Cesarean Section Surgery Research Articles

Management of Iatrogenic Ureteral Trauma Post Caesarean Section

Trauma in the ureter occurs in 1-2.5% of all urogenital trauma, and the most common causes of iatrogenic ureteral trauma come from the Obstetrics Gynecology field (59%). One of the causes of delayed diagnosis of ureteral trauma is the lack of operator awareness. This case report described a 29-year-old woman suspected of ureteral trauma after urine-like fluid was found during a cesarean section operation. After 12 days, a clear-yellowish fluid was obtained from the abdominal drain, so the patient was referred to urologists. The abdominal drain produced fluid approximately 250-300cc/24 hours, clear yellow color. IVP and left RPG inferred left distal ureter laceration AAST grade III. Re-exploration, ureteroneocystostomy using Boari Flap technique, and DJ-Stent insertion were done. On the second day postoperative, the abdominal drain production was < 25cc/24 hours in red color. Ureteral trauma is rare, often unnoticed, and often diagnosed late due to a lack of operator alertness.

Ultrasound-Guided Rectus Sheath Block versus Transversus Abdominus Plane Block for Post-Operative Analgesia in Elective Cesarean Section

Abstract Background Nerve root or myofascial irritation at the abdominal wall is a common cause of pain following surgeries such as cesarean section, cholecystectomy, prostatectomy, hysterectomy and transplant surgery. Aim of the Work The aim of this study is to test the efficacy of ultrasound guided TAP block versus ultrasound guided rectus sheath block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used. Patients and Methods In the current study eighty patients who received spinal anesthesia were included. Patients were divided randomly into two groups, each group consisted of 40 patients. Group A: Patients in this group received bilateral US guided TAP block at the end of surgery. Group B: Patients in this group received bilateral US guided rectus sheath block at the end of surgery. Results These result met with another study, Ayman Saleh et al which shows the time for first analgesic request (minutes) was significantly increased in TAP when compared to RS block groups (332.50±42.93 vs 220.10±21.51 minutes, respectively). Also, the total analgesic consumption (mg) was significantly reduced in TAP when compared to RS block groups respectively (90.40±27.02 vs 157.00±37.80 mg, respectively). Conclusion Ultrasound-guided TAP block was more effective than ultrasound-guided RS block in patients undergoing cesarean delivery with prolonged postoperative analgesia, less analgesics consumption and less postoperative nausea and vomiting.

Comparative Study of Post-Operative Analgesic Effect between Wound Site Infiltration and Bilateral U/S Guided Transversus Abdominis Plane Block with 0.25% Bupivacaine after Cesarean Section

Abstract Background The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses. Objectives This study assessed the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to local wound infiltration after cesarean section regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). Patients and Methods The study was conducted on 90 randomly chosen patients aged 25 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for cesarean section surgery in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 45 patients each: TAP block Group: received general anesthesia and 20 ml of 0.25% bupivacaine on each side by midaxillary approach under ultrasound guidance. Local wound infiltration: received general anesthesia and with 0.25% bupivacaine 30 ml at surgical site. Results The results of the study revealed that the Patients who received TAP block had significantly lower pain scores for 12 h after operation and decreased total need of analgesic in first 12 h post-operative compared with patients who received wound infiltration. Conclusion Bilateral TAP block was effective in reducing postoperative pain scores for 12 hours and lower total 12 hours postoperative pethidine consumption after cesarean section under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Intensive Management of Postoperative Septic Shock in Patient with Secundum Atrial Septal Defect: A Case Report

