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Réhabilitation précoce postopératoire après césarienne

Postoperative rehabilitation programme after caesarean delivery

  • Article de Synthèse / Review Article
  • Published:
Revue de médecine périnatale

Résumé

La césarienne concerne un grand nombre de patientes et de structures de soins. Grâce aux évolutions de la technique chirurgicale et du blocage efficace des afférences grâce à l’emploi de l’anesthésie locorégionale, l’agression tissulaire que représente la césarienne est bien moins importante qu’il y a quelques années encore. On peut même aujourd’hui considérer la césarienne comme une intervention chirurgicale mineure. Plus que dans d’autres domaines de la chirurgie, la restauration rapide de l’état physiologique est primordiale en raison de la création des liens mèreenfant. Pour restaurer le fonctionnement physiologique et accélérer le retour rapide à une vie normale, plusieurs actions sont possibles et méritent d’être mises en place rapidement dans toutes les structures. La limitation des soins invasifs (sonde urinaire, perfusion intraveineuse) représente le premier moyen simple. Ceci se traduit par une reprise précoce des boissons et de l’alimentation, tout en assurant une analgésie multimodale adéquate afin de réduire le recours aux antalgiques morphiniques et donc leurs effets secondaires. Prévenir de façon simple et efficace les hémorragies du postpartum grâce à l’administration d’une dose unique d’un ocytocique de longue durée d’action participe à la stratégie visant à raccourcir la durée du maintien de la voie veineuse.

Abstract

Caesarean delivery is more and more becoming a minor surgical procedure as present surgical techniques are associated with reduced trauma and because it is possible to return to normal life soon after surgery. Moreover, this surgical procedure is performed in numerous patients and institutions. More than in any other surgical procedure, rapid postoperative rehabilitation is essential to facilitate maternal and neonatal bonding. Improvement of present practice should be implemented rapidly in all institutions and may be obtained by modifying some simple but important strategies. Reducing invasiveness of care (postpartum avoidance of urinary catheter and of intravenous infusion) is the primary goal to achieve and is associated with rapid allowance of drinking in the post-anaesthesia care unit and oral feeding in the first hours after surgery. Adequate pain relief may be obtained by using multimodal strategies which allow a reduced use of opioids and their accompanying their side effects. Patient controlled oral analgesia can be combined with this strategy. Preventing postpartum haemorrhage by administration of an oxytocic drug, and choosing whenever possible carbetocin which is administered as a single injection also reduces the use of postoperative intravenous fluids. These simple and easy to implement recommendations should now be undertaken in every maternity unit by using multidisciplinary clinical pathways.

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Références

  1. Nikolajsen L, Sorensen HC, Jensen TS, Kehlet H (2004) Chronic pain following ceaesarean section. Acta Anaesthesiol Scand 48:111–116

    Article  PubMed  CAS  Google Scholar 

  2. Benhamou D, Bouaziz H, Chassard D, Ducloy JC, et al (2009) Anaesthetic practices for scheduled caesarean delivery: a 2005 French national survey. Eur J Anaesthesiol 26:694–700

    Article  PubMed  Google Scholar 

  3. Palmer CM, Emerson S, Vollgoropolous D, Alves D (1999) Dose-response relationship of subarachnoid morphine for postcesarean analgesia. Anesthesiology 90:437–444

    Article  PubMed  CAS  Google Scholar 

  4. Dahl JB, Jeppesen IS, Jorgensen H, Wetterslev J, et al (1999) Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology 91:1919–1927

    Article  PubMed  CAS  Google Scholar 

  5. Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration (2009) An Updated report by the American Society of Anesthesiologists Task Force on neuraxial opioids. Anesthesiology 110:218–230

    Google Scholar 

  6. Cohen SE, Desai JB, Ratner EF (1996) Ketorolac and spinal morphine for post caesarean analgesia. Int J Obst Anesth 5:14–18

    Article  CAS  Google Scholar 

  7. Allen TK, Jones CA, Habib AS (2012) Dexamethasone for the prophylaxis of postoperative nausea and vomiting associated with neuraxial morphine administration: a systematic review and meta-analysis. Anesth Analg 114:813–822

    Article  PubMed  CAS  Google Scholar 

  8. George RB, Allen TK, Habib AS (2009) Serotonin receptor antagonists for the prevention and treatment of pruritus, nausea, and vomiting in women undergoing cesarean delivery with intrathecal morphine: a systematic review and meta-analysis. Anesth Analg 109:174–182

