Department of Obstetrics and Gynecology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
Breastfeed Med. 2023 Feb;18(2):132-137. doi: 10.1089/bfm.2022.0208.
To compare the effect of different analgesic regimens on the time to initiate breastfeeding (BF) and ambulation after cesarean section (CS). This prospective, double-blinded, placebo-controlled randomized study included 300 women (20-40 years of age) of the American Society of Anesthesiologists status 1 or 2 with singleton term pregnancies scheduled for CS under spinal anesthesia. Women were allocated to three groups of 100 each by computer-generated randomization. As an adjunct to 1,000 mg intravenous acetaminophen, Group 1 received 100 mg rectal diclofenac, Group 2 received 100 mg rectal tramadol, and Group 3 received rectal glycerin suppository. The time to initiate BF and ambulation was compared between different analgesic regimens and corelated with pain score. BF (both with and without support) was initiated significantly earlier in Groups 1 and 2 as compared with control Group 3 ( < 0.001). A significantly shorter time was taken to initiate BF without support in Group 1 as compared with Group 2 ( = 0.028). The time to start ambulation (both with and without assistance) was significantly lower in Groups 1 and 2 as compared with Group 3 and in Group 1 versus Group 2 ( < 0.001). A significant positive correlation was found between the time to initiate BF with support and ambulation without assistance and postoperative pain score at 0, 1, and 6 hours. Effective post-CS analgesia affects early initiation of BF and ambulation in the immediate postnatal period. The inclusion of rectal diclofenac suppository in post-CS analgesic regimens is a promising approach to postoperative delivery care.
比较不同镇痛方案对剖宫产术后开始母乳喂养（BF）和活动的时间的影响。这项前瞻性、双盲、安慰剂对照随机研究纳入了 300 名（年龄 20-40 岁）ASA 分级 1 或 2 级、单胎足月妊娠的妇女，她们将接受椎管内麻醉下的剖宫产。通过计算机生成的随机数将妇女分为三组，每组 100 人。作为 1000mg 静脉注射对乙酰氨基酚的辅助治疗，第 1 组给予 100mg 直肠双氯芬酸钠，第 2 组给予 100mg 直肠曲马多，第 3 组给予直肠甘油栓剂。比较不同镇痛方案的开始 BF 和活动的时间，并与疼痛评分相关。与对照组第 3 组相比，第 1 组和第 2 组开始 BF（有或无支持）的时间明显更早（<0.001）。与第 2 组相比，第 1 组无需支持开始 BF 的时间明显更短（=0.028）。与第 3 组相比，第 1 组和第 2 组开始活动（有或无帮助）的时间明显更短，第 1 组与第 2 组相比时间也更短（<0.001）。在 0、1 和 6 小时时，与支持下开始 BF 和无需帮助下开始活动的时间与术后疼痛评分之间存在显著正相关。有效的剖宫产术后镇痛会影响产后即刻开始 BF 和活动。在剖宫产术后镇痛方案中加入直肠双氯芬酸钠栓剂是一种有前途的术后分娩护理方法。