Background: Sepsis is a life-threatening organ dysfunction caused by an abnormal inflammatory response to infection. This study aimed to describe the intensive management of postoperative septic shock in secundum atrial septal defect patients.
 Case presentation: A 28-year-old woman complaining of pus discharge and reddish swelling in the scar after a cesarean section operation. The patient has a history of pulmonary hypertension and secundum ASD. While in the ICU, examination of vital signs found the patient was weak, compost mentis conscious, blood pressure 80/55 mmHG (MAP 63), Respiration 28 times per minute, pulse 114 times per minute, temperature 38.6°C with 98% oxygen saturation with NRM 10 L/ and laboratory examinations obtained hemoglobin 8.6, leukocytes 14.870, platelets 236.000, hematocrit 24, albumin 2.4 and procalcitonin > 100.
 Conclusion: This study reported that septic shock is a life-threatening condition, especially in patients with congenital heart disease. Appropriate, rapid, and comprehensive treatment and addressing the source of infection are essential in managing sepsis shock.

Laporan Kasus : Acute Respiratory Distress Syndrome (ARDS) pada Pasien Post COVID-19 dengan Fibrosis

. The Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus (SARS- CoV2) has led to a pandemic situation. According to the WHO classification, COVID-19 patients could be classified with severity as uncomplicated illness, mild pneumonia, severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis and septic shock.Case illustration: A 25 year old female, with a chief complaint of shortness of breath and cough, history of cesarean section surgery with indications of severe preeclampsia and hysterectomy for uterine atony. weeks previously the patient was confirmed positive for COVID-19 without symptoms and tested negative through the Polymerase Chain Reaction (PCR) follow up examination. The Chest X-Ray showed the right lung atelectasis, bronchitis and minimal pleural effusion. CT scan of the chest showed a ground glass opacity in almost all bilateral lung segments with septal thickening in according with the picture of COVID pneumonia with cardiomegaly. The patient was intubated and put on a ventilator due to acute respiratory failure and the drugs include antiviral (oseltamivir), chloroquine, antibiotic (meropenem) and steroid (methylprednisolon) intravenous.Discussion: Post COVID-19 fibrosis is one of the emerging complications of COVID 19 pneumonia and ARDS. This case report highlights ARDS in patient with Pulmonary Post Covid-19 and its challenges in diagnosis and treatment. The combination treatment of mechanical ventilation and drugs such as antiviral,chloroquine, antibiotic, steroid intravenous could give the good outcome for the patient of ARDS due to Pulmonary Fibrosis Post COVID - 19

Antibiotics Resistance and Plasmid Curing Studies of Staphylococcus aureus associated with Wound Infection amongst Patients Accessing University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Staphylococcus aureus is a common hospital and community-acquired pathogen known to be frequently associated with wound infections, and has become important for its increasing level of resistance to antibiotics. Resistance of Staphylococcus aureus to antibiotics could be as a result of the presence of plasmids or resistance genes. The need to carry out plasmid curing of the isolates is very essential. The aim of the study was therefore to determine the antibiotics resistance pattern of staphylococcus aureus associated with wound infection amongst patients accessing university of Port Harcourt Teaching Hospital, Rivers State, Nigeria. A total of 150 specimens from different types of wounds (traumatic wound, caesarean section, scrotal wound, surgical wounds, burns, diabetic foot, and plastic surgery) were collected from the Hospital for a period of six months and processed for isolation of S. aureus, following standard microbiological procedures. The specimens were cultured on sterile Mannitol Salt Agar (MSA) plates and incubated at 37ºC for 24 hours. Antibiotic susceptibility tests of the isolates was performed using the Kirby-Bauer disc diffusion method, following CLSI guidelines. Plasmid genes of the isolates were cured using acridine orange. The study showed a decrease in antibiotic resistance of 17.3% for ofloxacin (OFL), 13.8% for gentamicin (GEN) and 3.5% for both ceftazidime (CAZ) and ceftriatone (CTR) after plasmid curing, with no apparent change in resistance for the rest of the antibiotics. The results of this study represent serious public health concerns, thus emphasizing the need for proper wound management.