    Article  PubMed  CAS  Google Scholar 

  9. Allen TK, Habib AS (2008) P6 stimulation for the prevention of nausea and vomiting associated with cesarean delivery under neuraxial anesthesia: a systematic review of randomized controlled trials. Anesth Analg 107:1308–1312

    Article  PubMed  Google Scholar 

  10. Abouleish E, Rawal N, Rashad M (1991) The addition of 0.2mg subarachnoid morphine to hyperbaric bupivacaine for caesarean delivery: a prospective study of 856 cases. Reg Anesth 16:137–140

    PubMed  CAS  Google Scholar 

  11. Carvalho B (2008) Respiratory depression after neuraxial opioids in the obstetric setting. Anesth Analg 107:956–961

    Article  PubMed  Google Scholar 

  12. Gehling M, Tryba M (2009) Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia 64:643–651

    Article  PubMed  CAS  Google Scholar 

  13. Cousins MJ, Mather LE (1984) Intrathecal and epidural administration of opioids. Anesthesiology 61:276–310

    Article  PubMed  CAS  Google Scholar 

  14. Liu SS, Richman JM, Thirlby RC, Wu CL (2006) Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg 203:914–932

    Article  PubMed  Google Scholar 

  15. Bamigboye AA, Hofmeyr GJ (2009) Local anaesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief (Review). The Cochrane Collaboration. http://www2.cochrane.org/reviews/en/ab006954.html (dernier accès le 25 août 2010)

  16. Lavand’homme PM, Roelants F, Waterloos H, De Kock MF (2007) Postoperative analgesic effects of continuous wound infiltration with diclofenac after elective cesarean delivery. Anesthesiology 106:1220–1225

    Article  PubMed  Google Scholar 

  17. Mishriky BM, George RB, Habib AS (2012) Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis. Can J Anesth 59:766–778

    Article  PubMed  Google Scholar 

  18. Costello JF, Moore AR, Wieczorek PM, et al (2009) The transversus abdominis plane block, when used as part of a mutimodal regimen. Reg Anesth Pain Med 34:586–589

    Article  PubMed  Google Scholar 

  19. Loane H, Preston R, Douglas MJ, et al (2012) A randomized controlled trial comparing intrathecal morphine with transversus abdominis plane block for post-cesarean delivery analgesia. Int J Obstet Anesth 21:112–128

    Article  PubMed  CAS  Google Scholar 

  20. Kanazi GE, Aouad MT, Abdallah FW, et al (2010) The analgesic efficacy of subarachnoid morphine in comparison with ultrasound-guided transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg 111:475–481

    Article  PubMed  CAS  Google Scholar 

  21. McMorrow RC, Ni Mhuircheartaigh RJ, Ahmed KA, et al (2011) Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section. Br J Anaesth 106:706–712

    Article  PubMed  CAS  Google Scholar 

  22. Tan TT, Teoh WH, Woo DC, et al (2012) A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia. Eur J Anaesthesiol 29:88–94

    Article  PubMed  CAS  Google Scholar 

  23. Eslamian L, Jalili Z, Jamal A, Marsoosi V, et al (2012) Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesia. J Anesth 26:334–338

    Article  PubMed  Google Scholar 

  24. Delaunay L, Catoire P (2009) Recommandation formalisée d’experts: les morphiniques oraux ont-ils une place dans l’analgésie postopératoire ? Ann Fr Anesth Reanim 28:e27–e32

    Article  PubMed  CAS  Google Scholar 

  25. Jakobi P, Weiner Z, Solt I, Alpert I, et al (2000) Oral analgesia in the treatment of post-cesarean pain. Europ J Obstet Gyn Reprod Biol 93:61–64

    Article  CAS  Google Scholar 

  26. Greene JF, Kuiper O, Morosky M, Wightman S, et al (1999) A postpartum self-medication program: effect on narcotic use. J Women’s Health and Gender-Based Med 8:1073–1076

    Article  CAS  Google Scholar 

  27. Holt M (2000) Patient-controlled oramorph-the future? Anaesthesia 55:933–934

    Article  PubMed  CAS  Google Scholar 

  28. Davis KM, Esposito MA, Meyer BA (2006) Oral analgesia compared with intravenous patient-controlled analgesia for pain after caesarean delivery: a randomised controlled trial. Am J Obstet Gynecol 194:967–971

