Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA.
Int J Obstet Anesth. 2010 Jan;19(1):10-5. doi: 10.1016/j.ijoa.2009.02.012. Epub 2009 Dec 1.
Studies examining the effects of various analgesics and anesthetics on postoperative pain following cesarean delivery conventionally use the scheduled cesarean population. This study compares postoperative analgesic requirements and recovery profiles in women undergoing scheduled cesarean compared to unplanned cesarean delivery following labor. We postulated that unplanned cesarean deliveries may increase postoperative analgesic requirements.
We conducted a retrospective chart review of 200 cesarean deliveries at Lucile Packard Children's Hospital, California. We examined the records of 100 patients who underwent scheduled cesarean delivery under spinal anesthesia (hyperbaric bupivacaine 12 mg with intrathecal fentanyl 10 microg and morphine 200 microg) and 100 patients that following a trail of labor required unplanned cesarean under epidural anesthesia (10-25 mL 2% lidocaine top-up with epidural morphine 4 mg after clamping of the umbilical cord). We recorded pain scores, analgesic consumption, time to first analgesic request, side effects, and length of hospital stay.
We found no differences in postoperative pain scores and analgesic consumption between scheduled and unplanned cesarean deliveries for up to five days postoperatively. There were no differences in treatment of side effects such as nausea, vomiting, or pruritus (P>0.05).
The results indicate that women experience similar pain and analgesic requirements after scheduled compared to unplanned cesarean delivery. This suggests that the non-scheduled cesarean population may be a suitable pain model to study pain management strategies; and that alterations in pain management are not necessary for the unplanned cesarean delivery population.
研究各种镇痛药和麻醉剂对剖宫产术后疼痛影响的传统方法是使用计划剖宫产人群。本研究比较了计划性剖宫产与产程中转为剖宫产的非计划性剖宫产术后的镇痛需求和恢复情况。我们推测，非计划性剖宫产可能会增加术后镇痛需求。
我们对加利福尼亚州 Lucile Packard 儿童医院的 200 例剖宫产进行了回顾性图表审查。我们检查了 100 例接受椎管内麻醉下计划性剖宫产（重比重布比卡因 12mg 加鞘内芬太尼 10μg 和吗啡 200μg）和 100 例在产程中转为需要硬膜外麻醉的非计划性剖宫产（脐带夹闭后硬膜外吗啡 4mg 加 10-25ml2%利多卡因）的患者记录。我们记录了疼痛评分、镇痛消耗、首次镇痛请求时间、副作用和住院时间。
我们发现，在术后 5 天内，计划性和非计划性剖宫产的术后疼痛评分和镇痛消耗没有差异。在处理副作用方面，如恶心、呕吐或瘙痒，也没有差异（P>0.05）。
结果表明，与计划性剖宫产相比，非计划性剖宫产的女性在术后经历类似的疼痛和镇痛需求。这表明，非计划性剖宫产人群可能是研究疼痛管理策略的合适疼痛模型；并且，对于非计划性剖宫产人群，不需要改变疼痛管理。