Epidural Anaesthesia Technique in Caesarean Section Operation in Pregnant Patients with Rheumatic Heart Disease and Severe Mitral Stenosis

Introduction: Mitral stenosis (MS) is the most common form of rheumatic heart disease (RHD). Pregnant women with moderate/severe MS are more prone to heart failure and pulmonary edema than normal pregnant women. It is very important to prevent the potential for maternal heart failure before delivery. This study aimed to present a case report on the epidural anaesthesia technique in caesarean section in pregnant patients with rheumatic heart disease and severe mitral stenosis.
 Case presentation: A 31-year-old pregnant woman patient came to the hospital with complaints of shortness of breath and found rheumatic heart disease and severe mitral stenosis. The patient was premedicated with fentanyl 50 mcg and midazolam 1 mg intravenously, followed by oxygen supplementation with a 2 lpm nasal cannula. Anaesthesia was performed using a lumbar epidural technique, with the insertion of an epidural catheter in the L1-L2 intervertebral space, targeting the T10-L1 dermatome and T6-L1 target of the viscerotome. The local anaesthesia agent chosen was plain bupivacaine with a concentration of 0.5% and a volume of 25 ml. The onset of action of epidural anaesthesia is achieved within 15 minutes as long as the operation is reached a total blockade as high as T6. During surgery, the patient is monitored with standard monitors and an artery line. There were no complaints of shortness of breath felt by the patient during the operation.
 Conclusion: Epidural anaesthesia technique can be performed safely in pregnant women with comorbid mitral regurgitation and atrial fibrillation, with good intraoperative hemodynamic stability.

Investigating the Prevalence and Causes of Surgical Site Infection and Surgical Wound Dehiscence After Cesarean Delivery: A Cohort Study in Zeynab Hospital in Shiraz-Iran

Background: Surgical site infection (SSI) and surgical wound dehiscence are among the main causes of readmission and an increase in treatment costs for patients undergoing cesarean section (CS) surgery. The present study aimed to investigate the prevalence and causes of SSI and surgical wound dehiscence after cesarean delivery in Zeinab hospital in Shiraz-Iran from January 2020 to August 2021. Methods: This prospective cohort study was conducted on 130 pregnant women who underwent CS in Zeinab hospital, Shiraz. All culture media were examined 24 and 48 hours after culturing. In addition, 10-14 days after the operation, patients were followed up by telephone to update data on their wound condition. The results were analyzed using descriptive statistics, χ2 , and logistic regression by SPSS 22. Results: The mean age of patients was 31.94 (5.59) years, and 57.7% of pregnant women had one history of previous CS. The prevalence of SSI infection after cesarean delivery was 20.76%, which is relatively high. Age (odds ratio [OR]=1.04, P≤0.001), weight (OR=1.09, P≤0.001), body mass index (OR=1.11, P≤0.001), the education level (OR=1.02, P≤0.001), history of previous CS (OR=2.79, P≤0.001), and the number of childbearing (OR=1.68, P≤0.001) were identified as predictive factors of SSI after CS. The culture results of 27 SSI patients (20.76%) were positive. Further, five out of 27 patients (18.51%) with SSI experienced complete wound dehiscence and were readmitted, and the other 22 patients (81.48%) only experienced SSI and received outpatient care. Conclusion: Among the factors affecting SSI, the history of previous CS played the main role in causing the infection. Pre- and post-cesarean care plays a major role in SSI and surgical wound healing. Moreover, it is necessary to continuously monitor and evaluate the implementation of infection control protocols and personnel and surgeons’ hand scrub in the operating room.

Uterocutaneous Fistula Complicating Caesarean Section: A Case Report

A uterocutaneous fistula (UCF) is a rare clinical presentation following Caesarean section (CS) and other pelvic surgeries. Presently, there are limited reports on the clinical management of UCF. This report describes a 35-year-old woman who presented with a four-year history of abdominal pain and cyclical bleeding from the skin after CS. Fistulography was carried out, and a diagnosis of UFC was made. She had a fistulectomy with the fistula tract excised, followed by debridement of the necrotic tissue and repair of the uterus. At the third-month postoperative follow-up, there was no recurrence of symptoms. A UCF is a rare condition that needs detailed investigation and timely medical and surgical management.

