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Analgesic requirements and pain experience after cesarean section under neuraxial anesthesia women with preeclampsia
Abstract Number: T-55
Abstract Type: Original Research
Introduction: Cesarean section (CS) is a common mode of delivery in women with preeclampsia(PE). There is no literature concerning postoperative pain following CS in PE & little information on the safety/efficacy of analgesics used in PE. Non-steroidal anti-inflammatory drugs(NSAIDS) should be used with caution in other hypertensive adults & there are case reports of their use causing acute hypertension & subsequent death in PE. It is theorised that analgesics that reduce the seizure threshold(tramadol & pethidine) should not be administered in PE due to the risk of seizures in PE. Magnesium sulphate is used to treat & prevent seizures in PE & may also provide analgesia when administered systemically. Acute perioperative pain management guidelines fail to differentiate between healthy pregnant(HP) woman & PE.1 This means that clinicians either follow these guidelines which may not be appropriate in PE or undertake management with little clinical guidance. We hypothesised that women with PE have a different postoperative pain experience & different pain management compared to HP women. We aimed to determine the current practice of analgesic administration & pain experience after CS in PE & compare this with HP(ASA I) women.
Method: After IRB approval, we conducted a single centre (7400 births/year) one-year retrospective case control study to determine analgesic administration, pain experience & adherence to postoperative pain protocol (strict regular paracetamol/oxycodone slow release/NSAIDs + as required tramadol & immediate release oxycodone for 48 hours) after CS in PE compared with HP women. Inclusions for all women were; neuraxial anaesthesia, no labour, no prior abdominal surgery, having first CS, surgery ≤60 minutes.
Results: 62 women were included;21 cases(PE) & 41 controls(HP). The cases & control were matched for age, height, weight, gravidity, parity, duration of surgery & previous surgical history. Cases had shorter gestation compared with controls (31.7±3.0 vs 38.5±1.1 weeks p<0.001). Cases received more spinal bupivacaine (mean difference 0.4 mg) & in the first six-hours postoperatively received(mean ± SD, % or median (IQR)), less oxycodone (11.5±3.9mg versus 14.3± 5.1mg, p<0.031), less often received parecoxib (43% versus 100%, p<0.001), & reported less maximum pain scores (0(0,5) versus (4(3,6)) p<0.005). Pain management protocol was followed in 78% of HP women & 43% of PE (p=0.023).
Conclusions: This study suggests that PE women experience less pain in the first 6-hours after CS despite receiving less analgesia, & have a different postoperative pain experience & receive different pain management compared to HP women. Earlier gestation, different analgesia regimens & the use of MgSO4 may explain these differences. Further research is needed to explore these novel findings.
Reference: 1. Macintyre PE et al. Acute Pain Management: Scientific Evidence (3rd edition) ISBN Online: 978-0-9775174-5-9