Meixnerová I, Huser M, Seidlová D, Janků P, Štourač P, Gál R
Ceska Gynekol. 2018 Winter;83(3):182-187.
Comparison of incisional and epidural analgesia in the treatment of postoperative pain after cesarean sectio.
Prospective cohort study in the period from 2015 to 2016.
Department of Obstetric and Gynecology, Masaryk University, University Hospital Brno.
The group included 72 patients in the 38th-41st. week of pregnancy. They were divided at the time of indication to the cesarean section (SC) into two groups according to the selected type of analgesia (epidural/incisional). Women with epidural analgesia (EA) received bupivacaine and sufentanil after surgery in the epidural catheter. A second group was patients during general anesthesia SC introduced into the surgical wound IA Painfusor which was continuously administered bupivacaine. The intensity of the patients pain was evaluated on the visual analogue scale (VAS). If the VAS exceeded 4, the dose of the opioid analgesic piritramide (additional dose of DDA analgesic) was administered intravenously. The intensity of pain and the number of DDAs required were evaluated 24 hours after SC. Satisfaction with pain relief, sleep quality, and patient side effects were assessed using a questionnaire.
Patients in the EA group (n = 36) evaluated postoperative pain (PB) value of 4.4 ± 1.8 according to VAS, women in group IA (n = 36) reported a PB according to VAS of 4.4 ± 1.3 (p = 0.972). The difference in the number of applied DDA was not statistically significant compared groups (2.3 ± 0.9 EA vs. 2.4 ± 0.9 IA, p = 0.301). By comparing the other parameters evaluated by the questionnaire statistically significant more vertigo cases were found in women with IA (22.2% EA vs. 72.2% IA, p < 0.001). In the other evaluated parameters the differences between the two methods were not statistically significant.
Epidural and incisional analgesia are comparable methods in the effectiveness of pain management during the first day of the cesarean section. Except for vertigo, both methods were also comparable in terms of the occurrence of undesirable effects.
比较剖宫产术后切口镇痛和硬膜外镇痛的效果。
2015年至2016年的前瞻性队列研究。
布尔诺大学医院马萨里克大学妇产科。
该组包括72例妊娠38 - 41周的患者。在剖宫产指征确定时，根据所选镇痛类型（硬膜外/切口）将她们分为两组。硬膜外镇痛（EA）组的女性在术后通过硬膜外导管接受布比卡因和舒芬太尼。第二组是在全身麻醉下行剖宫产手术的患者，将IA Painfusor置入手术切口，持续输注布比卡因。采用视觉模拟量表（VAS）评估患者的疼痛强度。如果VAS评分超过4分，则静脉注射阿片类镇痛药匹米诺定（额外剂量的DDA镇痛药）。在剖宫产术后24小时评估疼痛强度和所需DDA的数量。使用问卷评估患者对疼痛缓解的满意度、睡眠质量和副作用。
EA组（n = 36）患者根据VAS评估的术后疼痛（PB）值为4.4±1.8，IA组（n = 36）女性根据VAS报告的PB值为4.4±1.3（p = 0.972）。与其他组相比，应用DDA数量的差异无统计学意义（EA组为2.3±0.9，IA组为2.4±0.9，p = 0.301）。通过比较问卷评估的其他参数，发现IA组女性眩晕病例在统计学上显著更多（EA组为22.2%，IA组为72.2%，p < 0.001）。在其他评估参数中，两种方法之间的差异无统计学意义。
在剖宫产术后第一天的疼痛管理效果方面，硬膜外镇痛和切口镇痛是可比的方法。除眩晕外，两种方法在不良反应的发生方面也具有可比性。
