocols.METHODS:A questionnaire was completed during an interview with every obstetric anesthesia unit in all 25 delivery wards in Israel. Data were gathered on intraoperative anesthesia and analgesia protocols as well as postoperative pain relief protocols. A sub-analysis compared units whose director completed a formal obstetric anesthesia training program with those whose directors did not.RESULTS:
Neuraxial morphine was used routinely in 12% of hospitals. No unit providing intrathecal morphine complied with American Society of Anesthesiologists guidelines for respiratory monitoring after use of neuraxial opioids. Additionally, non-steroidal anti-inflammatory drugs (NSAIDs) .were used routinely in only half the wards, while patient-controlled analgesia was used infrequently. Postoperative verbal analog scores were not recorded routinely in 71% of units on postoperative day 1. The unit director's training significantly influenced the unit protocols.CONCLUSIONS:Intrathecal morphine, the gold standard of care in cesarean deliveries, is rarely used, mainly due to shortage of staff and lack of formal obstetric anesthesia training. In addition, NSAIDs are also underused. There is a need for more formal training for obstetric anesthesiologists in Israel.

Adición de fentanil o meperidina intratecales a lidocaína y epinefrina para raquia en cesárea electiva

Addition of intrathecal fentanyl or meperidine to lidocaine and epinephrine for spinal anesthesia in elective cesarean delivery.

Farzi F, Mirmansouri A, Forghanparast K, Heydarzadeh A, Abdollahzadeh M, Jahanyar Moghadam F.

Anesth Pain Med. 2014 Feb 7;4(1):e14081.


BACKGROUND:A common and useful approach to pain management is administration of neuraxial opioids. OBJECTIVES: Whether addition of fentanyl or meperidine to lidocaine and epinephrine for spinal anesthesia in elective cesarean delivery has any effects on duration of postoperative pain. PATIENTS AND METHODS: This was a clinical trial, conducted on 195 pregnant women candidates for elective cesarean section. All patients were in ASA classes I, and II aged 17-45 years, and were randomly allocated to three groups named as meperidine (P), fentanyl (F), and placebo (S). In the three groups (P, F, and S), 25 mg meperidine, 25 µg fentanyl and 0.5 mL saline with lidocaine and epinephrine were injected into the subarachnoid space for spinal anesthesia, respectively. Perioperative complications and Apgar scores were recorded. Duration of analgesia was measured from the end of operation for 24 hours by using VAS. The first VAS≥4 was recorded as the end of the painless period. Characteristics of sensory and motor block were assessed. Statistical analysis was performed with SPSS software. RESULTS: The mean duration of analgesia with meperidine, fentanyl or placebo were 9.46 ± 0.6, 6.27 ± 0.45, 2.06 ± 0.13 hours, respectively (P < 0.0001). There was significant difference between the group P and the other groups. Patients on meperidine had faster, longer and higher sensory block (P < 0.0001) and faster and longer motor block (P < 0.0001). Frequency of sedation in the group F was more than the others (P < 0.026). There was no difference in Apgar scores between the three groups (P < 0.45). CONCLUSIONS: Addition of meperidine or fentanyl to lidocaine and epinephrine solution increases the duration of postoperative analgesia incesarean section. Meperidine is a recommended adjuvant according to longer duration of analgesia and lower complications.

KEYWORDS:Anesthesia, Spinal; Fentanyl; Meperidine; Pain, Postoperative Cesarean Section

Anestesiología y Medicina del Dolor

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