Influence of the method of postoperative analgesia on the dynamics of intra-abdominal pressure in postpartum women with obesity

Abstract

Introduction: It is assumed that one of the factors of high incidence of postoperative complications in postpartum women with obesity is intra-abdominal hypertension (IAH). The aim of the work was to evaluate the dynamics of intra-abdominal pressure (IAP) in postpartum women with obesity, depending on the method of postoperative analgesia. The study involved 136 patients divided into 4 groups: control group - initial BMI of 18.5 to 24.9 kg / m2, II of group - patients with obesity I degree (n = 40); Group III - obesity II degree (n = 35); Group IV - III degree obesity (n = 21). All patients were divided into two subgroups - postoperative analgesia with opioids and epidural analgesia (EA). We investigated the timing of reversal of intestinal motility, passage of gas, nausea severity, dynamics IAP and compliance of the anterior abdominal wall. Postoperative dynamics IAP is associated with motor function of the intestine, which is dependent on the initial level of IAP. Paresis intestine often diagnosed at a rate of more than 95% of IAP percentile - for the control group of patients more than 20 mm Hg for patients with obesity more than 23 mm Hg., recorded before the operation. With the development of paresis bowel IAP dynamics within three postoperative days it was practically absent (Δ IAP = 2,55 ± 1,28 mm Hg). Postoperative EA, compared with the use of narcotic analgesics, significantly reduces IAP during the first postoperative day, which prevented the development of their intestinal paresis (RR 0.47; 95% CI: 0,24-0,83), reduced incidence of postoperative nausea (RR 0.47; 95% CI: 0,18-1,21), allows you to quickly reduce the level of IAP in the subsequent days of the postoperative period (59.7%, compared with the effect of opioids). The method of postoperative analgesia affects the dynamics of IAP. EA is the method of choice for postoperative analgesia in postpartum women with obesity and the initially high level of IAP.