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PubMed2003

A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage.

OBJECTIVE: The purpose of this study was to determine whether postcesarean section administration of ketorolac tromethamine reduces pain and narcotic usage. STUDY DESIGN: A double-blinded randomized, placebo-controlled trial of ketorolac tromethamine was performed. Patients were randomly assigned to receive either ketorolac tromethamine or placebo. Patient-controlled analgesia (PCA) was used for pain control. Visual analog scales (VAS) were administered postoperatively to assess pain levels. Morphine equivalents and attempts were recorded. RESULTS: There were 22 patients in each arm of the study. There was no significant difference between patient demographics, blood loss, and type of anesthesia. Pain scores were significantly different at 2, 3, 4, 6, 12, and 24 hours by analysis of variance (ANOVA) (P=.033). There was a significant decrease in pain medication usage (P=.008) in the study group. CONCLUSION: Ketorolac tromethamine is efficacious in reducing postoperative pain and narcotics usage after cesarean section.

Adult↗
PubMed1992

Epidural clonidine after cesarean section. Appropriate dose and effect of prior local anesthetic.

Epidurally administered clonidine represents a new approach to postcesarean section pain therapy, yet the appropriate bolus dose and infusion to provide effective pain relief have not been defined. In addition, whether 2-chloroprocaine, a commonly used local anesthetic for intraoperative anesthesia, interferes with clonidine's analgesia, as it does with that of opioids, has not been examined. In this study, using a randomized, blinded design, 63 women received either bupivacaine or 2-chloroprocaine for epidural anesthesia for cesarean section and then received, upon request for analgesia in the recovery room, epidural clonidine 400 micrograms or 800 micrograms bolus, each followed by a 24-h infusion of 40 micrograms/h, or an equivalent volume bolus and infusion of saline. In the bupivacaine group, both clonidine doses produced equivalent analgesia, as determined by pain scores and time to first supplemental intravenous morphine request, and sustained analgesia was produced by clonidine infusion, as measured by need for supplemental morphine. In contrast, 2-chloroprocaine diminished analgesia from 800 micrograms by 21% and abolished analgesia from 400 micrograms clonidine. After 2-chloroprocaine, sustained analgesia from continuous clonidine infusion was present only in the group who had received 800 micrograms clonidine. Clonidine did not alter resolution of residual local anesthetic sensory blockade, as measured by 2- or 4-segment regression following either local anesthetic, but did prolong duration of motor blockade in women receiving bupivacaine. Clonidine produced small decreases in heart rate and blood pressure. One patient received iv fluids for hypotension; one had asymptomatic bradycardia resolving without therapy; and one had mild hypoxemia with snoring during clonidine-induced sedation, responding to supplemental oxygen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Pelvic magnetic resonance venography reveals high rate of pelvic vein thrombosis after cesarean section.

In the run-in phase of a thromboprophylactic trial in women at moderate to high risk of deep vein thrombosis postcesarean section, we used magnetic resonance venography and found a surprisingly high rate of pelvic deep vein thrombosis (46% overall). Pelvic magnetic resonance venography may be a useful surrogate outcome in obstetric thromboprophylaxis studies but the clinical significance is not known.

Adult↗
PubMedDate not supplied

Combined continuous and demand narcotic dosing for patient-controlled analgesia after cesarean section.

New patient-controlled analgesia devices can deliver an analgesic by continuous infusion along with demand dosing. This prospective investigation involving postcesarean-section patients was undertaken to determine whether a combination of continuous infusion and demand dosing of meperidine would provide more effective analgesia than would demand dosing alone during the first 24 hours. During a 12-month period, 171 patients were prescribed meperidine postoperatively, using a 5- to 10-mg demand dose no more frequently than every 10 minutes. Patients were assigned to groups receiving no continuous infusion or infusion at rates of 10, 20, or 30 mg/h. The groups receiving continuous infusion showed more immediate and sustained pain relief, with no serious complications. All patients were able to understand the nurse, became ambulatory, and tolerated liquids on the first postoperative day. The infusion rate of 20 mg/h was most acceptable in requiring fewer demand doses while providing satisfactory pain relief without undesired sedation. In conclusion, a system combining continuous infusion and demand dosing was preferable to demand dosing alone, and added no apparent hazards.

