Douleur et Analgésie

, Volume 20, Issue 3, pp 167–172

Analgésie obstétricale et douleurs du post-partum

Article
  • 90 Downloads

Résumé

Les douleurs sévères aiguës du post-partum sont plus fréquentes qu’on ne le croit que ce soit après un accouchement par voie vaginale ou une césarienne. De plus, l’incidence rapportée dans la littérature de douleurs chroniques post-césarienne est relativement élevée et avec l’augmentation constante du taux de césariennes, risque de devenir un problème tangible. Quand on interroge les femmes sur leurs craintes et angoisses les plus importantes pendant l’accouchement, celles-ci rapportent que la douleur pendant la césarienne est ce qui les effraie le plus. La variabilité interindividuelle dans la sévérité de la douleur post-accouchement ou césarienne est influencée par de multiples facteurs tels que la sensibilité à la douleur, des facteurs psychologiques, l’âge et la variabilité génétique entre autres. Cette revue tente de revoir le concept de modèles permettant de prédire le risque de douleur aiguë sévère et douleur neuropathique résiduelle après accouchement vaginal ou césarienne, ainsi que de présenter les modalités antalgiques efficaces dans le contexte de la césarienne, avec une mention particulière pour les stratégies visant à prévenir la chronicisation de la douleur du post-partum.

Mots clés

Accouchement Césarienne Douleur Neurogène Péridural Intrathécal Opiacés 

Obstetric analgesia and postpartum pain

Abstract

Acute severe post-partum pain occurs more often than is thought both after vaginal and cesarean deliveries. Furthermore, the incidence of chronic pain after cesarean section has been reported to be relatively high and with the constant increase in cesarean section rates this could become a significant clinical problem. When questioning women’s fear and expectations, pain during and after cesarean section is the greatest concern. Individual variability in severity of post vaginal or operative delivery pain is influenced by multiple factors including sensitivity to pain, psychological factors, age, and genetics and leads to variability in postdelivery pain experience as well as requirements for analgesics. This review attempts to report on predictive models for the incidence of severe acute pain and chronic residual pain after both vaginal and cesarean deliveries, as well as present effective analgesic regimens for acute pain after cesarean deliveries with some focus on strategies to prevent chronicization of pain.

