What is the clinical evidence from this study?

Study design: Observational. Population: Cesarean section (n=212). Intervention: General anesthesia vs. Spinal anesthesia. Primary outcome: Postoperative pain intensity (Numeric Rating Scale scores) during the first 48 hours.

May 28, 2019Marmara medical journal2 citationsOpen Access

Comparing the effects of general and spinal anesthesia on the postoperative pain intensity in patients undergoing emergent or elective cesarean section

RAReyhan ArslantaşIstanbul Bilim University TUTümay UmuroĝluMarmara University

Key Result

General and spinal anesthesia resulted in similar postoperative pain intensity and analgesic requirements during the first 48 hours in patients undergoing emergent or elective cesarean sections.

Study Design

Type

Observational (n=212)

Multicenter

Structured PICO

Does general anesthesia compared to spinal anesthesia affect postoperative pain intensity in patients undergoing cesarean section?

Population

212 ASA I-II parturients aged 18-40 with singleton, uncomplicated full-term pregnancies undergoing emergent or elective cesarean delivery, evaluated for 48 hours postoperatively.

Exposure

General anesthesia (n=104; 53 elective, 51 emergent)

Comparator

Spinal anesthesia (n=108; 54 elective, 54 emergent)

Outcome

Postoperative pain intensity (Numeric Rating Scale scores) and analgesic agent requirements during the first 48 h postoperativelypatient reported

General and spinal anesthesia result in similar postoperative pain intensity and analgesic requirements in patients undergoing cesarean section.

Limitations

Did not measure plasma progesterone concentrations to predict analgesic effects
Analgesic consumption was not measured by patient-controlled analgesia method due to technical inefficiencies and lack of logistic support

Abstract

Objective: The aim of this study is to compare the effects ofgeneral and spinal anesthesia on postoperative pain intensity andanalgesic agent requirements in patients scheduled for emergent orelective cesarean sections.Patients and Methods: This was a prospective, observationalstudy conducted in patients underwent emergent or electivecesarean delivery under spinal or general anesthesia. Postoperativepain intensity and analgesic agent requirements, postoperativecomplications and patients’ satisfactions were evaluated during thefirst 48 h postoperatively.Results: A total of 212 parturients were enrolled; 104 (53elective, 51 emergent) patients received general and 108 (54elective, 54 emergent) patients received spinal anesthesia.Preoperatively, patients who underwent emergent cesarean sectionunder spinal or general anesthesia had higher Numeric Rating Scale(NRS) scores than the patients who underwent elective cesareandelivery (p<0.001). In the first postoperative 48 h, NRS painscores were similar in patients who underwent emergent or electivecesarean sections under spinal or general anesthesia. Postoperativeanalgesic agent requirements and patients’ satisfactions were notstatistically significant between groups.Conclusion: The effects of general and spinal anesthesia onpostoperative pain were similar in emergent and elective cesareansections. Therefore, postoperative analgesic effect should not be adetermining factor in choosing the anesthesia method in cesareansections.

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