Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Neuroaxial Anaesthesia and Safety Aspects
3.2. Comparison of Short-Acting versus Long-Acting Neuroaxial Opioids
3.3. Local and Regional Anesthesia Procedures
3.4. Dexamethasone
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Antoine, C.; Young, B.K. Cesarean section one hundred years 1920–2020: The Good, the Bad and the Ugly. J. Perinat. Med. 2020, 49, 5–16. [Google Scholar] [CrossRef]
- Gamez, B.H.; Habib, A.S. Predicting severity of acute pain after Cesarean delivery: A narrative review. Anesth. Analg. 2018, 126, 1606–1614. [Google Scholar] [CrossRef]
- Weibel, S.; Neubert, K.; Jelting, Y.; Meissner, W.; Wöckel, A.; Roewer, N.; Kranke, P. Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis. Eur. J. Anaesthesiol. 2016, 33, 853–865. [Google Scholar] [CrossRef]
- Schug, S.A.; Bruce, J. Risk stratification for the development of chronic postsurgical pain. Pain Rep. 2017, 2, e627. [Google Scholar] [CrossRef] [PubMed]
- Fletcher, D.; Stamer, U.M.; Pogatzki-Zahn, E.; Zaslansky, R.; Tanase, N.V.; Perruchoud, C.; Kranke, P.; Komann, M.; Lehman, T.; Meissner, W. euCPSP group for the Clinical Trial Network group of the European Society of Anaesthesiology. Chronic postsurgical pain in Europe: An observational study. Eur. J. Anaesthesiol. 2015, 32, 725–734. [Google Scholar] [CrossRef]
- Lavande’Homme, P. Postpartum chronic pain. Minerva Anestesiol. 2019, 85, 320–324. [Google Scholar] [CrossRef] [PubMed]
- Bijl, R.C.; Freeman, L.M.; Weijenborg, P.T.; Middeldorp, J.M.; Dahan, A.; van Dorp, E.L. A retrospective study on persistent pain after childbirth in the Netherlands. J. Pain Res. 2016, 9, 1–8. [Google Scholar]
- Apfelbaum, J.L.; Hawkins, J.L.; Agarkar, M.; Bucklin, B.A.; Connis, R.T.; Gambling, D.R.; Mhyre, J.; Nickinovich, D.G.; Sherman, H.; Tsen, L.C.; et al. Practice guidelines for obstetric anesthesia: An updated report by the American Society of Anesthesiologists Task Force onObstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016, 124, 270–300. [Google Scholar]
- Committee on Practice Bulletins—Obstetrics. Practice bulletin No. 177: Obstetric analgesia and anesthesia. Obstet Gynecol. 2017, 129, e73–e89. [Google Scholar] [CrossRef]
- Yonekura, H.; Mazda, Y.; Noguchi, S.; Tsunobuchi, H.; Shimaoka, M. Current epidemiology of the general anesthesia practice for cesarean delivery using a nationwide claims database in Japan: A descriptive study. J. Clin. Med. 2022, 11, 4808. [Google Scholar] [CrossRef]
- Guglielminotti, J.; Landau, R.; Li, G. Adverse events and factors associated with potentially avoidable use of general anesthesia in cesarean deliveries. Anesthesiology 2019, 130, 912–922. [Google Scholar] [CrossRef]
- D’Angelo, R.; Smiley, R.M.; Riley, E.T.; Segal, S. Serious complications related to obstetric anesthesia: The serious complication repository project of the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2014, 120, 1505–1512. [Google Scholar] [CrossRef]
- Bremerich, D.; Annecke, T.; Chappell, D.; Hanß, R.; Kaufner, L.; Kehl, F.; Kranke, P.; Girad, T.; Gogarten, W.; Greve, S.; et al. Die Geburtshilfliche Analgesie und Anästhesie. S1-Leitlinie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin in Zusammenarbeit mit der Deutschen Gesellschaft für Gynäkologie. 2020; AWMF-Leitlinie. Available online: https://register.awmf.org/assets/guidelines/001-038l_S1_Die-geburtshilfliche-Analgesie-und-Anaesthesie_2020-03.pdf (accessed on 14 November 2023).
- Seki, H.; Shiga, T.; Mihara, T.; Hoshijima, H.; Hosokawa, Y.; Hyuga, S.; Fujita, T.; Koshika, K.; Okada, R.; Kurose, H.; et al. Effects of intrathecal opioids on cesarean section: A systematic review and Bayesian network meta-analysis of randomized controlled trials. J. Anesth. 2021, 35, 911–927. [Google Scholar] [CrossRef]
- NICE Guideline NG192. Caesarean Birth. 2021. Available online: https://www.nice.org.uk/guidance/NG192 (accessed on 14 November 2023).