Keywords

Delivery Cesarean section Pain Neuropathic Epidural Spinal Opioids 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. 1.
    Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95(1): 69–76PubMedCrossRefGoogle Scholar
  2. 2.
    ACOG (2004) Committee Opinion #295: pain relief during labor. Obstet Gynecol 104(1): 213Google Scholar
  3. 3.
    Baka NE, Bayoumeu F, Boutroy MJ, et al. (2002) Colostrum morphine concentrations during post-caesarean intravenous patient-controlled analgesia. Anesth Analg 94(1): 184–187, table of contentsPubMedCrossRefGoogle Scholar
  4. 4.
    Benhamou D, Thorin D, Brichant JF, et al. (1998) Intrathecal clonidine and fentanyl with hyperbaric bupivacaine improves analgesia during caesarean section. Anesth Analg 87(3): 609–613PubMedCrossRefGoogle Scholar
  5. 5.
    Brandsborg B, Nikolajsen L, Hansen CT, et al. (2007) Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study. Anesthesiology 106(5): 1003–1012PubMedCrossRefGoogle Scholar
  6. 6.
    Capogna G, Celleno D, Zangrillo A, et al. (1995) Addition of clonidine to epidural morphine enhances postoperative analgesia after cesarean delivery Reg Anesth 20(1): 57–61PubMedGoogle Scholar
  7. 7.
    Carvalho B, Cohen SE, Lipman SS, et al. (2005) Patient preferences for anesthesia outcomes associated with caesarean delivery. Anesth Analg 101(4): 1182–1187, table of contentsPubMedCrossRefGoogle Scholar
  8. 8.
    Carvalho B, Roland LM, Chu LF, et al. (2007) Single-dose, extendedrelease epidural morphine (DepoDur) compared to conventional epidural morphine for post-caesarean pain. Anesth Analg 105(1): 176–183PubMedCrossRefGoogle Scholar
  9. 9.
    De Kock M, Lavand’homme P, Waterloos H (2005) The short-lasting analgesia and long-term antihyperalgesic effect of intrathecal clonidine in patients undergoing colonic surgery. Anesth Analg 101(2): 566–572, table of contentsPubMedCrossRefGoogle Scholar
  10. 10.
    Duale C, Frey C, Bolandard F, et al. (2003) Epidural versus intrathecal morphine for postoperative analgesia after caesarean section. Br J Anaesth 91(5): 690–694PubMedCrossRefGoogle Scholar
  11. 11.
    Eisenach JC, d’Angelo R, Taylor C, et al. (1994) An isobolographic study of epidural clonidine and fentanyl after caesarean section. Anesth Analg 79(2): 285–290PubMedCrossRefGoogle Scholar
  12. 12.
    Filos KS, Goudas LC, Patroni O, et al. (1992) Intrathecal clonidine as a sole analgesic for pain relief after caesarean section. Anesthesiology 77(2): 267–274PubMedCrossRefGoogle Scholar
  13. 13.
    Fredman B, Shapiro A, Zohar E, et al. (2000) The analgesic efficacy of patient-controlled ropivacaine instillation after caesarean delivery. Anesth Analg 91(6): 1436–1440PubMedCrossRefGoogle Scholar
  14. 14.
    Givens VA, Lipscomb GH, Meyer NL. A randomized trial of postoperative wound irrigation with local anaesthetic for pain after caesarean delivery. Am J Obstet Gynecol 2002; 186(6): 1188–1191PubMedCrossRefGoogle Scholar
  15. 15.
    Granot M, Lowenstein L, Yarnitsky D, et al. (2003) Post-caesarean section pain prediction by preoperative experimental pain assessment. Anesthesiology 98(6): 1422–1426PubMedCrossRefGoogle Scholar
  16. 16.
    Hsu HW, Cheng YJ, Chen LK, et al. (2003) Differential analgesic effect of tenoxicam on the wound pain and uterine cramping pain after caesarean section. Clin J Pain 19(1): 55–58PubMedCrossRefGoogle Scholar
  17. 17.
    Huang YC, Tsai SK, Huang CH, et al. (2002) Intravenous tenoxicam reduces uterine cramps after caesarean delivery. Can J Anaesth 49(4): 384–387PubMedGoogle Scholar
  18. 18.
    Kaya FN, Sahin S, Owen MD, et al. (2004) Epidural neostigmine produces analgesia but also sedation in women after caesarean delivery. Anesthesiology 100(2): 381–385PubMedCrossRefGoogle Scholar
  19. 19.
    Landau R, Lavand’homme P, Houle TT, et al. (2007) Predictive factors for acute pain after vaginal and caesarean delivery. Anesthesiology suppl 106: A27 (abstract)Google Scholar
  20. 20.
    Lavand’homme P, De Kock M (2006) The use of intraoperative epidural or spinal analgesia modulates postoperative hyperalgesia and reduces residual pain after major abdominal surgery. Acta Anaesthesiol Belg 57(4): 373–379PubMedGoogle Scholar
  21. 21.
    Lavand’homme P, De Kock M, Waterloos H (2005) Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology 103(4): 813–820PubMedCrossRefGoogle Scholar
  22. 22.
    Lavand’homme (2006) Post-caesarean analgesia: effective strategies and association with chronic pain. Curr Opin Anaesthesiol 19(3): 244–248PubMedCrossRefGoogle Scholar
  23. 23.
    Lavand’homme PM, Roelants F, Waterloos H, et al. (2007) Postoperative analgesic effects of continuous wound infiltration with diclofenac after elective caesarean delivery. Anesthesiology 106(6): 1220–1225PubMedCrossRefGoogle Scholar
  24. 24.
    Lavand’homme P, Roelants F, Fuzier-mercier V, et al. (2006) Postoperative analgesic and antihyperalgesic effects of spinal clonidine for caesarean section. Anesthesiology suppl A997 (abstract)Google Scholar
  25. 25.
