Що потрібно змінити для підвищення ефективності знеболювання після кесаревого розтину? Аналіз результатів опитування анестезіологів Вінницької області

Abstract

Postoperative pain control after cesarean delivery is an important issue for patients and health care providers. The incidence of inadequate рost-cesarean delivery analgesia can be as high as 50%. Pain after caesarean section is often under-treated due to unfounded fears that analgesic drugs or interventions might induce maternal and neonatal side-effects and because the severity of post-caesarean section pain is often underestimated. Purpose - to analyze the compliance of postoperative anesthesia in obstetric hospitals and departments of Vinnytsya and Vinnytsya region with current treatment protocols. Materials and methods. We conducted a multicenter regional survey among 21 medical institutions with the participation of 69 anesthesiologists who provide care to obstetric patients in Vinnytsya and Vinnytsya region. The e-questionnaire included questions about the assessment of pain intensity and choice of analgesic (s) for women who give birth by caesarean section and timing of its conduction. The obtained results reflect the practice of 21/23 (91.3%) obstetric hospitals and departments in the city of Vinnytsya and Vinnytsya region. Data analysis was performed using the statistical package «SPSS 20» (SPSS Inc.) version 21.0.0 for Windows. Results. The results of our study show that the majority (87%) of anesthesiologists in Vinnytsya region evaluate postoperative pain using a description of the intensity of pain by the parturients or the Visual Analog Scale. It was found that among anesthesiologists who provide care to obstetric patients, 81.1% support the principles of multimodal analgesia. The basis of multimodal analgesia is the appointment of acetaminophen and nonsteroidal anti-inflammatory drugs with or without opioids. Conclusions. The prospect of increase the effectiveness of post-caesarean section analgesia is the development and implementation in Vinnytsya and Vinnytsya region of a clear unified strategy for the treatment of postoperative pain. At the same time, it is necessary to implement the concept of preventive analgesia and the planned administration of non-opioid analgesics at fixed intervals (every 6 hours). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: caesarean section, рost-cesarean delivery analgesia, pain assessment, multimodal analgesia.