- Vyas, N.; Sahu, D.K.; Parampill, R. Comparative study of intrathecal sufentanil bupivacaine versus intrathecal bupivacaine in patients undergoing elective cesarean section. J. Anaesthesiol. Clin. Pharmacol. 2010, 26, 488–492. [Google Scholar] [CrossRef]
- Bremerich, D. Pain therapy after C-section. Anästh. Intensivmed. 2019, 60, 394–402. [Google Scholar]
- Chen, X.; Qian, X.; Fu, F.; Fu, H.; Bein, B. Intrathecal sufentanil decreases the median effective dose (ED50) of intrathecal hyperbaric ropivacaine of caesarean delivery. Acta Anaesthesiol. Scand. 2010, 54, 284–290. [Google Scholar] [CrossRef] [PubMed]
- Sultan, P.; Gutierrez, M.C.; Carvalho, B. Neuroaxial morphine and respiratory depression: Finding the right balance. Drugs. 2011, 71, 1807–1819. [Google Scholar] [CrossRef]
- Agrawal, A.; Asthana, V.; Sharma, J.P.; Gupta, V. Efficacy of lipophilic vs lipophobic opioids in addition to hyperbaric bupivacaine for patients undergoing lower segment caesarean section. Anesth. Essays. Res. 2016, 10, 420–424. [Google Scholar] [PubMed]
- Staikou, C.; Paraskeva, A. The effects of intrathecal and systemic adjuvants on subarachnoid block. Minerva Anesthesiol. 2014, 80, 96–112. [Google Scholar]
- Kinsella, S.M.; Winton, A.L.; Mushambi, M.C.; Ramaswamy, K.; Swales, H.; Quinn, A.C.; Popat, M. Failed tracheal intubation during obstetric general anaesthesia: A literature review. Int. J. Obstet. Anesth. 2015, 24, 356–374. [Google Scholar] [CrossRef]
- Quinn, A.C.; Milne, D.; Columb, M.; Gorton, H.; Knight, M. Failed tracheal intubation in obstetric anaesthesia: 2 yr national case-control study in the UK. Br. J. Anaesth. 2013, 110, 74–80. [Google Scholar] [CrossRef] [PubMed]
- Ong, B.Y.; Cohen, M.M.; Palahniuk, R.J. Anesthesia for cesarean section–effects on neonates. Anesth. Analg. 1989, 68, 270–275. [Google Scholar] [CrossRef]
- Maternal Mortality 2019–2021. Available online: https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2019-2021 (accessed on 14 November 2023).
- Hawkins, J.L. Anesthesia-related maternal mortality. Clin. Obstet. Gynecol. 2003, 46, 679–687. [Google Scholar] [CrossRef] [PubMed]
- Sharawi, N.; Carvalho, B.; Habib, A.S.; Blake, L.; Mhyre, J.M.; Sultan, P. A systematic review evaluating neuraxial morphine and diamorphine-associated respiratory depression after cesarean delivery. Obstet. Anesthesiol. 2018, 127, 1385–1395. [Google Scholar] [CrossRef] [PubMed]
- Amstrong, S.; Fernando, R. Side-effects and efficacy of neuraxial opioids in pregnant patients at delivery: A comprehensive review. Drug Safety 2016, 39, 381–399. [Google Scholar] [CrossRef] [PubMed]
- Abdollahpour, A.; Azadi, R.; Bandari, R.; Mirmohammadkhani, M. Effects of adding midazolam and sufentanil to intrathecal bupivacaine on analgesia quality and postoperative complications in elective cesarean section. Anesthesiol. Pain Med. 2015, 5, e23565. [Google Scholar] [CrossRef] [PubMed]
- Ali, W.A.; Mohammed, M.; Abdelraheim, A.R. Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial. Indian J. Anaesth. 2020, 64, 965–970. [Google Scholar] [CrossRef]
- Bhattacharjee, A.; Singh, N.R.; Singh, S.S.; Debbrama, B.; Debbarma, P.; Singh, T.H. A comparative study of intrathecal clonidine and fentanyl along with bupivacaine in spinal anesthesia for caesarean section. J. Med. Soc. 2015, 29, 145–149. [Google Scholar]
- Bindra, T.K.; Kumar, P.; Jindal, G. Postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl in cesarean section: A double-blind randomized comparative study. Anesth. Essays Res. 2018, 12, 561–565. [Google Scholar] [CrossRef]