Asuhan Keperawatan pada Ibu Post Sectio Caesarea Di Ruangan Kebidanan RSUD Poso

Introduction: post sectio caesarean delivery has a five times greater risk of complications compared to normal delivery, problems that commonly occur in post section caesarean mothers are postpartum bleeding, infection, and swollen breasts. For this reason, comprehensive nursing care is needed and improving health in clients can be done by a nursing care approach. The purpose of this study was to provide nursing care for post sectio caesarea mothers in the obstetrics room at Poso Hospital. Methods : The research method is using a descriptive method with a case study approach of 1 patient of post sectio caesarea mother. Results: assessment of the patient complained of pain in the abdomen after cesarean section surgery, the pain was felt like stabbing, the pain disappeared, the patient looked grimacing, there was a surgical wound, there were 14 stitches, wound size 11 cm, wound width 0.2 cm, pain scale 8, blood pressure 110/80 mmhg, breathing 20x / m, pulse 80x / m, temperature 37 ̊C post section caesarea 6 hours. The patient said the milk had not come out, the patient said the baby cried when breastfed, the milk did not gush or drip, the nipples looked flat, the baby did not want to suck. Nursing problems acute pain, ineffective breastfeeding. Nursing Interventions Pain management, relaxation therapy, positioning, mobilization support, analgesic breastfeeding education, and giving the baby the opportunity to breastfeed. Implementation was carried out for 5 evaluation results showed reduced pain, the patient said he could do activities, the patient no longer complained of pain in the abdomen, pain scale 3, the patient said the milk had started to come out, the patient said the baby had not cried when breastfed, the milk had come out, the patient looked more relaxed and comfortable. Conclusion: pain management, relaxation therapy, positioning, mobilization support, giving analgesic breastfeeding education, and providing opportunities for babies to breastfeed are effective in providing nursing care to post section caesarea mothers. Suggestions patients can carry out nursing interventions independently according to what is taught by researchers.

Hubungan Gangguan Citra Tubuh dengan Tingkat Stres Pasien Pasca Operasi Sectio Caesaria (SC) di Ruang Madinah Rumah Sakit PKU Muhammadiyah Sekapuk

Caesarean section surgery often causes psychological problems in patients, namely fear that has an impact on anxiety which can cause a decrease in the condition of reproductive disorders, disruption of blood flow, comfort, pain. Personality image, and the way people see themselves affects the psychological aspect. A realistic and consistent self-image will also give them a steady capacity for awareness, which will help them succeed in life. In the research conducted, this type of Analytical Descriptive was applied through a cross-sectional approach. The independent variable in this study is body image. The dependent variable applied to the study uses stress levels. The study population was all patients who underwent Caesarian Section (SC) deliveries at PKU Muhammadiyah Sekapuk Hospital. Part of the research sample was secaria patients, non-probability sampling technique with purposive sampling of the study sample. The sample size is 24 post-cesarean section (SC) patients. statistical test using spearman rank. The body image of post SC patients at PKU Muhammadiyah Sekapuk Hospital is dominated by negative 70.8%. The stress level of post SC patients at PKU Muhammadiyah Sekapuk Hospital is quite dominant at 45.8%. The results of the Spearman rank test p = 0.008 <0, there is a link between body image disturbance and the stress level of post SC patients at PKU Muhammadiyah Sekapuk Hospital

The Use of Prophylactic Antibiotics for Cesarean Section Delivery and The Incident of Surgical Site Infection