Adult↗
PubMed1988

Results of a multicenter comparative study of single-dose cefotetan and multiple-dose cefoxitin as prophylaxis in patients undergoing cesarean section.

A study to compare the prophylactic efficacy of a single 2 g dose of cefotetan with multiple 2 g doses of cefoxitin in reducing the incidence of postcesarean section infection was evaluated in a multicenter trial of 269 women. No significant differences in clinical or bacteriologic response were detected between the two groups. A successful clinical response rate was achieved in 139 of 162 of the evaluable subjects given cefotetan (86 percent) and in 71 of 79 patients (90 percent) given cefoxitin. The respective satisfactory bacteriologic response rates were 91 percent (135 of 148 patients) and 93 percent (68 of 73 patients). The incidences of endometritis for cefotetan and cefoxitin (12 percent and 5 percent, respectively) and of postoperative wound infection (3 percent and 5 percent, respectively) were also not significantly different. Bactericidal levels of cefotetan were maintained in plasma in the immediate postpartum period. Both drugs were well tolerated. Single-dose prophylaxis with cefotetan was comparable to multiple doses of cefoxitin in reducing infectious morbidity in women undergoing cesarean section.

Adult↗
PubMed1980

Role of extraperitoneal cesarean section.

The matter of attempting to revive extraperitoneal cesarean section as a viable option appears generally to be greeted with considerable emotion. Such emotion usually arises among those unfamiliar with the technique. As shown by the data from the University of Colorado, once one becomes accustomed to the procedure, there appears to be no greater hazard than that of the standard transperitoneal approach. The data cannot be interpreted as showing a distinct advantage to extraperitoneal cesarean section, as there was a substantially higher use of preoperative antibiotics to reduce morbidity. However, the patients who underwent the exttaperitoneal procedure had a greater preoperative morbidity potential, necessitating the use of such antibiotics. Apgar scores remain lower at 1 minute, partly because of the delivery of one stillborn infant and a somewhat higher incidence of premature infants in distress. In addition, the delay in delivery of the fetus frequently encountered when inexperienced surgeons attempt this operation as a new surgical experience is clearly a factor as well. One must accept, however, that the operation has a highly attractive rationale. To place the procedure in proper perspective, a prospective, controlled study based on random selection must be done. One additional control population that would help to sort out some aspects of the benefits of the extraperitoneal approach would be a population of patients in whom routine draining of the retrovesical space is carried out, as is done in the exptraperitoneal operation. With these groups for comparison, the extraperitoneal operation may finally be placed in its true perspective. This can be accomplished only by scientific endeavor, not by speculation. Extraperitoneal cesarean section represents a viable alternative to transperitoneal delivery or cesarean hysterectomy in the presence of uterine infection, presumed or proven. Despite the wealth of information concerning the efficacy of a wide spectrum of antibiotic regimens for the prevention or treatment of postcesarean section morbidity in the modern era, infection remains a problem that has merely been somewhat controlled. It is incumbent upon resident education programs to provide trainees with the broadest spectrum of options and skills. Since the extraperitoneal operation not only has benefits in anatomic training but also possesses a rational basis for the avoidance of serious postoperative pelvic infectious complications, this operation deserves reconsideration in the modern era. The occasional postoperative pelvic abscess that subjects a patient to one or more subsequent operative procedures and to the attendant risks of death or sterility, make any procedure designed to avoid these complications appear more worthwhile. Until the demon of postoperative infection is successfully and permanently caged, we must continue to consider all reasonable options toward this end. Scheider has stated that "a difference to be a difference must make a difference." With this we agraee...

