Orbach-Zinger Sharon, Ioscovich Alexander, Aviram Amir, Babytz Sergei, Fein Shai, Reuveni Alon, Eidelman Leonid A
Isr Med Assoc J. 2014 Mar;16(3):153-6.
Postoperative pain is a common problem after cesarean deliveries.
To characterize common obstetric anesthesia practices after cesarean deliveries in Israel in order to standardize postoperative pain relief protocols.
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.
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.
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.
剖宫产术后疼痛是常见问题。
描述以色列剖宫产术后常见的产科麻醉操作，以便规范术后疼痛缓解方案。
对以色列所有25个分娩病房的每个产科麻醉单元进行访谈时完成一份调查问卷。收集术中麻醉和镇痛方案以及术后疼痛缓解方案的数据。一项子分析比较了其主任完成正式产科麻醉培训项目的单元与未完成的单元。
12%的医院常规使用鞘内吗啡。没有一个提供鞘内吗啡的单元在使用鞘内阿片类药物后符合美国麻醉医师协会的呼吸监测指南。此外，只有一半的病房常规使用非甾体抗炎药（NSAIDs），而患者自控镇痛很少使用。71%的单元在术后第1天未常规记录术后视觉模拟评分。单元主任的培训对单元方案有显著影响。
鞘内吗啡作为剖宫产护理的金标准很少使用，主要是由于人员短缺和缺乏正式的产科麻醉培训。此外，NSAIDs的使用也不足。以色列需要对产科麻醉医生进行更正规的培训。
