Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany.
Minerva Anestesiol. 2011 Nov;77(11):1043-9. Epub 2011 May 20.
The need for a cesarean delivery may interfere negatively with the overall experience of childbirth. Several factors related to anesthesiological management such as postoperative pain and discomfort, nausea and pruritus, and postdural puncture headache (PDPH), may lead to dissatisfaction and have a negative impact on early mobilization and a new mother's ability to care for her newborn baby. Optimal prophylaxis and treatment decrease these complications, increase satisfaction, and prevent chronic pain. This survey determined how prophylaxis and treatment of pain, PDPH, nausea, and pruritus after cesarean section (CS) is managed.
A questionnaire was sent to 709 departments of anesthesiology serving an obstetric unit in Germany. The questionnaire asked about different aspects of pain management, the management of accidental dural puncture (ADP), and treatment of PDPH. Further we asked about therapy and prophylaxis of nausea and pruritus in the peripartal setting.
In all, 360 questionnaires (50.8%) were returned; 346 were complete and analyzed (accounting for 330000 births per year). Paracetamol (77.5%) and piritramide (85.6%) are the most common analgesics used. If epidural catheters were used for anesthesia for CS, 47.7% were used for postoperative pain therapy. However, 92.7% of the departments removed catheters in less than 24 hours after delivery. In case of an ADP most departments (69.9%) repeated puncture, 2.6% placed catheters intrathecally. Median blood volume for an epidural blood patch was 10ml.
Apart from conservative treatment of PDPH, prophylaxis and treatment of pain after cesarean delivery, PDPH, nausea, and pruritus varied widely, indicating the need for the qualitative evaluation of overall management.
剖宫产的需要可能会对分娩的整体体验产生负面影响。一些与麻醉管理相关的因素，如术后疼痛和不适、恶心和瘙痒以及腰穿后头痛（PDPH），可能导致不满，并对早期活动和新妈妈照顾新生儿的能力产生负面影响。最佳的预防和治疗可以减少这些并发症，提高满意度，并预防慢性疼痛。本调查确定了剖宫产术后（CS）疼痛、PDPH、恶心和瘙痒的预防和治疗方法。
向德国为产科单位提供服务的 709 个麻醉科部门发送了一份问卷。问卷询问了疼痛管理的不同方面、意外硬脊膜穿刺（ADP）的管理以及 PDPH 的治疗。此外，我们还询问了围产期恶心和瘙痒的治疗和预防。
共收回 360 份问卷（50.8%）；346 份完整并进行了分析（每年约 33 万例分娩）。扑热息痛（77.5%）和哌替啶（85.6%）是最常用的镇痛药。如果硬膜外导管用于 CS 的麻醉，47.7%用于术后疼痛治疗。然而，92.7%的科室在分娩后不到 24 小时内将导管拔出。如果发生 ADP，大多数科室（69.9%）会重复穿刺，2.6%会将导管置入蛛网膜下腔。硬膜外血贴的中位数血容量为 10ml。
除了 PDPH 的保守治疗外，剖宫产术后疼痛、PDPH、恶心和瘙痒的预防和治疗方法差异很大，这表明需要对整体管理进行定性评估。