    Lim Y, Jha S, Sia AT, et al. (2005) Morphine for post-caesarean section analgesia: intrathecal, epidural or intravenous? Singapore Med J 46(8): 392–396PubMedGoogle Scholar
  26. 26.
    Maguire MF, Ravenscroft A, Beggs D, et al. (2006) A questionnaire study investigating the prevalence of the neuropathic component of chronic pain after thoracic surgery. Eur J Cardiothorac Surg 29(5): 800–805PubMedCrossRefGoogle Scholar
  27. 27.
    Melzack R (1993) Labour pain as a model of acute pain. Pain 53(2): 117–120PubMedCrossRefGoogle Scholar
  28. 28.
    Melzack R (1984) The myth of painless childbirth (the John J. Bonica lecture). Pain 19(4): 321–337PubMedCrossRefGoogle Scholar
  29. 29.
    Nielsen PR, Norgaard L, Rasmussen LS, et al. (2007) Prediction of postoperative pain by an electrical pain stimulus. Acta Anaesthesiol Scand 51(5): 582–586PubMedCrossRefGoogle Scholar
  30. 30.
    Nikolajsen L, Brandsborg B, Lucht U, et al. (2006) Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Acta Anaesthesiol Scand 50(4): 495–500PubMedCrossRefGoogle Scholar
  31. 31.
    Nikolajsen L, Sorensen HC, Jensen TS, et al. (2004) Chronic pain following caesarean section. Acta Anaesthesiol Scand 48(1): 111–116PubMedCrossRefGoogle Scholar
  32. 32.
    Paech MJ, Pavy TJ, Orlikowski CE, et al. (2004) Post-caesarean analgesia with spinal morphine, clonidine, or their combination. Anesth Analg 98(5): 1460–1466, table of contentsPubMedCrossRefGoogle Scholar
  33. 33.
    Palmer CM, Emerson S, Volgoropolous D, et al. (1999) Doseresponse relationship of intrathecal morphine for post-caesarean analgesia. Anesthesiology 90(2): 437–444PubMedCrossRefGoogle Scholar
  34. 34.
    Pan PH, Coghill R, Houle TT, et al. (2006) Multifactorial preoperative predictors for post-caesarean section pain and analgesic requirement. Anesthesiology 104(3): 417–425PubMedCrossRefGoogle Scholar
  35. 35.
    Pan PH, Smiley RM, Houle TT, et al. (2007) Chronic pain after delivery is it different between vaginal and operative deliveries? Anesthesiology suppl 106(A-28 (abstract)Google Scholar
  36. 36.
    Pan PH, Smiley RM, Houle TT, et al. (2007) Predictive factors for chronic pain at eight weeks after vaginal or caesarean deliveries. Anesthesiology suppl 106(A-133 (abstract)Google Scholar
  37. 37.
    Perkins FM, Kehlet H (2000) Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 93(4): 1123–1133Google Scholar
  38. 38.
    Roelants F (2006) The use of neuraxial adjuvant drugs (neostigmine, clonidine) in obstetrics. Curr Opin Anaesthesiol 19(3): 233–237PubMedCrossRefGoogle Scholar
  39. 39.
    Sarvela J, Halonen P, Soikkeli A, et al. (2002) A double blinded, randomized comparison of intrathecal and epidural morphine for elective caesarean delivery. Anesth Analg 95(2): 436–440, table of contentsPubMedCrossRefGoogle Scholar
  40. 40.
    Sen S, Ozmert G, Aydin ON, et al. (2005) The persisting analgesic effect of low-dose intravenous ketamine after spinal anaesthesia for caesarean section. Eur J Anaesthesiol 22(7): 518–523PubMedCrossRefGoogle Scholar
  41. 41.
    Siddik SM, Aouad MT, Jalbout MI, et al. (2001) Diclofenac and/or propacetamol for postoperative pain management after caesarean delivery in patients receiving patient controlled analgesia morphine. Reg Anesth Pain Med 26(4): 310–315PubMedCrossRefGoogle Scholar
  42. 42.
    Van Tuijl I, Van Klei WA, Van der Werff DB, et al. (2006) The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain and morphine requirements after caesarean section: a randomized controlled trial. Br J Anaesth 97(3): 365–370PubMedCrossRefGoogle Scholar
  43. 43.
    Vicente KJ, Kada-Bekhaled K, Hillel G, et al. (2003) Programming errors contribute to death from patient-controlled analgesia: case report and estimate of probability. Can J Anaesth 50(4): 328–332PubMedCrossRefGoogle Scholar
  44. 44.
    Wilder-Smith CH, Hill L, Dyer RA, et al. (2003) Postoperative sensitization and pain after caesarean delivery and the effects of single intramuscular doses of tramadol and diclofenac alone and in combination. Anesth Analg 97(2): 526–533, table of contentsPubMedCrossRefGoogle Scholar
  45. 45.
    Woolf CJ, Salter MW (2000) Neuronal plasticity: increasing the gain in pain. Science 288(5472): 1765–1769PubMedCrossRefGoogle Scholar
  46. 46.
    Yost NP, Bloom SL, Sibley MK, et al. (2004) A hospital-sponsored quality improvement study of pain management after caesarean delivery. Am J Obstet Gynecol 190(5): 1341–1346PubMedCrossRefGoogle Scholar
  47. 47.
    Zohar E, Luban I, Zunser I, et al. (2002) Patient-controlled bupivacaine wound instillation following caesarean section: the lack of efficacy of adjuvant ketamine. J Clin Anesth 14(7): 505–511PubMedCrossRefGoogle Scholar
  48. 48.
    Zohar E, Shapiro A, Eidinov A, et al. (2006) Post-cesarean analgesia: the efficacy of bupivacaine wound instillation with and without supplemental diclofenac. J Clin Anesth 18(6): 415–421PubMedCrossRefGoogle Scholar

Copyright information

© Médecine et Hygiène et Springer-Verlag France 2007

Authors and Affiliations

  1. 1.Service d’AnesthésiologieHôpitaux universitaires de GenèveGenève 14Suisse

Personalised recommendations