Abstract
PurposeCarboprost may induce adverse reactions when used to treat postpartum hemorrhage. We aimed to explore the effects of intravenous infusion of low-dose remifentanil to prevent such reactions.MethodsWe enrolled parturient patients scheduled for elective cesarean section. Anesthesiologist administered combined spinal epidurals at the L3/4 interspace, with 0.5% hyperbaric bupivacaine subarachnoid space injections (1.5–2.5 ml). We randomly divided parturient patients, administered carboprost during surgery, into the remifentanil group (group R) and the control group (group C). Patients in group R received an intravenous target-controlled infusion of remifentanil (target effect-site concentration, 1.5 ng/ml) simultaneously with a carboprost tromethamine injection (250 µg). Patients in group C received a normal saline infusion with carboprost. We recorded and analyzed the incidence of carboprost-related adverse reactions (vomiting, nausea, chest congestion, flushing, hypertension, tachycardia, cough, and shivering), and assessed patient comfort using a numerical rating scale ([NRS], on which 0 was very uncomfortable and 10 was very comfortable).ResultsAfter applying inclusion and exclusion criteria, we conducted statistical analysis of the data from 70 women. The incidence of vomiting was significantly lower in group R than in group C (14.3 vs. 51.4%, p < 0.01); and the incidence of nausea, chest congestion, facial flushing, and hypertension were significantly lower in group R than in group C (all p < 0.01). Furthermore, the patients’ comfort scores were significantly higher in group R than in group C (8.0 ± 1.8 vs. 3.6 ± 2.1, p < 0.01).ConclusionOur results demonstrate that an intravenous low-dose remifentanil infusion can effectively prevent carboprost-related adverse reactions during cesarean delivery under combined spinal and epidural anesthesia.Clinical Trial RegistrationWe pre-registered this study at http://www.chictr.org.cn/showproj.aspx?proj=27707 (ChiCTR1800016292).
Highlights
Postpartum hemorrhage accounts for almost 20% of maternal mortality cases worldwide (Ducloy-Bouthors et al, 2014; Lockhart, 2015; Henriquez et al, 2018)
Our results demonstrate that an intravenous low-dose remifentanil infusion can effectively prevent carboprost-related adverse reactions during cesarean delivery under combined spinal and epidural anesthesia
The mean mean arterial pressure (MAP) was significantly higher at T3 in group C in group R (p < 0.01); see Table 3 and Figures 2–4. These results demonstrate that intravenous infusions of low-dose remifentanil can effectively alleviate adverse reactions induced by myometrial injection of carboprost during cesarean delivery under combined spinal and epidural anesthesia
Summary
Postpartum hemorrhage accounts for almost 20% of maternal mortality cases worldwide (Ducloy-Bouthors et al, 2014; Lockhart, 2015; Henriquez et al, 2018). Prostaglandin F2 alpha analogs may induce a series of adverse reactions, including nausea, vomiting, headaches, diarrhea, facial flushing, and high blood pressure (Buttino and Garite, 1986; Bai et al, 2014). These adverse events are generally mild and nonfatal (Buttino and Garite, 1986), they increase the discomfort of parturient patients and adds an unpleasant experience to the patient undergoing cesarean deliveries under spinal-epidural anesthesia. While apart from symptomatic treatment, there are no standard treatments for carboprost side effects
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