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Tenoxicam Prevents Discomfort Symptoms Related to Uterus Manipulation Inducing Vagotonia During Cesarean Section
Abstract Number: T-34
Abstract Type: Original Research
Purpose: Symptoms such as nausea, vomiting, chest tightness, bradycardia and shoulder or abdominal discomfort sensation induced by vagotonia (pathological over-activity of the parasympathetic vagus tone) during uterus manipulation were commonly perplexing obstetricians and complained by patients when undergoing spinal anesthesia for cesarean section (C/S). Our previous study has indicated Tenoxicam might reduce the intensity of uterine contraction pain after C/S without increasing side effects. This study intended to elucidate the effectiveness of Tenoxicam in preventing those discomfort symptoms.
Methods: 105 ASA class I~II women scheduled for C/S were enrolled in this prospective, double blind study. Spinal anesthesia with 0.5% hyperbaric bupivacaine was administered for to reach the dermatome level of T4 at least. Blood pressure was controlled within 10% of baseline by intravenous hydration and ephedrine. 105 patients were randomly divided into two groups: Group T (N=50) received intravenous Tenoxicam 20mg in 5 mL normal saline immediately after skin incision and Group N (N=50) with 5 mL pure normal saline. The incidence and severity of those symptoms induced by vagotonia during uterus manipulation were recorded by anesthetic nurse blind to the injection formula. Nausea and vomiting were treated with prochlorperazine 5mg if needed; bradycardia with atropine and chest tightness, shoulder or abdominal discomfort sensations with thiopental sodium 150~200 mg if indicated. Chi-square test was used to calculate for the incidence and severity of those variables and p＜0.05 was defined as significant.
Results: Our pilot observational study (N=30, without any prophylaxis) showed the incidence of nausea (14/30), vomiting (10/30), chest tightness (8/30), bradycardia (4/30) and shoulder (15/30) or abdominal (12/30) discomfort sensation. 2 patient in Group T and 3 in Group N were withdrawal, due to inadequate anesthesia. P > 0.05 was noted in the incidence and severity of nausea & vomiting and in the severity of chest tightness and bradycardia, while p <0.05 was noted in the incidence chest tightness and bradycardia and in the incidence and severity of shoulder or abdominal discomfort sensation.
Discussion: When patients suffered from those discomfort symptoms and could not tolerate, medication treatment might be the first choice. However, prophylaxis strategy for preventions could be another clinical approach. Our result indicated that prophylaxis with Tenoxicam can significantly decrease the incidence of chest tightness, bradycardia and shoulder or abdominal discomfort sensation induced by vagotonia. It might be explained by the theoretically effect of Tenoxicam to block vagus pathway and decrease visceral pain or referred symptoms. Prophylaxis with Tenoxicam might have effect in reducing the incidence and severity of nausea and vomiting, without statistic significance. It might be explained that not only vagotonia but also other contributing mechanisms.