Timely initiation of breastfeeding and its factors among women delivered via cesarean section under spinal anesthesia at the University of Gondar Comprehensive Specialized Hospital, north-west Ethiopia, 2021: a hospital-based cross-sectional study.

The mode of delivery influences breastfeeding practice. Moreover, cesarean deliveries under anesthesia-related risk factors affect the timing of breastfeeding initiation compared to vaginal deliveries. In addition, high rates of cesarean section (CS) deliveries and low breastfeeding rates are important public health concerns for all developing countries. Objective: This study aimed to determine the timely initiation of breastfeeding and its factors among women delivered via CS under spinal anesthesia. Methods: Institutional-based cross-sectional study was employed among 422 systematically selected mothers from April to June 2021. Data were collected by a structured questionnaire. Data entry and analysis were done using Epi Data and Stata version 14.0. Binary logistic regressions were computed to identify factors. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare statistical significance. Results: Delayed initiation of breastfeeding (DIBF) was 41.8%. Mothers who had an emergency CS (AOR =2.13, 95% CI [1.21-3.75]), had less than four antenatal care (ANC) follow-ups (AOR=1.77, 95% CI [1.02-3.13]), had moderate to severe pain during the perioperative period (AOR=2.65, 95% CI [1.24-5.54]), primipara (AOR=1.89; 95% CI [1.20-3.25]), used intraoperative opioid medications (AOR=1.86; 95% CI [1.01-3.30]), and had no skin-to-skin contact (AOR=2.1, 95% CI [1.27-3.51]) were associated with DIBF. Conclusion and recommendation: DIBF after cesarean delivery was high. Emergency CS, less than four ANC visits, immediate postoperative pain, and lack of skin-to-skin contact were factors associated with delayed breastfeeding. Health care providers, especially anesthetists, in the operation theater, should implement multimodal analgesics and minimize opioid consumption. Moreover, they should keep the newborn in skin-to-skin contact to initiate breastfeeding in the operation theater soon after birth.

Modalidades en Terapia Física para el Manejo del Dolor de la Cicatriz Post Cesárea No Mayor a 6 Meses de Evolución. Scoping Review / Physical Therapy Modalities for the Management of Post Cesarean Section Scar Pain not more than 6 Months Old. Scoping Review.

Introducción. El manejo del dolor y cicatrización post cesárea es diferente a los otros manejos post operatorios debido a que la madre debe recuperarse lo más pronto posible para el cuidado del recién nacido. La evidencia referente al impacto de las intervenciones en terapia física para el manejo del dolor en este tipo de cicatriz es limitada. Objetivo. Identificar las modalidades en fisioterapia disponibles para el manejo del dolor sobre la cicatriz de la cesárea, con una evolución menor a 6 meses. Metodología. Se realizó un scoping review según la metodología propuesta de Arskey y O'Malley, y PRISMA-Scr. Las bases de datos empleadas para la búsqueda fueron PubMed, ScienceDirect, Scopus, Scielo y Google Scholar, incluyendo artículos en el idioma inglés y español publicados entre enero de 2012 y abril de 2022. Resultados. Se incluyeron 6 estudios de tipo prospectivo. Identificando 4 modalidades de intervención en terapia física para el alivio del dolor de la cicatriz post cesárea en un periodo de evolución menor a 6 meses, entre las cuales se encuentran: TENS, Láser, Infrarrojo y Ejercicio Terapéutico. Siendo el TENS la modalidad más empleada en los estudios. Conclusión. Existe una escasa evidencia de intervenciones de terapia física en el manejo de la cicatriz durante el proceso de cicatrización post cesárea en los primeros 6 meses de evolución. La modalidad más relevante es el TENS garantizando una herramienta terapéutica con respuesta efectiva sin efectos adversos y coadyuvante a la disminución de uso de medicación analgésica.