According to the 2018 Riskesdas data, the ratio of deliveries by cesarean section in 2018 was recorded at 17.6% of a total of 78,736 deliveries. One of the serious problems in postoperative treatment that has an impact on increasing morbidity, mortality, and increasing medical costs is surgical site infection (SSI). To reduce the risk of infection, efforts are made by giving prophylactic antibiotics followed by surgical procedures. The aim of this study was to determine the use of prophylactic antibiotics in cesarean section surgery and to determine the incidence of surgical site infection (SSI) in patients after Sectio Caesarea surgery in one of a private hospital in Kediri City. This study was an observational descriptive study with retrospective data collection through tracing of medical record data of patients who underwent Caesarean section surgery in 2021. The samples that entered the inclusion criteria were patients who received surgical prophylaxis with antibiotics and returned to the hospital for control after 1 week postoperatively. Samples that met the inclusion criteria were 89 patients. The sampling technique used purposive sampling. This study collected data on prophylactic antibiotics used and the incidence of SSI on days 1, 3 and (7-10) postoperatively. The results showed that the types of prophylactic antibiotics in patients undergoing sectio caesarea were ceftriaxone 2 g (99%) and cefotaxime 2 g (1%). Whereas there were 3 patients (3%) who had SSI on days 7-10 postoperatively.

O10 Maternal Anaemia and Postoperative Outcomes After Caesarean Section Surgery - The MAPOC Study

O10 Maternal Anaemia and Postoperative Outcomes After Caesarean Section Surgery - The MAPOC Study

Cholecystitis Associated with HELLP Syndrome in previously preeclampsia Patient

In this article, we report a pregnant woman with HELLP syndrome (hemolysis findings, elevated liver enzymes, and low platelets) and acute cholecystitis. She was first admitted due to epigastric pain, nausea, and vomiting, which was managed and discharged after three days. She was admitted due to severe right upper quadrant pain, which sonography showed cholecystitis; however, the levels of lactate dehydrogenase level, ALT, AST, and platelet suspects to HELLP syndrome, and after two days of current admission, these parameters became 2148 IU/L, 199 U/L, 230 U/L, and 43000 respectively, which led us to a definitive diagnosis of HELLP syndrome patient underwent cesarean section surgery, which led to significant improvement in laboratory findings Afterward, on day 3, the patient went on laparoscopic cholecystectomy surgery. Finally, on the seventh day of admission, all parameters were normal, and the patient was discharged without complications.

Dysmetabolic encephalopathy of the maternity hospital associated with spinal anesthesia

The review article discusses in detail the problem of complications in maternity patients associated with spinal anesthesia and cesarean section surgery. The evidence base demonstrating the risk of complications in pregnant women with the development of acute neurological conditions is presented. The problems of the toxic effect of a local anesthetic (bupivacaine) and the consequences of a coronavirus infection on the body of pregnant women are considered separately.

Patient-controlled intravenous administration of dexmedetomidine with nalbuphine versus sufentanil for post cesarean delivery analgesia: A retrospective observational study.

This retrospective observational study aims to investigate the patient-controlled intravenous analgesia (PCIA) of dexmedetomidine (DEX) with nalbuphine (NAL) versus sufentanil (SUF) for post-cesarean delivery management. A total of 300 women were evaluated who underwent cesarean section surgery with combined spinal-epidural anesthesia. After surgery, all patients were connected to a patient-controlled analgesia pump. The PCIA protocol was programmed with 0.11 μg/kg/h DEX in combination with 0.03 μg/kg/h SUF in Group I (n = 150) or 0.11 μg/kg/h DEX in combination with 0.03 mg/kg/h NAL in Group II (n = 150). There was no significant difference in incision pain and sedation level between the two groups within 48 h after the surgery assessed by visual analog scale (VAS) and Ramsay sedation scale, respectively. However, at 2, 6, 12, and 24 h after surgery, visceral pain at rest and at mobilization was alleviated in the Group II as compared with the Group I with lower VAS scores. Moreover, fewer adverse reactions were found in the Group II when compared with Group I, including postpartum respiratory depression, nausea/vomiting, urinary retention, and cardiovascular events. Overall, there was an increased patient satisfaction in the Group II as compared with the Group I. Based on the results of this study, it seems that adding NAL to PCIA with DEX, as compared to SUF with DEX, have an effect on reducing the intensity of visceral pain after cesarean section with less adverse reactions and higher patient satisfaction.

