Effect of Anesthesia Techniques on Pain Severity, Hemodynamic Changes, and Patients’ Satisfaction in Elective Cesarean Section
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.
2. Yeoh SB, Leong SB, Heng AST. Anaesthesia for lower-segment caesarean section: Changing perspectives. Indian J Anaesth 2010;54:409-14.
3. Niino Y. The increasing cesarean rate globally and what we can do about it. Biosci Trends 2011;5:139-50.
4. Chestnut DH, Wong CA, Tsen LC, Kee WDN, Beilin Y, Mhyre J. Chestnut's obstetric anesthesia: principles and practice: Elsevier Health Sciences; 2014.
5. Kee WN. Confidential enquiries into maternal deaths: 50 years of closing the loop. Br J Anaesth 2005;94:413-6.
6. Emmett R, Cyna A, Andrew M, Simmons S. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. The Cochrane Library. 2002.
7. Wong C. General anesthesia is unacceptable for elective cesarean section. Int J Obstet Anesth 2010;19:209-12.
8. Abdollahpour A, Azadi R, Bandari R, Mirmohammadkhani M. Effects of adding midazolam and sufentanil to intrathecal bupivacaine on analgesia quality and postoperative complications in elective cesarean section. Anesth Pain Med 2015;5: e23565.
9. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric Anesthesia Workforce SurveyTwenty-year Update. Anesthesiology 2005;103:645-53.
10. Gori F, Pasqualucci A, Corradetti F, Milli M, Peduto V. Maternal and neonatal outcome after cesarean section: the impact of anesthesia. J Matern Fetal Neonatal Med 2007;20:53-7.
11. Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. Int J Obstet Anesth 2008;17:329-35.
12. Fathi M, Imani F, Joudi M, Goodarzi V. Comparison between the effects of ringers lactate and hydroxyethyl starch on hemodynamic parameters after spinal anesthesia: A Randomized clinical trial. Anesth Pain Med 2013;2:127-33.
13. Alimian M, Mohseni M, Safaeian R, Faiz SHR, Majedi MA. Comparison of hydroxyethyl starch 6% and crystalloids for preloading in elective caesarean section under spinal anesthesia. Med Arch 2014;68:279-81.
14. Nesek Adam V, Rasic Z, Schwarz D, Grizelj-Stojcic E, Rasic D, Krstonijevic Z, et al. The effect of spinal versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing peripheral vascular surgery. Coll Antropol 2012;36:1301-5.
15. Sharaf A, Burki AM, Mahboob S, Bano R. Comparison of postoperative pain relief following use of spinal anesthesia versus general anesthesia for patients undergoing laparoscopic cholecystectomy. Anaesthesia, Pain & Intensive Care 2018;22.
16. Naghibi K, Saryazdi H, Kashefi P, Rohani F. The comparison of spinal anesthesia with general anesthesia on the postoperative pain scores and analgesic requirements after elective lower abdominal surgery: A randomized, double-blinded study. J Res Med Sci 2013;18:543-8.
17. Richardson MG. Regional anesthesia for obstetrics. Anesthesiol Clin North Am 2000;18:383-406.
18. Mattingly JE, D’Alessio J, Ramanathan J. Effects of obstetric analgesics and anesthetics on the neonate. Pediatric Drugs 2003;5:615-27.
19. Littleford J. Effects on the fetus and newborn of maternal analgesia and anesthesia: a review. Can J Anaesth 2004;51:586-609.
20. Kavak ZN, Başgül A, Ceyhan N. Short-term outcome of newborn infants: spinal versus general anesthesia for elective cesarean section: A prospective randomized study. Eur J Obstet Gynecol Reprod Biol 2001;100:50-4.
21. Ghazi A, Raja Y. Combined low-dose spinal-epidural anaesthesia versus single-shot spinal anaesthesia for elective caesarean delivery. Int J Obstet Anesth 2007;16:90-1.
22. Cyna, A. M, Andrew, M, Emmett, R. S, Middleton, P, Simmons, S. W. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006; 18: CD002251.
23. RD. M. Miller's anesthesia. Philadelphia: Elsevier, 2015.
24. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain),
numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis Care Res 2011;63: 240-52.
25. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Obstetrícia de Williams. Brasil: McGraw Hill, 2016.
26. Qarekhani P, Sadatian A. Principals of obstetrics & gynecology. Tehran: Noore-Danesh. 2009;248.
27. Darvishi E, Mortazavi S, Nedjat S, Holakouie Naieni K. Experiences of women and gynecologists on the choice of delivery method: A qualitative research. J Health Sys Res. 2012;8:59-68.
28. Havas F, Orhan Sungur M, Yenigün Y, Karadeniz M, Kilic M, Özkan Seyhan T. Spinal anesthesia for elective cesarean section is associated with shorter hospital stay compared to general anesthesia. Agri 2013;25:55-63.
29. Hong J-Y, Lim KT. Effect of preemptive epidural analgesia on cytokine response and postoperative pain in laparoscopic radical hysterectomy for cervical cancer. Reg Anesth Pain Med 2008;33:44-51.
30. Herroeder S, Pecher S, Schönherr ME, Kaulitz G, Hahnenkamp K, Friess H, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg 2007;246:192-200.
31. Weis F, Beiras-Fernandez A, Schelling G, Briegel J, Lang P, Hauer D, et al. Stress doses of hydrocortisone in high-risk patients undergoing cardiac surgery: effects on interleukin-6 to interleukin-10 ratio and early outcome. Crit Care Med 2009;37:1685-90.
32. Simsek E, Karapinar K, Bugra O, Ulus AT, Sarigul A. Effects of albumin and synthetic polypeptide-coated oxygenators on IL-1, IL-2, IL-6, and IL-10 in open heart surgery. Asian J Surg 2014;37:93-9.
33. Mosser DM, Zhang X. Interleukin‐10: new perspectives on an old cytokine. Immunol Rev 2008;226:205-18.
34. Sun X, Wang D, Yu H, Hu L. Serial cytokine levels during wound healing in rabbit maxillary sinus mucosa. Acta Otolaryngol 2010;130:607-13.
35. Kim WH, Hur M, Park S-K, Yoo S, Lim T, Yoon HK, et al. Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for caesarean delivery: a network meta-analysis. Int J Obstet Anesth 2019;37:5-15.