Risk factors of inadequate pain control after cesarean delivery under neuraxial anesthesia
Journal Title: Journal of Air Force Medical University - Year 2023, Vol 44, Issue 4
Abstract
Objective To analyze the risk factors of inadequate pain control in parturients who received neuraxial anesthesia and underwent patient-controlled intravenous analgesia ( PCIA) after cesarean delivery ( CD). Methods The parturients who underwent CD in Xijing Hospital, Air Force Medical University from July 2017 to July 2020 were screened, and according to the 24 h postoperative activity pain score [using Numerical Rating Scale (NRS)], they were divided into no to mild pain (NRS 0 -3 points) group and moderate to severe pain (NRS 4 -10 points) group. Demographic, co-morbidity, obstetric and perioperative data of parturients in the two groups were collected. Univariate and multivariate logistic regression analysis was used to identify the risk factors that might be related to moderate to severe pain after CD. Results Finally, 2 254 cases were included for analysis, and 1 992 cases experienced moderate to severe pain, with an incidence of 88. 4%. Univariate logistic regression analysis showed that postoperative PCIA formula, preoperative combination of gestational diabetes mellitus (GDM), intraoperative combination of other operations, intraoperative epidural morphine, and intraoperative intravenous injection of non-steroid anti-inflammatory drugs (NSAIDs) were statistically associated with moderate to severe pain after CD (P <0. 01, P <0. 05). Multivariate logistic regression analysis showed that the following factors were associated with moderate to severe pain after CD: PCIA formula (P < 0. 001, OR = 0. 588, 95% CI: 0. 439 0. 788 in sufentanil + nalbuphine group; P = 0. 013, OR = 1. 828, 95% CI: 1. 136 2. 941 in fentanyl group), GDM (P = 0. 013, OR = 2. 262, 95% CI: 1. 184 4. 320), intraoperative epidural morphine ( P = 0. 023, OR = 0. 428, 95% CI: 0. 206 0. 889 ) and intraoperative intravenous injection of NSAIDs (P < 0. 001, OR = 0. 508, 95% CI: 0. 388 0. 665). Conclusion GDM is a risk factor of inadequate pain control after CD under neuraxial anesthesia. Intraoperative epidural morphine and intravenous injection of NSAIDs can reduce the occurrence of moderate to severe pain after CD. Compared with sufentanil or fentanyl, the combination of nalbuphine and sufentanil in PCIA formula can also reduce the occurrence of inadequate pain control.
Authors and Affiliations
WANG Yiting, WANG Lini, WANG Huan, NIE Huang
Keywords
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