Prevention of bladder damage during repeated caesarean sections

Repeated cesarean section operations are becoming a daily practice in obstetric institutions of the 2nd and 3rd groups. With each subsequent operation, due to adhesions or infectious complications (obstetric peritonitis), the risks of injuries to organs adjacent to the uterus increase. Objective: development of a method for preventing to the bladder injury during repeated cesarean section operations. Materials and methods: Prospective cohort studies were performed in 320 patients with the scar after Caesarean Section who underwent a repeated cesarean section: 186 patients were operated in plan and 134 in urgent situation. All patients had given the hydropreparation of paravesical tissue by 0.5 % solution of novocaine 20 ml, which was injected under the vesicouterine fold from the side of the round ligaments for the prevention injury of bladder. Statistical processing was carried out using the Statistica 13 package. Results and discussion: With partial mobilization of the posterior wall, bladder injury in group 1 was in 2 patients, in group 2 in 4 patients (2 = 1.544, p = 0.215). The injury of the bladder walls in group 2 occurred in patients operated on for obstetric peritonitis and was caused by pronounced infiltration of paravisical tissue and inflammatory changes in the lower segment of the uterus. Conclusions: The developed method by hydropreparation the paravesical tissue allows minimizing the number of bladder injuries with a pronounced adhesive process in the lower segment of the uterus or tissue infiltration with purulent-inflammatory complications.

Effect of chamomile aromatherapy with and without oxygen on pain of women in post cesarean section with spinal anesthesia: A randomized clinical trial

BackgroundPain is the most common side effect in cesarean section with spinal anesthesia. It seems that oxygen therapy and chamomile aromatherapy may diminish pain. The present study was conducted to examine and compare the effect of chamomile aromatherapy with and without oxygen on the severity of pain of women following cesarean section surgery with spinal anesthesia. MethodsThe present randomized clinical trial study was carried out on 136 women undergoing cesarean section surgery with spinal anesthesia at Imam Sajad Hospital, Yasuj, Iran in 2020. The eligible women were assigned into four 34-member groups including oxygen therapy plus aromatherapy, oxygen therapy, aromatherapy, and control via block randomization. Each of these interventions were performed 6, 6.30 and 7 h post operation. In the first intervention group, one drop of chamomile essential oil with distilled water was poured into a small nebulizer using a simple mask connected to 6 L of oxygen. The second intervention group received oxygen without chamomile aromatherapy at similar times, and the third intervention group received chamomile aromatherapy without oxygen. The control group received only routine interventions. The instrument used in the research was visual analog scale which was completed by the researcher 6, 12, 18 h after cesarean section. The data were analyzed by the SPSS software version 20. ResultsThere was a significant difference in the intensity of pain of patients between the various groups of study following the interventions (P < 0.001). Pain intensity reduced significantly in the group receiving combined intervention of chamomile aromatherapy plus oxygen compared to the other three groups. Moreover, the pain intensity diminished more in the groups undergoing each of these interventions alone as compared to the control group (P < 0.05). ConclusionsThe combined intervention of chamomile aromatherapy with oxygen was more effective than each of the chamomile aromatherapy and oxygen interventions alone in reducing the pain of cesarean section patients though each intervention alone was still effective in lowering pain post-operation.

