Department of Anesthesiology, Sainte-Justine Hospital, University of Montréal, and the Departments of Anesthesiology and Pain Medicine and Obstetrics and Gynecology, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal (CEMTL), University of Montreal, Montréal, Québec, Canada.
Obstet Gynecol. 2020 May;135(5):1145-1151. doi: 10.1097/AOG.0000000000003821.
To compare the effect of exteriorized with in situ uterine repair on intraoperative nausea and vomiting during elective cesarean delivery under spinal anesthesia using a phenylephrine infusion.
This study was a randomized double-blinded controlled trial of 180 women undergoing elective cesarean delivery using a standardized anesthetic protocol. Patients were randomized to exteriorization (n=90) or in situ uterine repair (n=90). The spinal anesthetic, phenylephrine infusion, and blood pressure management were all standardized. The primary outcome was postdelivery intraoperative nausea and vomiting using a 4-point scale (0-3). A sample size of 80 patients per group was needed to demonstrate a 50% reduction in intraoperative nausea and vomiting with in situ repair.
From November 2015 through July 2018, 180 patients were enrolled. Incidence of postdelivery intraoperative nausea and vomiting was 39% in the exteriorization group compared with 22% in the in situ group (P=.01). Incidence of hypotension (80% vs 50%; P<.001) and tachycardia (33% vs 17%; P=.02) was significantly higher in the exteriorization group, and more phenylephrine boluses were administered to this group (median 4 boluses [first and third quartiles 1.25-7] vs 2 [0-4]; P<.001). The duration of surgery, blood loss, and postoperative hemoglobin decline were similar between groups.
In situ uterine repair for elective cesarean delivery under spinal anesthesia with a phenylephrine infusion is associated with less postdelivery intraoperative nausea and vomiting.
ClinicalTrials.gov, NCT02587013.
比较在脊髓麻醉下使用苯肾上腺素输注行择期剖宫产时外置与原位子宫修复对术中恶心呕吐的影响。
这是一项采用标准化麻醉方案行择期剖宫产的随机双盲对照试验，共纳入 180 例患者。患者随机分为外置组（n=90）或原位修复组（n=90）。脊髓麻醉、苯肾上腺素输注和血压管理均标准化。主要结局是采用 4 分制（0-3 分）评估产后术中恶心呕吐。每组需要 80 例患者才能证明原位修复可使术中恶心呕吐减少 50%。
2015 年 11 月至 2018 年 7 月，共纳入 180 例患者。外置组产后术中恶心呕吐发生率为 39%，而原位组为 22%（P=.01）。外置组低血压（80% vs 50%；P<.001）和心动过速（33% vs 17%；P=.02）发生率明显更高，且该组给予更多苯肾上腺素推注（中位数 4 次[第 1 四分位数和第 3 四分位数 1.25-7] vs 2 次[0-4]；P<.001）。两组手术时间、失血量和术后血红蛋白下降相似。
在脊髓麻醉下使用苯肾上腺素输注行择期剖宫产时行原位子宫修复与术后术中恶心呕吐发生率降低相关。
ClinicalTrials.gov，NCT02587013。