- Berger, J.S.; Gonzalez, A.; Hopkins, A.; Alshaeri, T.; Jeon, D.; Wang, S.; Amdur, R.L.; Smiley, R. Dose-response of intrathecal mor-phine when administered with intravenous ketorolac for post-cesarean analgesia: A two-center, prospective, randomized, blinded trial. Int. J. Obstet. Anesth. 2016, 28, 3–11. [Google Scholar] [CrossRef]
- Booth, J.L.; Harris, L.C.; Eisenach, J.C.; Pan, P.H. A randomized controlled trial comparing two multimodal analgesic tech-niques in patients predicted to have severe pain after cesarean delivery. Anesth. Analg. 2016, 122, 1114–1119. [Google Scholar] [CrossRef]
- Carvalho, B.; Mirza, F.; Flood, P. Patient choice compared with no choice of intrathecal morphine dose for caesarean analgesia: A randomized clinical trial. Br. J. Anaesth. 2017, 118, 762–771. [Google Scholar] [CrossRef]
- Carvalho, B.; Sutton, C.D.; Kowalczyk, J.J.; Flood, P.D. Impact of patient choice for different analgesic protocols on opioid consumption: A randomized prospective trial. Reg. Anesth. Pain Med. 2019, 44, 578–585. [Google Scholar] [CrossRef]
- Sharpe, E.E.; Molitor, R.J.; Arendt, K.W.; Torbenson, V.E.; Olsen, D.A.; Johnson, R.L.; Schroeder, D.R.; Jacob, A.K.; Niesen, A.D.; Sviggum, H.P. Intrathecal morphine versus intrathecal hydromorphone for analgesia after caesarean delivery. Anesthesiology 2020, 132, 1382–1391. [Google Scholar] [CrossRef]
- Dahl, J.B.; Jeppesen, I.S.; Jørgensen, H.; Wetterslev, J.; Møiniche, S. 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 1999, 91, 1919–1927. [Google Scholar] [CrossRef]
- Sultan, P.; Halpern, S.H.; Pushpanathan, E.; Patel, S.; Carvalho, B. The effect of intrathecal morphine dose on outcomes after elective cesarean delivery: A meta-analysis. Anesth. Analg. 2016, 123, 154–164. [Google Scholar] [CrossRef]
- Botea, M.O.; Diana Lungeanu, D.; Petrica, A.; Sandor, M.I.; Huniadi, A.C.; Barsac, C.; Marza, A.M.; Moisa, R.C.; Maghiar, L.; RaluBotea, R.M.; et al. Perioperative analgesia and patients’ satisfaction in spinal anesthesia for cesarean section: Fentanyl versus morphine. J. Clin. Med. 2023, 12, 6346. [Google Scholar] [CrossRef]
- Roofthooft, E.; Joshi, G.P.; Rawal, N.; Van de Velde, M.; on behalf of the PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy and supported by the Obstetric Anaesthetists Association. PROSPECT guideline for elective caesarean section: Update systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2022, 76, 665–680. [Google Scholar] [CrossRef] [PubMed]
- Tamura, T.; Yokota, S.; Ito, S.; Shibata, Y.; Nishiwaki, K. Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: A crossover volunteer study. J. Anesth. 2019, 33, 26–32. [Google Scholar] [CrossRef] [PubMed]
- Blanco, R. The mechanism of the quadratus lumborum block: A peripheral sympathetic field block? Br. J. Anaesth. 2016, 117. [Google Scholar] [CrossRef]
- Shao, L.; Luo, X.; Ye, Y.; Liu, L.; Cai, Y.; Xia, Y.; Papadimos, T.J.; Wang, Q.; Pan, L. Anterior Quadratus Lumborum block area comparison in the three different volumes of ropivacaine: A double-blind, randomized controlled trial in healthy volunteers. BMC Anesthesiol. 2022, 22, 365. [Google Scholar] [CrossRef]
- Aoyama, Y.; Sakura, S.; Abe, S.; Wada, M.; Saito, Y. Analgesic effects and distribution of cutaneous sensory blockade of quadratus lumborum block type 2 and posterior transversus abdominis plane block: An observational comparative study. Korean J. Anesthesiol. 2020, 73, 326–333. [Google Scholar] [CrossRef] [PubMed]
- Hussain, N.; Brull, R.; Weaver, T.; Zhou, M.; Essandoh, M.; Abdallah, F.W. Postoperative analgesic effectiveness of quadratus lumborum block for cesarean delivery under spinal anesthesia. Anesthesiology 2021, 134, 72–87. [Google Scholar] [CrossRef]