Investigating the effects of the COVID-19 pandemic on obstetric anesthesia and perioperative outcomes in cesarean section surgery

Aim: In the literature, studies comparing the preferred anesthesia methods and related parameters in obstetric anesthesia during the pandemic period with the pre-pandemic period are limited. I n this study, primarily in patients who gave birth by cesarean section before and during the COVID-19 (Coronavirus disease 19) pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, length of hospital stay, clinical urgency of the patients and ASA (American Society of Anesthesiologists) scores. In addition, in patients who underwent cesarean section with positive and negative PCR (Polymerase Chain Reaction) tests during the COVID-19 pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, hospital stay, clinical urgency of the cases and ASA scores.&#x0D; Material and Method: In this retrospective, single-center study, we noted down and compared types of cesarean section (elective or emergency), anesthesia techniques (spinal, spinal+epidural, or general anesthesia), and patients’ ages, ASA scores, PCR test results, postoperative complications (e.g., pneumonia, excessive postpartum bleeding), and lengths of hospital stay.&#x0D; Results: We carried out this study with the data of 2,406 women, 1,458 of whom gave birth before the pandemic. The findings revealed that the rate of developing complications, the length of hospital stay, the number of patients with an ASA score of 3 and above, and the use of spinal anesthesia significantly increased during the pandemic. Moreover, 182 women were COVID-19-positive among a total of 948 applicants during the pandemic. Although the ASA scores and complication rates were significantly higher among those with a positive PCR test result, the length of hospital stay was similar between the patients by their PCR test results. &#x0D; Conclusion: Our findings revealed a significant decrease in spinal + epidural anesthesia, which was frequently adopted before, in cases with cesarean section during the pandemic. Spinal anesthesia was mostly used alone. Despite increased complication rates in PCR-positive patients with higher ASA scores undergoing cesarean section, we concluded no significant change in the length of hospital stay. In cases of increased risk of infection and transmission (e.g., pandemic), neuraxial blocks may be preferred as an anesthesia technique to minimize the risk of infection in emergency obstetric operations. It should also be noted that the risk of developing postoperative complications always be high during pandemics.

Comparison of the Dexmedetomidine and Sufentanil Added to Spinal Anesthesia with Bupivacaine for Hemodynamic Stability and Postoperative Analgesia in Elective Cesarean Section Surgery: A Single-Blinded Randomized Clinical Trial

Background: Hemodynamic instability, including hypotension and bradycardia, can occur due to spinal anesthesia by bupivacaine. However, it is possible to reduce the chance of hemodynamic changes by the reduction of the dose of bupivacaine and/or the addition of adjunctive agents. Objective: This study aimed to compare the effects of the addition of intrathecal dexmedetomidine and sufentanil to spinal anesthesia with bupivacaine in elective cesarean section (CS). Methods: This prospective single-blinded randomized clinical trial with parallel groups was performed on 60 pregnant women who were candidates for elective CS in Imam Reza Hospital in Kermanshah, Iran. In addition to receiving 10 mg of hyperbaric bupivacaine 0.5%, they were randomly divided into two groups to receive intrathecal sufentanil 5 μg (30 cases) or dexmedetomidine 5 μg (30 cases). Changes in blood pressure, heart rate, and occurrence of side effects (e.g., nausea, vomiting, headache, and shivering) were recorded within 1 h after the injections. Moreover, the postoperative analgesia rate and duration (using a visual analog scale [VAS]) were recorded within the first 24 h after the completion of the CS. Headache severity (using a VAS) was also measured during the first week after CS. Results: Patients declared their satisfaction with analgesia after surgery. No significant difference was found between the two groups in terms of heart rate and systolic and diastolic blood pressure changes during the first 60 min. Similarly, no significant difference was observed between the two groups in terms of the severity of incision pain in the first 24 h after CS surgery. On days 3, 4, and 5, none of the patients in the sufentanil and bupivacaine group had headaches (VAS=0), but patients in the dexmedetomidine and bupivacaine group had some degree of headache (P=0.040). Conclusions: Based on the results, intrathecal administration of bupivacaine with either sufentanil or dexmedetomidine in CS did not have significantly different effects, except for slightly more severe headaches in the dexmedetomidine group. Therefore, no superiority of one drug over the other was observed for intrathecal administration with bupivacaine in CS.