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Patients Prefer Spinal Anesthesia Without Long Lasting Neuraxial Narcotics Over General Anesthesia for Repeat Cesarean Delivery Despite Increased Post Delivery Pain and Pruritis
Abstract Number: T2I-486
Abstract Type: Original Research
Spinal anesthesia (SA) conveys significant benefit to the parturient undergoing cesarean delivery (CD), but is not used with the same frequency in Eastern European hospitals as those in Western Europe. We recently began a project to increase the use of SA for CD at the University Clinical Center of Republic of Srpska (UKCRS). We instituted a post delivery quality improvement process, developed in partnership with Kybele Worldwide, to analyze patient satisfaction and common side effects after general (GA) or SA for CD during our project period.
Patient de-identified data collection were approved by the Ethical Commitee of UKC RS. GA was conducted using a propofol, succinylcholine induction, inhaled isoflurane in air/oxygen maintenance with 100 ug to 200 ug of IV fentanyl, and atracurium muscle relaxation. SA utilized 12 mg of 0.5% intrathecal isobaric bupivacaine and 15 ug of fentanyl. Systemic ketoprofen and tramadol were administered prn for post CD pain relief. Patient data were collected by a blinded UKC RS Quality Improvement team on the first postoperative day, July-September, 2017. Age, height, weight, parity, number of previous CDs, type of anesthesia with previous CD, instances of nausea ,vomiting (N/V) and pruritis, and a 0 – 10 verbal analog scale score (VAS) of overall post CD pain since delivery and patient satisfaction were recorded. Students t, chi square, and Mann-Whitney U tests were used where appropriate. A p ≤ 0.05 was considered significant.
The survey included data from 157 patients; 123 received GA (79%); 34, SA (21%). Age, height, weight, parity, and number of previous CDs did not vary between groups. Overall satisfaction scores and the incidence of N/V were similar. Patients reported higher overall post CD VAS pain scores and more post CD pruritis with SA. Of 61 patients with previous GA for CD, 13 received SA.; no one received GA after prior SA. All 13 patients with current SA and prior GA expressed preference for SA over GA for future CD.
Overall satisfaction scores for both groups were high. The patients in SA group had higher overall post CD pain scores and pruritus, thus emphasizing the need for adoption of long acting neuraxial opioids for post CD pain relief at UKCRS. Despite increased post CD pain and pruritis, parturients prefer SA over GA for a subsequent CD.