- Hansen, C.K.; Dam MSteingrimsdottir, G.E.; Laier, G.H.; Lebech, M.; Poulsen, T.D.; Chan, V.W.S.; Wolmarans, M.; Bendtsen, T.F.; Børglum, J. Ultrasound-guided transmuscular quadratus lumborum block for elective cesarean section significantly reduces postoperative opioid consumption and prolongs time to first opioid request: A double-blind randomized trial. Reg. Anesth. Pain Med. 2019, 44, 896–900. [Google Scholar] [CrossRef]
- Krohg, A.; Ullensvang, K.; Rosseland, L.A.; Langesæter, E.; Sauter, A.R. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: A randomized clinical trial. Anesth. Analg. 2018, 126, 559–565. [Google Scholar] [CrossRef] [PubMed]
- Gabriel, R.A.; Burton, B.N.; Curran, B.P.; Urman, R.D. Regional anesthesia abdominal blocks and local infiltration after cesarean delivery: Review of current evidence. Curr. Pain Headache Rep. 2021, 24, 28. [Google Scholar] [CrossRef]
- Singh, N.P.; Monks, D.; Makkar, J.K.; Palanisamy, A.; Sultan, P.; Singh, P.M. Efficacy of regional blocks or local anaesthetic infiltration for analgesia after caesarean delivery: A network meta-analysis of randomised controlled trials. Anaesthesia 2022, 77, 377–380. [Google Scholar] [CrossRef]
- Telnes, A.; Skogvoll, E.; Lonnee, H. Transversus abdominis plane block vs. Wound infiltration in caesarean section: A randomised controlled trial. Acta Anaesthesiol. Scand. 2015, 59, 496–504. [Google Scholar] [CrossRef] [PubMed]
- Tawfik, M.M.; Mohamed, Y.M.; Elbadraw, R.E. Transversus abdominis plane block versus wound infiltration for analgesia after cesarean delivery: A randomized controlled trial. Anesth. Analg. 2017, 124, 1291–1297. [Google Scholar] [CrossRef]
- Grape, S.; Kirkham, K.R.; Albrecht, E. Transversus abdominis plane block versus local anaesthetic wound infiltration for analgesia after caesarean section. Eur. J. Anaesthesiol. 2022, 39, 244–251. [Google Scholar] [CrossRef]
- Stopar-Pintaric, T.; Blajic, I.; Visic, U.; Znider, M.; Plesnicar, A.; Vlassakov, K.; Lucovnik, M. Posteromedial quadratus lumborum block versus wound infiltration after caesarean section. Eur. J. Anaesthesiol. 2021, 38, 138–144. [Google Scholar] [CrossRef]
- Aksoy, H.; Gökahmetoglu, G.; Ak, M.; Aksoy, Ü. Subcutaneous wound infiltration of ketamine is superior to bupivacaine in terms of pain perception and opioid consumption after cesarean section: A double-blinded randomized placebo-controlled clinical trial. Eur. Rev. Med. Pharmacol. Sci. 2023, 27, 8860–8867. [Google Scholar]
- Bozorgmanesh, M.; Valibeik, S.; Shokrpour, M.; Maktabi, M.; Kamali, A. Effect of combined paracetamol and dexmethasone vs. paracetamol on postoperative nausea vomiting after cesarean section. J. Perinat. Med. 2022, 50, 1067–1072. [Google Scholar] [CrossRef]
- Ankouni, T.; Kanawati, S.; Khatib, R.E.; Hassan, J.E.; Itani, S.E.; Rajab, O.; Naja, Z. Ondansetron versus ondansetron with dexamethasone to prevent intrathecal-morphine pruritus for caesarean patients: Randomised double-blind trial. J. Obstet. Gynaecol. 2021, 41, 1080–1086. [Google Scholar] [CrossRef] [PubMed]
- Singh, N.P.; Makkar, J.K.; Yadav, N.; Goudra, B.G.; Singh, P.M. The analgesic efficiency of intravenous dexamethasone for postcaesarean pain. A systematic review with meta-analysis and trial sequential analysis. Eur. J. Anaesthesiol. 2022, 39, 498–510. [Google Scholar] [CrossRef] [PubMed]
