Ida Mitsuru, Enomoto Junko, Yamamoto Yumiko, Onodera Hiroki, Kawaguchi Masahiko
Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
JA Clin Rep. 2018 Sep 10;4(1):66. doi: 10.1186/s40981-018-0206-x.
Evaluating patient satisfaction with anesthesia is critical for improving their experiences. We investigated perioperative anesthetic satisfaction and associated predictive factors in patients receiving cesarean delivery under neuraxial anesthesia (spinal anesthesia only or combined spinal-epidural anesthesia).
This was an institutionally approved retrospective chart review of patients who received cesarean delivery under spinal anesthesia and postoperative evaluation administered by anesthesiologists from January 2009 to December 2013. Multiple pregnancies and patients reporting headache prior to cesarean delivery were excluded. Patients were divided into satisfied and not satisfied groups according to their scores from the 4-point Likert scale. Multivariate analysis was used to identify explanatory factors associated with satisfaction.
Of 813 patients enrolled, 425 (52.2%) were classified as satisfied. Combined spinal-epidural anesthesia (CSEA) (odds ratio, 3.3; 95% confidence interval, 1.08-10.1) was positively associated with satisfaction. Paresthesia during needle insertion (odds ratio, 0.56; 95% confidence interval, 0.42-0.76), lightning pain during neuraxial anesthesia (odds ratio 0.62; 95% confidence interval, 0.39-0.98), failed block (odds ratio 0.28; 95% confidence interval, 0.09-0.87), and intraoperative use of antiemetic (odds ratio 0.71; 95% confidence interval, 0.53-0.94) were negatively associated with satisfaction. In the 792 patients receiving spinal anesthesia only, the same factors except for CSEA were associated with satisfaction.
The addition of epidural to spinal anesthesia for cesarean delivery can increase patient satisfaction, whereas paresthesia during needle insertion, lightning pain, failed block, and the use of intraoperative antiemetic were major obstacles to patient satisfaction.
评估患者对麻醉的满意度对于改善其体验至关重要。我们调查了接受腰麻（仅蛛网膜下腔麻醉或腰麻 - 硬膜外联合麻醉）剖宫产患者的围手术期麻醉满意度及相关预测因素。
这是一项经机构批准的回顾性病历审查，研究对象为2009年1月至2013年12月期间接受蛛网膜下腔麻醉剖宫产且由麻醉医生进行术后评估的患者。排除多胎妊娠以及剖宫产术前报告有头痛的患者。根据4点李克特量表评分将患者分为满意组和不满意组。采用多变量分析来确定与满意度相关的解释因素。
在纳入的813例患者中，425例（52.2%）被归类为满意。腰麻 - 硬膜外联合麻醉（CSEA）（比值比，3.3；95%置信区间，1.08 - 10.1）与满意度呈正相关。穿刺时感觉异常（比值比，0.56；95%置信区间，0.42 - 0.76）、腰麻时闪电样疼痛（比值比0.62；95%置信区间，0.39 - 0.98）、阻滞失败（比值比0.28；95%置信区间，0.09 - 0.87）以及术中使用止吐药（比值比0.71；95%置信区间，0.53 - 0.94）与满意度呈负相关。在仅接受蛛网膜下腔麻醉的792例患者中，除CSEA外，相同因素与满意度相关。
剖宫产腰麻联合硬膜外麻醉可提高患者满意度，而穿刺时感觉异常、闪电样疼痛、阻滞失败以及术中使用止吐药是影响患者满意度的主要障碍。