Cesarean Section↗
PubMed2003

[Bacteriological study of surgical infected wounds in elective surgery. Bacteriology of surgical wound infection].

OBJECTIVE: To identify the frequency and type of microorganisms isolated from infected surgical wounds at the Instituto Nacional de Perinatología, and identify the association among the microorganisms isolated and the outcome of the infected patients. METHODOLOGY: Observational, descriptive and cross-sectional study carried out between January 1999 and January 2001. Postoperative patients of an obstetric or gynecologic procedure, complicated with a surgical wound infection and with a culture and smear of the wound, were included. RESULTS: During the study period 41 surgical wound infections were identified. The general incidence of surgical infections was 3.9 infections per 1,000 surgical procedures. The incidence of infections after abdominal hysterectomy was 12.4 per 1,000, after vaginal hysterectomy 6.5 per 1,000, postcesarean section 5.3 per 1,000 and after episiotomy 1 per 1,000 procedures. The comparison among bacterial isolates in 1988 with 1999-2000 period showed a high frequency of gram negative bacteria isolation in the second period. CONCLUSIONS: In this study the incidence of surgical infections was less than the incidence reported in the medical literature, but the type of bacteria isolated was similar to other studies.

Adolescent↗
PubMed2002

[Cesarean section: current management of postoperative acute pain. Continuous and intermittent epidural analgesia with and without elastomeric infusion device].

OBJECTIVE: To compare the analgesia quality obtained in the management of the acute pain in 50 puerperae post-cesarean section using one of the two therapeutic modalities. The results were evaluated using descriptive and inferential statistics. MATERIAL AND METHOD: Controlled, systematized a clinical trial, carried out from January to June of 2001. REGIMES AND RESULTS: A) Continuous epidural analgesia. With fentanyl citrate plus bupivacaine using a low flow elastomerics infuser (Single day Baxter infuser) 85% referred mild pain in rest or activity; 3% or less in analogic scale visual (VAS) in the first 24 hours of postoperative. B) Intermittent epidural analgesia. With bupivacaine plus intravenous Ketorolaco; 59% of the cases referred mild pain, 32% moderate pain and 9% severe. CONCLUSION: Management of acute pain postcesarean section should be priority with continuous epidural analgesia using the infuser and concentrations of drugs referred in order to minimize the incidence and magnitude of acute postoperative pain.

Acute Disease↗
PubMed1985

Single- versus three-dose cefotaxime prophylaxis for cesarean section.

A prospective randomized study was undertaken in 100 patients undergoing cesarean section to evaluate the efficacy of cefotaxime when given as a single-dose versus the more traditional triple-dose regimen for prophylaxis. Analysis of the results demonstrated no significant differences in febrile morbidity (14 versus 20%) or postoperative endometritis (10 versus 14%) between the single- and triple-dose groups, respectively. Pretherapy aerobic and anaerobic placental cultures were positive in 60% of the overall study population. In those patients who subsequently developed endometritis, seven (58%) had a positive placental culture, suggesting that this technique is relatively nonspecific as a screening procedure. Results of transcervical culture in the endometritis patients most often demonstrated a polymicrobial picture. Several of the organisms cultured were found to be resistant to cefotaxime, supporting the need to better guide antimicrobial therapy by routine endometrial culturing in patients who fail prophylaxis. The results of the present study suggest that single-dose administration of cefotaxime is equally effective as triple-dose therapy in reducing postcesarean section endometritis.

Adult↗
PubMed1991

Chlamydia trachomatis infection during pregnancy.

Although transmission of Chlamydia trachomatis to infants during vaginal birth can result in conjunctivitis and pneumonitis, there is uncertainty about other adverse effects of chlamydial infection during pregnancy. There is some evidence that it may contribute to adverse complications such as premature rupture of membranes, preterm labor and birth, low birth weight, and still birth. Infection with C. trachomatis is also implicated in postabortal, postcesarean section, and postpartum maternal infections. Treatment of chlamydial infection during pregnancy has proved beneficial in the prevention of neonatal morbidity and is now recommended by the Centers for Disease Control.

