Résumé
Background: After spinal anesthesia, patients undergoing cesarean section are more likely to develop hemodynamic changes. The baricity of local anesthetic has an important role on spinal blockade effects. The aim of this study was to compare the isobar and hyperbaric bupivacaine 0.5% plus fentanyl on maternal hemodynamics after spinal anesthesia for C/S
Methods: In this double-blind study, 84 healthy pregnant women undergoing C/S using bupivacaine 0.5% isobar [study group, n=42] or hyperbaric [control group, n=42] for spinal anesthesia were scheduled. The study was conducted from 21 April 2014 to 21 November 2014 at Al-Zahra Hospital, Tabriz, Iran. Parameters such as maternal hemodynamics, block characteristics, side effects, and neonatal Apgar scores were recorded. Data were analyzed using the SPSS software by performing chi-square test, Fisher's exact test, one-way ANOVA, Mann-Whitney U-test, and student's t test
Results: The incidence of hypotension in the isobar group was lower than the hyperbaric group, although it was not statistically significant [40.47% vs. 61.9%, P=0.08]. The duration of hypotension was shorter in the study group [1.6 +/- 7.8 min vs. 7.4 +/- 12.5 min, P=0.004]. The dose of ephedrine was lower in the study group [2.4 +/- 6.6 mg vs. 5.3 +/- 10.7 mg, P=0.006]. The main maternal side effect is sustained hypotension that was seen in 0 patients of the isobar and 7 [16.66%] of hyperbaric groups [P=0.006]. None of the neonates had Apgar score
Conclusion: Isobaric bupivacaine is associated with more hemodynamic stability and shorter sensory and motor blockade in mothers under spinal anesthesia for C/S
Résumé
Effective pain therapy after cesarean section is essential for parturient comfort and to allow early ambulation to facilitate care of her infant. This study evaluated the analgesic effect of preventive 1gr intravenous paracetamol on postoperative pain and analgesic consumption during the 24 hours after cesarean section. One-hundred American Society of Anesthesiologists [ASA] 1 or 2 status parturient scheduled for elective cesarean section under spinal anesthesia. Patients received 1gr iv paracetamol into 100 ml normal saline [study group; n=50] or normal saline alone [placebo group; n=50] 20 minutes before the end of operation. Pain scores were lower in the study group in the Post anesthesia care unit [PACU] [p<0.001] and up to 4h after operation [p<0.001]. Cumulative analgesic consumption was lower in the study group [p<0.001]. Preventive administration of 1gr iv paracetamol reduces the intensity of pain in the PACU and until 4h after operation and analgesic consumption following cesarean section