    Article  PubMed  CAS  Google Scholar 

  29. Striebel HW, Scheitza W, Philippi W, et al (1998) Quantifying oral analgesic consumption using a novel method and comparison with patient-controlled intravenous analgesic consumption. Anesth Analg 86:1051–1053

    PubMed  CAS  Google Scholar 

  30. Striebel HW, Römer M, Kopf A, Schwagmeier R (1996) Patient controlled oral analgesia with morphine. Can J Anaesth 43:749–753

    Article  PubMed  CAS  Google Scholar 

  31. Olofsson CI, Ekblom AO, Ekman-Ordeberg GE, Irestedt LE (1997) Postpartum urinary retention: a comparison between two methods of epidural analgesia. Eur J Obstet Gynecol Reprod Biol 71:31–34

    Article  PubMed  CAS  Google Scholar 

  32. Buchholz NP, Daly-Grandeau E, Huber-Buchholz MM (1994) Urological complications associated with caesarean section. Eur J Obstet Gynecol Reprod Biol 56:161–163

    Article  PubMed  CAS  Google Scholar 

  33. Ghoreishi J (2003) Indwelling urinary catheters in cesarean delivery. Int J Gynaecol Obstet 83:267–270

    Article  PubMed  CAS  Google Scholar 

  34. Li L, Wen J, Wang L, Li YP, Li Y (2011) Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review. BJOG 118:400–409

    Article  PubMed  CAS  Google Scholar 

  35. Benhamou D, Técsy M, Parry N, et al (2002) Audit of an early feeding program after Cesarean delivery: patient wellbeing is increased. Can J Anesth 49:814–819

    Article  PubMed  Google Scholar 

  36. Soriano D, Dulitzki M, Keidar N, et al (1996) Early oral feeding after cesarean delivery. Obstet Gynecol 87:1006–1008

    Article  PubMed  CAS  Google Scholar 

  37. Kramer RL, Van Someren JK, Qualls CR, Curet LB (1996). Postoperative management of cesarean patients: the effect of immediate feeding on the incidence of ileus. Obstet Gynecol 88:29–32

    Article  PubMed  CAS  Google Scholar 

  38. Kimura T, Tanizawa 0, Mori K, et al (1992) Structure and expression of a human oxytocin receptor. Nature 356:526–529

    Article  PubMed  CAS  Google Scholar 

  39. Tsen LC, Balki M (2010) Oxytocin protocols during cesarean delivery: time to acknowledge the risk/benefit ratio? Int J Obstet Anesth 19:243–245

    Article  PubMed  Google Scholar 

  40. Mockler JC, Murphy DJ, Wallace EM (2010) An Australian and New Zealand survey of practice of the use of oxytocin at elective caesarean section. Aust N Z J Obstet Gynaecol 50:30–35

    Article  PubMed  Google Scholar 

  41. Gungorduk K, Ascoglu O, Celkko Ol, Olgac Y, et al (2010) Use of additional oxytocin to reduce blood loss at elective caesarean section: a randomised control trial. Aust N Z J Obstet Gynaecol 50:36–39

    Article  PubMed  Google Scholar 

  42. Murphy DJ, Macgregor H, Munishankar B, Mcleod G (2009) A randomised controlled trial of oxytocin 5UI and placebo infusion versus oxytocin 5UI and 30UI infusion for the control of blood loss at elective caesarean section-pilot study. Eur J Obstet Gynecol Reprod Biol 142:30–33

    Article  PubMed  CAS  Google Scholar 

  43. Su LL, Chong YS, Samuel M (2012) Carbetocin for preventing postpartum haemorrhage. Cochrane Database Syst Rev 4: CD005457

    PubMed  Google Scholar 

  44. Weinstein MC, Skinner JA (2010) Comparative effectiveness and health care spending-implications for reform. N Engl J Med 362:460–465

    Article  PubMed  CAS  Google Scholar 

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Correspondence to D. Benhamou.

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Wyniecki, A., Benhamou, D. Réhabilitation précoce postopératoire après césarienne. Rev. med. perinat. 4, 119–125 (2012). https://doi.org/10.1007/s12611-012-0197-1

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  • DOI: https://doi.org/10.1007/s12611-012-0197-1

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