Comparison of incisional and epidural analgesia in the treatment of postoperative pain after cesarean section

Czech version

Authors: I. Meixnerová ¹; M. Huser ¹; D. Seidlová ^2,3; Petr Janků ¹; P. Štourač ⁴; R. Gál ²
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA ¹; Klinika anesteziologie, resuscitace a intenzivní medicíny LF MU a FN, Brno, přednosta prof. MUDr. R. Gál, Ph. D. ²; II. anesteziologicko-resuscitační oddělení FN, Brno, primářka MUDr. D. Seidlová, Ph. D. ³; Klinika dětské anesteziologie a resuscitace LF MU a FN, Brno, přednosta doc. MUDr. P. Štourač, Ph. D. ⁴
Published in: Ceska Gynekol 2018; 83(3): 182-187

Overview

Objective:

Comparison of incisional and epidural analgesia in the treatment of postoperative pain after cesarean sectio.

Design:

Prospective cohort study in the period from 2015 to 2016.

Setting:

Department of Obstetric and Gynecology, Masaryk University, University Hospital Brno.

Material and methods:

The group included 72 patients in the 38th–41st. week of pregnancy. They were divided at the time of indication to the cesarean section (SC) into two groups according to the selected type of analgesia (epidural/incisional). Women with epidural analgesia (EA) received bupivacaine and sufentanil after surgery in the epidural catheter. A second group was patients during general anesthesia SC introduced into the surgical wound IA Painfusor which was continuously administered bupivacaine. The intensity of the patient‘s pain was evaluated on the visual analogue scale (VAS). If the VAS exceeded 4, the dose of the opioid analgesic piritramide (additional dose of DDA analgesic) was administered intravenously. The intensity of pain and the number of DDAs required were evaluated 24 hours after SC. Satisfaction with pain relief, sleep quality, and patient side effects were assessed using a questionnaire.

Results:

Patients in the EA group (n = 36) evaluated postoperative pain (PB) value of 4.4 ± 1.8 according to VAS, women in group IA (n = 36) reported a PB according to VAS of 4.4 ± 1.3 (p = 0.972). The difference in the number of applied DDA was not statistically significant compared groups (2.3 ± 0.9 EA vs. 2.4 ± 0.9 IA, p = 0.301). By comparing the other parameters evaluated by the questionnaire statistically significant more vertigo cases were found in women with IA (22.2% EA vs. 72.2% IA, p < 0.001). In the other evaluated parameters the differences between the two methods were not statistically significant.

Conclusion:

Epidural and incisional analgesia are comparable methods in the effectiveness of pain management during the first day of the cesarean section. Except for vertigo, both methods were also comparable in terms of the occurrence of undesirable effects.

Keywords:

cesarean section, postoperative analgesia, epidural analgesia, incisional analgesia, Painfusor

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