Carvalho Brendan, Cohen Sheila E, Lipman Steven S, Fuller Andrea, Mathusamy Anbu D, Macario Alex
*Department of Anesthesia, Stanford University School of Medicine, Stanford, California; and †Bronx-Lebanon Hospital, Bronx, New York.
Anesth Analg. 2005 Oct;101(4):1182-1187. doi: 10.1213/01.ane.0000167774.36833.99.
When deciding on neuraxial medication (e.g., spinal opioids) for cesarean delivery (CS) under regional anesthesia, anesthesiologists make treatment decisions that "trade off" relieving pain with the potential for increased risk of side effects. No previous studies have examined obstetric patients' anesthesia preferences. Researchers administered 100 written surveys to pregnant women attending our institutions' expectant parent class. We determined patients' preferences for importance of specific intraoperative and postoperative anesthesia outcomes using priority ranking and relative value scales. We also explored patients' fears, concerns, and tolerance regarding CS and analgesics. Eighty-two of 100 surveys were returned and analyzed. Pain during and after CS was the greatest concern followed by vomiting, nausea, cramping, pruritus, and shivering. Ranking and relative value scores were closely correlated (R2 = 0.7). Patients would tolerate a visual analog pain score (0-100 mm) of 56 +/- 22 before exposing their baby to the potential effects of analgesics they receive. In contrast to previous general surgical population surveys that found nausea and vomiting as primary concerns, we found pain during and after CS as parturients' most important concern. Common side effects such as pruritus and shivering caused only moderate concern. This information should be used to guide anesthetic choices, e.g., inclusion of spinal opioids given in adequate doses.
Medical care can be improved by incorporating patients' preferences into medical decision making. We surveyed obstetric patients to determine their preferences regarding potential cesarean delivery anesthesia outcomes. Unlike general surgical patients who rate nausea and vomiting highest, parturients considered pain during and after cesarean delivery the most important concern.
在决定用于区域麻醉下剖宫产（CS）的神经轴用药（如脊髓阿片类药物）时，麻醉医生做出的治疗决策是在缓解疼痛与增加副作用风险之间进行“权衡”。此前尚无研究调查产科患者的麻醉偏好。研究人员对参加我院准父母课程的孕妇进行了100份书面调查。我们使用优先级排序和相对价值量表确定了患者对特定术中及术后麻醉结果重要性的偏好。我们还探讨了患者对剖宫产和镇痛药的恐惧、担忧及耐受性。100份调查问卷中有82份被收回并进行分析。剖宫产期间及术后的疼痛是最主要的担忧，其次是呕吐、恶心、抽筋、瘙痒和寒战。排序得分与相对价值得分密切相关（R2 = 0.7）。在让婴儿暴露于所接受镇痛药的潜在影响之前，患者能够耐受视觉模拟疼痛评分（0 - 100毫米）为56±22。与之前发现恶心和呕吐是主要担忧的普通外科人群调查不同，我们发现剖宫产期间及术后的疼痛是产妇最重要的担忧。常见的副作用如瘙痒和寒战仅引起中等程度的担忧。这些信息应用于指导麻醉选择，例如给予足够剂量的脊髓阿片类药物。
将患者偏好纳入医疗决策可改善医疗护理。我们调查了产科患者以确定他们对潜在剖宫产麻醉结果的偏好。与将恶心和呕吐列为最高担忧的普通外科患者不同，产妇认为剖宫产期间及术后的疼痛是最重要的担忧。
