Abstract
BackgroundAnalgesia after Cesarean delivery (CD) requires early ambulation to prevent thromboembolic disease and to facilitate baby care. We retrospectively reviewed anesthesia charts and medical records of patients who underwent CD to compare the efficacy of spinal anesthesia supplemented with intrathecal morphine hydrochloride (ITM) and combined spinal–epidural anesthesia followed by opioid-free epidural analgesia (CSEA-EDA).FindingsAll subjects underwent CD at Nagaoka Chuo General Hospital between February 2012 and January 2013. Patient characteristics, time to first analgesic rescue after CD, and analgesic use after CD were examined. Incidences of postural hypotension, lower extremity numbness/weakness, postoperative nausea/vomiting (PONV), and pruritus were also examined for 48 h after CD. Average time to first analgesic use after CD (ITM 25.13 ± 16.07 h, CSEA-EDA 22.42 ± 16.27 h, p = 0.521) and cumulative probability of rescue analgesic use (p = 0.139 by log-rank test) were comparable between groups. However, average analgesic use within 24 h was lower in the ITM group (0.75 ± 1.05 times) than in the CSEA-EDA group (1.52 ± 1.72 times, p = 0.0497). Numbness or motor weakness in lower extremities only occurred in the CSEA-EDA group, and pruritus only occurred in the ITM group.ConclusionsThe results of this study suggest that ITM is better than CSEA-EDA for anesthesia following CD with regard to pain control. Also, ITM would be advantageous for early ambulation following CD because of lower incidence of numbness and motor weakness in lower extremities compared to CSEA-EDA.
Highlights
Analgesia after Cesarean delivery (CD) requires early ambulation to prevent thromboembolic disease and to facilitate baby care
The results of this study suggest that intrathecal morphine hydrochloride (ITM) is better than Combined spinal–epidural anesthesia (CSEA)-epidural analgesia (EDA) for anesthesia following CD with regard to pain control
ITM would be advantageous for early ambulation following CD because of lower incidence of numbness and motor weakness in lower extremities compared to CSEA-EDA
Summary
Study subjects This retrospective cohort study was performed at Nagaoka Chuo General Hospital. The study was reviewed and approved by the Nagaoka Chuo General Hospital institutional review board. Patients that underwent spinal anesthesia without ITM or general anesthesia for CD were excluded from analyses. ITM group received 0.5 % hyperbaric bupivacaine (8.5–12 mg) supplemented with 100 μg of intrathecal preservative-free morphine hydrochloride. The CSEAEDA group had an epidural catheter inserted at the T11/ 12, T12/L1, or L1/2 intervertebral space using standard procedures. After test dose administration (3 mL bolus of 1 % mepivacaine), 0.5 % hyperbaric bupivacaine (3.5– 9.0 mg) was administered into the intrathecal space. After surgery, 0.2 % ropivacaine was administered through the epidural catheter (4 mL/h) using a disposable infuser (Coopdeck Baloonjector 300 with PCA apparatus, Daiken Medical, Osaka, Japan). The CSEA-EDA group had anesthesia administered by one physician (KS), and the ITM group had anesthesia administered by two physicians (HS or TF)
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