Department of Anesthesiology, Uonuma Kikan Hospital, Minami-Uonuma, Niigata 949-7302, Japan.
Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan.
Medicine (Baltimore). 2022 Jul 1;101(26):e29709. doi: 10.1097/MD.0000000000029709.
Intraoperative nausea and vomiting (IONV) is a common symptom during cesarean section (CS) delivery causing significant discomfort to patients. Combined spinal and epidural anesthesia (CSEA) can provide both intraoperative anesthesia and postoperative analgesia. During CSEA, it is reasonable to administer local anesthetics to the epidural space before patient complaints to compensate for the diminished effect of spinal anesthesia. Therefore, we hypothesized that intraoperative epidural administration of 2% mepivacaine would reduce the incidence of IONV.
Patients who were scheduled for elective CS were randomly allocated to 2 groups. Patients and all clinical staff except for an attending anesthesiologist were blinded to the allocation. After the epidural catheter was inserted at the T11-12 or T12-L1 interspace, spinal anesthesia was performed at the L2-3 or L3-4 interspace to intrathecally administer 10 mg of 0.5% hyperbaric bupivacaine. Twenty min after spinal anesthesia, either 5 mL of 2% mepivacaine (group M) or saline (group S) was administered through an epidural catheter. Vasopressors were administered prophylactically to keep both the systolic blood pressure ≥ 80 % of the baseline value with the absolute value ≥ 90 mm Hg and the mean blood pressure ≥ 60 mm Hg. The primary endpoint was the incidence of IONV. The secondary endpoints were degree of nausea, the degree and incidence of pain, and Bromage score.
Ninety patients were randomized, and 3 patients were excluded from the final analysis. There was no significant difference in the incidence of IONV between the groups (58% in group M and 61% in group S, respectively, P = .82). In contrast, the incidence and degree of intraoperative pain in group M were significantly lower compared to group S. In addition, the incidence of rescue epidural administration of fentanyl (18% vs 47%) or mepivacaine (2.3% vs 25%) for intraoperative pain was lower in group M compared to group S.
Our results indicate that epidural administration of 2% mepivacaine 20 minutes after spinal anesthesia does not reduce the incidence of IONV in CS under CSEA. However, intraoperative epidural administration of 2% mepivacaine was found to improve intraoperative pain.
剖宫产术中恶心呕吐（IONV）是一种常见症状，会给患者带来明显不适。脊髓-硬膜外联合麻醉（CSEA）可提供术中麻醉和术后镇痛。在 CSEA 中，在患者出现不适之前向硬膜外腔给予局部麻醉剂以补偿脊髓麻醉效果的减弱是合理的。因此，我们假设术中硬膜外给予 2%甲哌卡因会降低 IONV 的发生率。
择期行剖宫产术的患者被随机分配到 2 组。患者和所有临床工作人员（除一名主治麻醉师外）均对分组情况不知情。在 T11-12 或 T12-L1 间隙插入硬膜外导管后，在 L2-3 或 L3-4 间隙行脊髓麻醉，向蛛网膜下腔给予 10mg 0.5%布比卡因。脊髓麻醉后 20min，通过硬膜外导管给予 5ml 2%甲哌卡因（M 组）或生理盐水（S 组）。预防性给予血管加压药，以保持收缩压≥基础值的 80%，绝对值≥90mmHg，平均血压≥60mmHg。主要终点是 IONV 的发生率。次要终点是恶心程度、疼痛程度和发生率以及 Bromage 评分。
90 名患者被随机分组，3 名患者被排除在最终分析之外。两组 IONV 的发生率无显著差异（M 组 58%，S 组 61%，P=0.82）。相比之下，M 组术中疼痛的发生率和程度明显低于 S 组。此外，M 组术中需要补救性硬膜外给予芬太尼（18% vs 47%）或甲哌卡因（2.3% vs 25%）用于治疗疼痛的发生率也低于 S 组。
我们的结果表明，在 CSEA 下脊髓麻醉后 20min 硬膜外给予 2%甲哌卡因并不能降低剖宫产术中 IONV 的发生率。然而，术中硬膜外给予 2%甲哌卡因可改善术中疼痛。
