Espinós Ramírez Carles, Roca Amatria Gisela, Castellví Obiols Pere, Martínez-Rodríguez David, Raynard Mireia, Viscasillas Draper Blanca, Masgoret Paula, Rodríguez Cosmen Cristina, Subirana Giménez Laura, Martinez García Maria, Mestres Gerard, Melo Martha, Nebot Galindo Alèxia, Montero Gaig Natàlia, Sánchez-Migallón Virginia, Valencia Royo David, Pacheco Comino Nuria Lara, Bermejo Perez Inés, Santos Farré Cristina, Toll Salillas Lluís, Alonso Gelabert Arnau, Homs Marta, Ribas Patricia, Teixell Claudia, Plaza Moral Ana María, Tena Bea, Fernández Castiñeira Adrián, Armengol Gay Mireia, Fort Pelai Beatriz, García Bartoló Carolina, Mestre Iniesta Carolina, Peig Font Anna, Esteller Paula Gil, Clave Jean Louis, Gasca Pera Sandra, Batalla Astrid, Vargas Raidi Verónica
Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain.
Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC Barcelona), 08017 Sant Cugat del Vallès, Spain.
J Clin Med. 2025 Jun 30;14(13):4638. doi: 10.3390/jcm14134638.
Caesarean section is considered one of the surgeries with the highest prevalence of postoperative pain, yet this is often underestimated and undertreated. This study was aimed at evaluating the prevalence and severity of postoperative pain, assessing which analgesic strategy is the most effective and identifying those risk factors associated with poorer analgesic results. A multi-centre observational study was conducted on 514 women undergoing elective caesarean section. The primary endpoints included postoperative pain severity at rest and with movement at 6 and 24 h. The combination of intrathecal morphine and fentanyl with acetaminophen and Non Steroid Anti-inflammatory Drugs (NSAIDs) was associated with better pain control than any of the following treatments: intrathecal fentanyl with systemic acetaminophen and NSAIDs (2.49 ± 2.04 vs. 3.91 ± 2.75, ES = -0.610, = 0.01), elastomeric pump at 6 h at rest (2.49 ± 2.04 vs. 4.10 ± 2.86, ES -0.733, = 0.04) and with movement (4.44 ± 2.41 vs. 6.14 ± 3.08, ES -0.671, = 0.01) or epidural analgesia (4.44 ± 2.41 vs. 5.65 ± 2.57, ES -0.496, = 0.02). No risk factors predicting poorer postoperative analgesia were found. The prevalence of postoperative pain control after elective caesarean section is high. The best analgesic postoperative regimen includes intrathecal morphine together with fentanyl and systemic analgesics. No risk factors associated with poorer outcomes were found.
剖宫产被认为是术后疼痛发生率最高的手术之一，但这种疼痛常常被低估且治疗不足。本研究旨在评估术后疼痛的发生率和严重程度，评估哪种镇痛策略最有效，并确定与镇痛效果较差相关的危险因素。对514例行择期剖宫产的女性进行了一项多中心观察性研究。主要终点包括术后6小时和24小时静息及活动时的疼痛严重程度。鞘内注射吗啡和芬太尼联合对乙酰氨基酚及非甾体抗炎药（NSAIDs）的镇痛效果优于以下任何一种治疗方法：鞘内注射芬太尼联合全身使用对乙酰氨基酚及NSAIDs（2.49±2.04 vs. 3.91±2.75，效应量=-0.610，P=0.01）、6小时静息时使用弹性泵（2.49±2.04 vs. 4.10±2.86，效应量=-0.733，P=0.04）及活动时使用（4.44±2.41 vs. 6.14±3.08，效应量=-0.671，P=0.01）或硬膜外镇痛（4.44±2.41 vs. 5.65±2.57，效应量=-0.496，P=0.02）。未发现预测术后镇痛效果较差的危险因素。择期剖宫产后疼痛控制的发生率较高。最佳的术后镇痛方案包括鞘内注射吗啡联合芬太尼及全身镇痛药。未发现与较差预后相关的危险因素。