- Kiasari, A.Z.; Aghaei, N.; Aezzi, G.; Alipour, A.; Ghavibonyeh, K. Effects of intrathecal and intravenous dexamethasone on complications associated with intrathecal morphine after cesarean section: A comparative study. J. Edu. Health Promot. 2022, 11, 28. [Google Scholar]
- Maged, A.M.; Deeb, W.S.; Elbaradie, S.; Elzayat, A.R.; Metwally, A.A.; Hamed, M.; Shaker, A. Comparison of local and intravenous dexamethasone on post operative pain and recovery after caesarean section. A randomized controlled trial. Taiwan J. Obstet. Gynecol. 2018, 57, 346–350. [Google Scholar] [CrossRef] [PubMed]
- Cardoso, M.M.; Leite, A.O.; Santos, E.A.; Gozzani, J.L.; Mathias, L.A.S.T. Effect of dexamethasone on prevention of postoperative nausea, vomiting and pain after caesarean section: A randomized, placebo-controlled, double-blind trial. Eur. J. Anaesthesiol. 2013, 30, 102–105. [Google Scholar] [CrossRef] [PubMed]
- Ituk, U.; Thenuwara, K. The effect of a single intraoperative dose of intravenous dexamethasone 8 mg on postcesarean delivery analgesia: A randomized controlled trial. Int. J. Obstet. Anesth. 2018, 35, 57–63. [Google Scholar] [CrossRef] [PubMed]
- Aga, A.; Abrar, M.; Ashebir, Z.; Seifu, A.; Zewdu, D.; Teshome, D. The use of perineural dexamethasone and transverse abdominal plane block for postoperative analgesia in cesarean section operatins under spinal anesthesia: An observational study. BMC Anesthesiol. 2021, 21, 292. [Google Scholar] [CrossRef] [PubMed]
- Roofthooft, E.; Joshi, G.P.; Rawal, N.; Van de Velde, M. PROSPECT guideline for elective caesarean section: An update. Anaesthesia 2023, 78, 1170–1179. [Google Scholar] [CrossRef]
- AWMF S3-Leitlinie “Behandlung Akuter Perioperativer und Posttraumatischer Schmerzen”. Available online: https://register.awmf.org/assets/guidelines/001-025l_S3_Behandlung-akuter-perioperativer-posttraumatischer-Schmerzen_2022-11.pdf (accessed on 19 November 2023).
- La Via, L.; Minardi, C.; Brancati, S.; Valenti, S.; Messina, S.; Garofalo, E.; Bruni, A.; Murabito, P.; Bernardini, R.; Sanfilippo, F. Fentanyl vs morphine as adjuvant to spinal anesthesia for caesarean section: An observational study. Euromediterranean Biomed. J. 2023, 18, 79–83. [Google Scholar]
- Irwin, R.; Stanescu, S.; Buzaianu, C.; Rademan, M.; Roddy, J.; Gormley, C.; Tan, T. Quadratus lumborum block for analgesia after caesarean section: A randomised controlled trial. Anaesthesia 2020, 75, 89–95. [Google Scholar] [CrossRef] [PubMed]
- Salama, E.R. Ultrasound-guided bilateral quadratus lumborum block vs. intrathecal morphine for post-operative analgesia after cesarean section: A randomized controlled trial. Korean J. Anesthesiol. 2020, 73, 121–128. [Google Scholar] [CrossRef] [PubMed]
- Niklasson, B.; Arnelo, C.; Öhman, S.G.; Segerdahl, M.; Blanck, A. Oral oxycodone for pain after caesarean section: A randomized comparison with nurse-administered iv morphine in a pragmatic study. Scand. J. Pain 2015, 7, 17–24. [Google Scholar] [CrossRef] [PubMed]
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Gerbershagen, M.U.; Baagil, H. Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept. Medicina 2024, 60, 358. https://doi.org/10.3390/medicina60030358
Gerbershagen MU, Baagil H. Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept. Medicina. 2024; 60(3):358. https://doi.org/10.3390/medicina60030358
Chicago/Turabian StyleGerbershagen, Mark Ulrich, and Hanaa Baagil. 2024. "Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept" Medicina 60, no. 3: 358. https://doi.org/10.3390/medicina60030358
APA StyleGerbershagen, M. U., & Baagil, H. (2024). Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept. Medicina, 60(3), 358. https://doi.org/10.3390/medicina60030358