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The influence of preoperative epidural labor analgesia on postoperative pain in parturients undergoing emergency cesarean section

A retrospective analysis

Einfluss der präoperativen Epiduralanästhesie auf den postoperativen Schmerz bei Gebärenden mit Notfall-Kaiserschnitt

Eine retrospektive Analyse

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Abstract

Background

Intense noxious input from the periphery may result in central sensitization and hyperexcitability, thus accentuating subsequent postoperative pain. Parturients who undergo emergency cesarean section (C-sec) after experiencing labor pain often develop labor pain-induced sensitization.

Objective

This retrospective study evaluated whether parturients without epidural labor analgesia (ELA) who underwent emergency C‑sec, experienced more severe postoperative pain and required more rescue analgesics during the postoperative period.

Methods

The institution’s medical database was searched for parturients who underwent emergency C‑sec under spinal anesthesia for any reason between January 2013 and December 2016. Those who underwent elective C‑sec under spinal anesthesia were included as the reference arm. Parturients were divided into three groups: ELA, no-ELA and elective. Characteristics of patients and perioperative outcomes were evaluated. As primary outcomes, numerical rating scale (NRS) for postoperative pain (0–10) was recorded up to 96 h postoperatively, and use of rescue analgesics was evaluated at 6, 24, and 48 h postoperatively.

Results

In the ELA, no-ELA, and elective groups, 61, 73, and 88 parturients, respectively, were ultimately enrolled. The NRS for pain were similar among the three groups, except at 6 h postoperatively. Parturients in the no-ELA group demonstrated significantly higher NRS at 6 h postoperatively than those in the ELA group (P = 0.01).More patients in the no-ELA group required rescue analgesics than in the ELA (P = 0.001) and elective groups (P < 0.001) at 6–24 h postoperatively. Moreover, the proportion of patients requiring rescue analgesics ≥2 times was also significantly higher in the no-ELA group (vs. the ELA group, P = 0.004; vs. the elective group, P < 0.001).

Conclusion

Parturients undergoing emergency C‑sec without ELA management during labor experienced greater postoperative pain and a greater use of rescue analgesics during the postoperative period. The findings suggest that administration of ELA before emergency C‑sec may act as pre-emptive analgesia against postoperative pain.

Zusammenfassung

Hintergrund

Intensive periphere Schmerzstimuli können zu einer zentralen Sensibilisierung und Übererregbarkeit führen, wodurch sich die späteren postoperativen Schmerzen verstärken können. Gebärende, die sich unter Wehenschmerzen einem Notfall-Kaiserschnitt unterziehen, entwickeln häufig eine wehenschmerzbedingte Sensibilisierung.

Ziele

In dieser retrospektiven Studie wurde untersucht, ob bei Gebärenden ohne Epiduralanästhesie (EDA), bei denen ein Notfall-Kaiserschnitt durchgeführt wurde, stärkere postoperative Schmerzen auftraten und im postoperativen Zeitraum mehr Zusatzanalgetika erforderlich waren.

Methoden

Die medizinische Datenbank der Einrichtung wurde nach Gebärenden durchsucht, bei denen zwischen Januar 2013 und Dezember 2016 aus irgendeinem Grund ein Notfall-Kaiserschnitt unter Spinalanästhesie durchgeführt wurde. Diejenigen, die einen elektiven Kaiserschnitt unter Spinalanästhesie erhielten, wurden als Vergleichsgruppe gescreent. Die Gebärenden wurden in 3 Gruppen unterteilt: EDA-, Nicht-EDA- und elektive Gruppe. Es wurden Daten zu den Patientencharakteristika sowie zum perioperativen und postoperativen Verlauf erfasst. Als primäre Ergebnisse wurde die numerische Rating-Skala (NRS) für postoperative Schmerzen (0–10) bis 96 h postoperativ aufgezeichnet und die Anwendung von Zusatzanalgetika wurde 6, 24 und 48 h postoperativ bewertet.

Ergebnisse

Bei der EDA-, Nicht-EDA- und elektiven Gruppe wurden letztendlich 61, 73 bzw. 88 Gebärende eingeschlossen. Die NRS-Scores für postoperative Schmerzen waren in den 3 Gruppen ähnlich, mit Ausnahme von 6 h postoperativ. Die Gebärenden in der Nicht-EDA-Gruppe zeigten 6 h postoperativ eine signifikant höhere NRS-Werte als diejenigen in der EDA-Gruppe (p = 0,01). Allerdings benötigten 6–24 h nach der Operation mehr Patienten in der Nicht-EDA-Gruppe Zusatzanalgetika als in der EDA-Gruppe (p = 0,001) und der elektiven Gruppe (p < 0,001). Darüber hinaus war der Anteil der Patienten, die mehr als 2‑mal so viele Zusatzanalgetika benötigten, in der Nicht-EDA-Gruppe signifikant höher als in den beiden anderen Gruppen (gegenüber der EDA-Gruppe, p = 0,004; gegenüber der elektiven Gruppe, p < 0,001).

Schlussfolgerung

Bei Gebärenden, die in der Wehenperiode einen Notfall-Kaiserschnitt ohne EDA erhielten, traten stärkere postoperative Schmerzen auf, denen während der postoperativen Zeit ein verstärkter Einsatz von Zusatzanalgetika folgte. Die Ergebnisse legen nahe, dass die Verabreichung von EDA vor einem Notfall-Kaiserschnitt als präventive Analgesie gegen postoperative Schmerzen wirken kann.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of)

    H.-Y. Park, Y.-W. Park, J.-W. Hwang, S.-H. Do & H.-S. Na

  2. Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Gachon, Korea (Republic of)

    H.-Y. Park

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  1. H.-Y. Park
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  2. Y.-W. Park
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Correspondence to H.-S. Na.

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Conflict of interest

H.-Y. Park, Y.-W. Park, J.-W. Hwang, S.-H. Do and H.-S. Na declare that they have no competing interests. This research did not receive any specific grant from funding agencies in the public, commercial, or no-for-profit sectors.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee (Institutional Review Board of Seoul National University Bundang Hospital (B-1709/418-105)) and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. The requirement for informed consent was waived.

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Park, HY., Park, YW., Hwang, JW. et al. The influence of preoperative epidural labor analgesia on postoperative pain in parturients undergoing emergency cesarean section. Anaesthesist 69, 352–358 (2020). https://doi.org/10.1007/s00101-020-00753-2

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