剖宫产术中疼痛：一项与患者相关的前瞻性观察性研究，评估术中疼痛和静脉用药的发生率及危险因素。

Pain during cesarean delivery: A patient-related prospective observational study assessing the incidence and risk factors for intraoperative pain and intravenous medication administration.

作者信息

Sanchez Jose, Prabhu Rohan, Guglielminotti Jean, Landau Ruth

机构信息

Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA.

出版信息

Anaesth Crit Care Pain Med. 2024 Feb;43(1):101310. doi: 10.1016/j.accpm.2023.101310. Epub 2023 Oct 20.

DOI:10.1016/j.accpm.2023.101310

PMID:37865217

Abstract

INTRODUCTION

The incidence of pain during cesarean delivery (PDCD) remains unclear. Most studies evaluated PDCD using interventions suggesting inadequate analgesia: neuraxial replacement, unplanned intravenous medication (IVM), or conversion to general anesthesia. Few assess self-reported pain. This study evaluates the incidence of and risk factors for self-reported PDCD and IVM administration.

METHODS

Between May and September 2022, English-speaking women undergoing cesarean delivery under neuraxial anesthesia were approached within the first 48 h. Participants answered a 16-question survey about intraoperative anesthesia care. Clinical characteristics were extracted from electronic medical records. The primary outcome was PDCD. Secondary outcomes were analgesic IVM (opioids alone or in combination with ketamine, midazolam, or dexmedetomidine) and conversion to general anesthesia. Risk factors for PDCD and analgesic IVM were identified using multivariable logistic regression models.

RESULTS

Pain was reported by 46/399 (11.5%; 95% CI: 8.6, 15.1) participants. Analgesic IVM was administered to 16 (34.8%) women with PDCD and 45 (12.6%) without. Conversion to general anesthesia occurred in 3 (6.5%) women with and 4 (1.1%) without PDCD. Risk factors associated with PDCD were substance use disorder and intrapartum epidural extension. Risk factors associated with analgesic IVM were PDCD, intrapartum epidural extension when ≥2 epidural top-ups were given for labor analgesia, and longer surgical duration.

DISCUSSION

In our cohort of scheduled and unplanned cesarean deliveries, the incidence of PDCD was 11.5%. A significant proportion of women (15.1%) received analgesic IVM, of which some but not all reported pain, which requires further evaluation to identify triggers for IVM administration and strategies optimizing shared decision-making.

摘要

引言

剖宫产分娩期间疼痛（PDCD）的发生率尚不清楚。大多数研究使用提示镇痛不足的干预措施来评估PDCD：神经轴替代、非计划静脉用药（IVM）或转为全身麻醉。很少有研究评估自我报告的疼痛。本研究评估自我报告的PDCD和IVM给药的发生率及危险因素。

方法

在2022年5月至9月期间，对在神经轴麻醉下接受剖宫产分娩的英语为母语的女性，在术后48小时内进行随访。参与者回答了一份关于术中麻醉护理的16个问题的调查问卷。临床特征从电子病历中提取。主要结局是PDCD。次要结局是镇痛性IVM（单独使用阿片类药物或与氯胺酮、咪达唑仑或右美托咪定联合使用）和转为全身麻醉。使用多变量逻辑回归模型确定PDCD和镇痛性IVM的危险因素。

结果

46/399（11.5%；95%CI：8.6，15.1）名参与者报告有疼痛。16名（34.8%）有PDCD的女性和45名（12.6%）无PDCD的女性接受了镇痛性IVM。3名（6.5%）有PDCD的女性和4名（1.1%）无PDCD的女性转为全身麻醉。与PDCD相关的危险因素是物质使用障碍和产时硬膜外扩展。与镇痛性IVM相关的危险因素是PDCD、在分娩镇痛时给予≥2次硬膜外追加药物时的产时硬膜外扩展以及手术时间较长。