Chlamydia Infections↗
PubMed1990

Spinal opioids: a nursing perspective.

Nursing care of the patient receiving spinal opioids for pain control is reviewed in a comprehensive manner. Selection of patients, nursing management and patient outcomes are discussed. Three pain control techniques are described: epidural opioid injection for cancer pain, epidural opioid infusion for acute postoperative pain, and single dose spinal opioids for postcesarean section pain. Monitoring and pharmacologic aspects common to all three forms of spinal opioid treatment are given, and specific nursing interventions for each therapy are delineated.

Analgesia, Epidural↗
PubMed1982

Vaginal colonization with resistant aerobic bacteria after antibiotic therapy for endometritis.

To assess the effect of broad-spectrum antibiotic therapy upon vaginal colonization, we collected vaginal specimens for culturing at the end of therapy from 50 patients treated for postcesarean section endometritis. Infected patients had participated in a double-blind therapy protocol and had received either clindamycin plus gentamicin or cefamandole plus placebo. Repeat vaginal culturing was performed 6 weeks later. Similar vaginal specimens for culturing were collected from 25 control patients who also had undergone cesarean section but had not received antibiotics. Of 26 patients treated with cefamandole, 16 (62%) developed vaginal colonization with isolates resistant to that drug; of 24 patients treated with clindamycin-gentamicin, two (8%) developed isolates resistant to these agents (p less than 0.001). Among 25 control patients, there was only one isolate resistant to cefamandole and none resistant to clindamycin-gentamicin. Compared to controls, more antibiotic-treated patients developed isolates resistant to cefamandole (p = 0.001) and to clindamycin-gentamicin (p = 0.06). Colonization did not persist, and there were no late infections in this population.

Adult↗
PubMed1996

Naloxone versus nalbuphine infusion for prophylaxis of epidural morphine-induced pruritus.

This randomized, double-blind study compared the efficacy of two mu-receptor antagonists, naloxone and nalbuphine, in the prophylactic management of pruritus in postcesarean section patients receiving epidural morphine. Dosages of study drugs were individualized by the use of a patient self-administration (PSA) device. All 51 patients were healthy women who received a uniform epidural anesthetic and epidural morphine (5 mg). Coded solutions were infused for 24 h, with 5-min PSA lockout times: Group A (n = 17), nalbuphine 2.5 mg/h, PSA nalbuphine 1 mg; Group B (n = 16), naloxone 50 micrograms/hr, PSA saline; Group C (n = 18), naloxone 50 micrograms/h, PSA naloxone 40 micrograms. Patients were assessed for pruritus and pain every 8 h for 24 h. Both naloxone and nalbuphine provided good relief for pruritus; median pain and pruritus scores were in the none-to-mild range (0-3) for all groups at all assessment intervals. The pruritus scores of the PSA saline group were higher during the 16- to 24-h period (P < 0.05) than the scores of either group receiving A-receptor antagonist by PSA. There was evidence of shortening of the duration of analgesia in patients receiving naloxone who required treatment for pruritus after 16 h. Patients who self-administered large doses of nalbuphine over the first 8 h also reported pain scores consistent with reversal of analgesia. The potency ratio for naloxone:nalbuphine for antagonism of the pruritic effects of epidural morphine was approximately 40:1. Intervention to treat either unrelieved pruritus or pain, respectively, was necessary in the following numbers of patients: Group A, 0/1; Group B, 1/1; Group C, 2/2. Prophylactic infusions offer the potential for labor cost savings by minimizing the need for episodic therapeutic interventions to treat pruritus.

Analgesia, Epidural↗
PubMed1990

Practical points in the care of the obstetric surgical patient.

