Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
Int J Obstet Anesth. 2021 Feb;45:56-60. doi: 10.1016/j.ijoa.2020.11.003. Epub 2020 Nov 17.
Cesarean delivery is one of the most common procedures performed worldwide. We conducted this prospective cohort study to evaluate the association between local anesthetic infiltration (LAI) pain prior to spinal anesthesia and pain and morphine consumption within 24 h after cesarean delivery (primary outcomes). A secondary objective was to assess the association between LAI pain and pain at one month postoperatively.
Recruitment of 216 eligible women scheduled for elective cesarean delivery. Local infiltration before spinal anesthesia was performed using a 24-gauge needle and 3 mL 2% plain lidocaine. All subjects received 2.2 mL 0.5% hyperbaric bupivacaine with 200 µg morphine for spinal anesthesia. A 0-10 verbal numerical rating scale was used to assess LAI pain severity, and subsequent pain at 24 h, 1, 3 and 12 months.
We found a moderate correlation between LAI pain intensity and severity of acute pain at rest (rho=0.56, P <0.001) and with movement (rho=0.58, P <0.001) and a weak correlation with morphine consumption (rho=0.17, P=0.01) within 24 h postoperatively. We also found a positive correlation between LAI pain and the severity of persistent wound pain at rest (rho=0.30, P <0.001) and with movement (rho=0.52, P <0.001) at 1 month. The incidence of wound pain at 1, 3 and 12 months postoperatively was 37.1%, 7.0% and 1.4%, respectively.
Pain from LAI prior to spinal anesthesia is significantly associated with subsequent postoperative pain both acutely and at one month in women scheduled for elective cesarean delivery under spinal anesthesia.
剖宫产术是全球最常见的手术之一。我们进行了这项前瞻性队列研究，以评估椎管内麻醉前局部麻醉浸润（LAI）疼痛与剖宫产术后 24 小时内疼痛和吗啡消耗（主要结局）之间的关系。次要目的是评估 LAI 疼痛与术后一个月时疼痛之间的关系。
招募了 216 名计划择期行剖宫产术的合格女性。在椎管内麻醉前使用 24 号针和 3 mL 2%普通利多卡因进行局部浸润。所有患者均接受 2.2 mL 0.5%布比卡因加 200 µg 吗啡行椎管内麻醉。使用 0-10 级视觉模拟评分法评估 LAI 疼痛严重程度，以及术后 24 小时、1 个月、3 个月和 12 个月时的疼痛。
我们发现 LAI 疼痛强度与静息时急性疼痛的严重程度（rho=0.56，P<0.001）和运动时（rho=0.58，P<0.001）之间存在中度相关性，与术后 24 小时内吗啡消耗之间存在弱相关性（rho=0.17，P=0.01）。我们还发现 LAI 疼痛与术后 1 个月时静息时（rho=0.30，P<0.001）和运动时（rho=0.52，P<0.001）持续性伤口疼痛的严重程度之间存在正相关。术后 1、3 和 12 个月时伤口疼痛的发生率分别为 37.1%、7.0%和 1.4%。
椎管内麻醉前的 LAI 疼痛与择期行椎管内麻醉剖宫产术女性术后急性和 1 个月时的疼痛显著相关。