Background. Post cesarean scar pain management is different from other postoperative management because the mother must recover as soon as possible to care for the newborn. Evidence regarding the impact of physical therapy interventions for c-section scar pain management is limited. Objetive. To identify the physical therapy modalities available for pain management of the c-section scar within the first 6 months since the procedure. Methods. A scoping review was performed according to the methodology proposed by Arskey and O'Malley PRISMA-Scr. The databases used for the search were PubMed, ScienceDirect, Scopus, Scielo and Google Scholar, including articles in English and Spanish published between January 2012 and April 2022. Results. 6 prospective studies were included. Four physical therapy modalities were identified post cesarean scar pain relief in a period of evolution less than 6 months, among which are: TENS, Laser, Infrared and Therapeutic Exercise. TENS being the most used modality in the studies. Conclusion. There is scarce evidence of physical therapy interventions in scar management during the post cesarean healing process in the first 6 months of evolution. The most relevant modality is TENS, guaranteeing a therapeutic tool with effective response without adverse effects and contributing to the decrease in the use of analgesic medication.

Analgesia postoperatoria en operación cesárea / Postoperative analgesia in caesarean section

Resumen: El dolor por cesárea se caracteriza por ser moderado a severo. El manejo analgésico inicia en el preoperatorio con la evaluación de los factores de riesgo, continúa con la técnica anestésica y termina con la planificación de la analgesia postoperatoria. La técnica anestésica recomendada es el bloqueo epidural, siempre y cuando no existan signos de amenaza inminente para la vida de la mujer o el feto como: coagulopatía, choque hipovolémico, aumento de la presión intracraneal e insuficiencia respiratoria aguda. Para el bloqueo epidural se recomienda el uso de dosis combinada de anestésico local, adyuvante opioide y bicarbonato. En el postoperatorio, la analgesia debe ser multimodal, aplicando vía intravenosa AINE/COX-2 y complementar el manejo con paracetamol, continuando con analgesia epidural controlada por el paciente. Recientemente, técnicas regionales como el bloqueo TAP bilateral (plano transverso del abdomen) y el bloqueo iliohipogástrico e ilioinguinal bilateral han demostrado ser buenas estrategias analgésicas (para ver artículo completo visitehttp://www.painoutmexico.com).

Abstract: Cesarean section pain is expected from moderate to severe. The analgesic management begins in the preoperative, with the evaluation of the risk factors, continues with the definition of the anesthetic technique to be used, and finish with the planed anesthetic technique. Recommended anesthetic technique is epidural block, provided there is no imminent threat to the life of the woman or the fetus, coagulopathies, hypovolemic shock, increased intracranial pressure and acute respiratory. For epidural block the combined dose of local anesthetic, opioid adjuvant and bicarbonate is recommended. In the postoperative period, analgesia should be multimodal applying intravenously the synergy of NSAIDs/COX-2 and continuing with analgesia via epidural controlled by the patient (PCA). Regional techniques such as transverse plane blockage of the abdomen and iliohypogastric and ilioinguinal block are good analgesic strategies (for full version and recommendations visithttp://www.painoutmexico.com) .

The comparison of intraincisional injection tramadol, pethidine and bupivacaine on postcesarean section pain relief under spinal anesthesia.

BACKGROUND: Bupivacaine, tramadol, and pethidine has local anesthetic effect. The aim of this study was to compare effect of subcutaneous (SC) infiltration of tramadol, pethidine, and bupivacaine on postoperative pain relief after cesarean delivery. MATERIALS AND METHODS: 120 patient, scheduled for elective cesarean section under spinal anesthesia, were randomly allocated to 1 of the 4 groups according to the drugs used for postoperative analgesia: Group P (Pethidine) 50 mg ,Group T (Tramadol) 40 mg, Group B (Bupivacaine 0.25%) 0.7 mg/kg, and Group C (control) 20CC normal saline injection in incision site of surgery. Pain intensity (VAS = visual analogous scale) at rest and on coughing and opioid consumption were assessed on arrival in the recovery room, and then 15, 30, 60 minutes and 2, 6, 12, 24 hours after that. RESULTS: VAS scores were significantly lower in groups T and P compared with groups B and C except for 24 hours (VAS rest) and 6 hours (VAS on coughing) postoperatively (P < 0.05). The number of patients requiring morphine were significantly different between the groups (105 doses vs. 87, 56, 46, doses for group C, B, T and P, respectively, P < 0.05) in all the times, except for 2 and 6 hours postoperatively. CONCLUSIONS: The administration of subcutaneous pethidine or tramadol after cesarean section improves analgesia and has a significant morphine-sparing effect compared with bupivacaine and control groups.