Although not all PACUs provide care to patients postcesarean section, most PACUs do provide care to patients who are either pregnant for nonobstetric surgery or for patients terminating pregnancy. Although all of these patients will have postanesthetic priorities of airway, oxygenation, and cardiac stability, these priorities are intensified because of the physiological changes associated with pregnancy. Knowledge of these physiological changes can help increase the PACU nurse's ability to understand and meet the needs of the obstetric patient in the PACU.

Abortion, Induced↗
PubMed1991

Anesthetic considerations in preeclampsia.

The successful anesthetic management of women with preeclampsia requires familiarity with the pathophysiology and hemodynamic changes characteristic of the disease process. Currently, overwhelming laboratory and clinical evidence attests to the safety and benefits of continuous lumbar epidural anesthesia in women with preeclampsia. For women with the milder form of the disease process, routine anesthetic care is sufficient. In those with severe preeclampsia, blood pressure should be controlled and intravascular volume status optimized with the aid of invasive monitoring. It is important to remember that decreased plasma proteins and presence of hepatic and renal dysfunction can influence maternal responses to drug therapy. The use of short-acting beta-adrenergic blocking agents, such as esmolol, and calcium entry-blocking agents, such as nifedipine, for blood pressure control before anesthetic induction and the role of epidural morphine and clonidine for postcesarean section pain relief are currently under investigation.

Anesthesia↗
PubMedDate not supplied

Clindamycin in the treatment of obstetric and gynecologic infections: a review.

The spectrum of clindamycin's activity includes anaerobes and gram-positive aerobes other than enterococci. No inactivation or incompatibility of clindamycin phosphate has been shown in intravenous solutions usually used clinically. After oral administration, clindamycin is almost completely absorbed, with mean peak serum levels reached in 45 to 60 minutes. Clindamycin is widely distributed in many body fluids and tissues. Its normal half-life is two to three hours, and thus it can be given at six-hour intervals. Because of its excellent coverage against anaerobes, gram-positive cocci, and Chlamydia trachomatis, clindamycin is the preferred antimicrobial agent for serious infections of the female genital tract. Clindamycin plus tobramycin or an aminoglycoside is effective treatment for pelvic inflammatory disease, particularly when a tubo-ovarian abscess is present. In post-cesarean section endometritis, clindamycin plus gentamicin has been shown to be more effective than any other treatment. Clindamycin (alone or with an aminoglycoside) has been used successfully in posthysterectomy vaginal cuff infections and, with an aminoglycoside, in septic abortions. Clindamycin has been well tolerated in studies of animals and human subjects; its most significant side effects develop in the gastrointestinal system.

Abortion, Septic↗
PubMed1980

A retrospective survey of female sterilisation for the years 1968 to 1973. Analysis of morbidity and post-sterilisation complications for 5 years.

Between 1968 and 1973, 2122 women were sterilised, 52.2% were by laparotomy, 46.3% by laparoscopy. Sterilisation was performed after abortion in 38.5%, after delivery in 22.5%, and as an interval procedure in 38.5% of cases. Laparoscopy had a lower incidence of side effects than laparotomy, and sterilisation as an interval procedure was safer than after delivery or abortion. A five-year follow-up of patients revealed a low incidence of late side effects; only 34 patients required hysterectomy and in 18 this was not due to the sterilisation. Failure of sterilisation (0.5%) was evenly distributed between the various methods; operative trauma was low 0.6% for laparoscopy and 0.2% for laparotomy. There were 4 maternal deaths, only 2 were related to the procedure.

Adult↗
PubMed1980

Sterilization by cesarean hysterectomy.

A study of 112 cesarean hysterectomies is presented. They were performed in a 220-bed community hospital by six obstetricians in private practice. Eighty-nine cases were planned during the prenatal course of uncomplicated pregnancies. Twenty-three were unplanned and were performed because of severe medical, surgical, or obstetric problems. Postoperative performance and rate of complications were more favorable in the planned group. True indications for cesarean hysterectomy are discussed. In selected cases, sterilization by cesarean hysterectopmy may be the procedure of choice at the time of repeat cesarean section.

Cesarean Section↗