Enten Garrett, Shenouda Mina A, Samuels David, Fowler Naomi, Balouch Maha, Camporesi Enrico
Research, Tampa General Hospital, Tampa, USA.
Anesthesia, Tampa General Hospital, Tampa, USA.
Cureus. 2019 Sep 22;11(9):e5725. doi: 10.7759/cureus.5725.
Introduction While uncommon for cesarean delivery, general anesthesia may be patient requested or necessary due to maternal contraindication. Traditionally, opioids are used as a part of the general anesthetic. Because of their associated complications, it is standard to limit opioid use and fetal narcotic exposure during cesarean delivery. We conducted a retrospective study to evaluate the feasibility of multi-modal opioid-free general anesthesia for cesarean delivery. Methods Electronic medical records were obtained for patients receiving general anesthesia for cesarean delivery of live pregnancies through 2017 at our tertiary care facility. Post-operative pain was estimated using a 10-cm visual analogue scale and by calculating postoperative narcotic requirements in milligram morphine equivalents (MME) over three-time periods: during post-anesthesia recovery in the post-anesthesia care unit (PACU), the first 24 hrs after PACU discharge, and 24-48 hrs after PACU discharge. Apgar scores were also obtained to quantify neonatal effects of the general anesthetic. Results Eight of 17 patients (47.06%) received opioid-free anesthesia (OFA), and nine of 17 patients (52.94%) received anesthesia with opioids (OA). No significant difference was found between groups in terms of postoperative mean Visual Analog Scale (VAS) pain score over each time period. Similarly, no significant difference was found between groups in terms of postoperative narcotics requirement at all study points. Apgar scores were not significantly different between the two groups. Conclusion The OFA group displayed equivalent analgesia to the OA group in terms of self-reported VAS pain scores and postoperative MME. A larger prospective study is recommended to fully evaluate OFA for cesarean delivery.
引言 虽然剖宫产很少使用全身麻醉，但由于产妇的禁忌症，患者可能会要求或需要进行全身麻醉。传统上，阿片类药物被用作全身麻醉的一部分。由于其相关并发症，在剖宫产期间限制阿片类药物的使用和胎儿的麻醉暴露是标准做法。我们进行了一项回顾性研究，以评估剖宫产多模式无阿片类药物全身麻醉的可行性。方法 通过我们的三级医疗保健机构获取了2017年接受全身麻醉进行活产剖宫产的患者的电子病历。使用10厘米视觉模拟量表评估术后疼痛，并通过计算三个时间段内以毫克吗啡当量（MME）表示的术后麻醉需求：在麻醉后护理单元（PACU）的麻醉后恢复期间、PACU出院后的头24小时以及PACU出院后的24 - 48小时。还获得了阿氏评分以量化全身麻醉对新生儿的影响。结果 17例患者中有8例（47.06%）接受了无阿片类药物麻醉（OFA），17例患者中有9例（52.94%）接受了含阿片类药物麻醉（OA）。在每个时间段的术后平均视觉模拟量表（VAS）疼痛评分方面，两组之间未发现显著差异。同样，在所有研究点的术后麻醉需求方面，两组之间也未发现显著差异。两组之间的阿氏评分无显著差异。结论 在自我报告的VAS疼痛评分和术后MME方面，OFA组与OA组显示出等效的镇痛效果。建议进行更大规模的前瞻性研究以全面评估剖宫产的OFA。
