PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations.
PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations.
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DOI：
10.1111/anae.15339
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发表时间：
2021-05
期刊：
影响因子：
10.7
通讯作者：
PROSPECT Working Group* of the European Society of Regional Anaesthesia and Pain Therapy and supported by the Obstetric Anaesthetists’ Association
中科院分区：
文献类型：
--
作者：
Roofthooft E;Joshi GP;Rawal N;Van de Velde M;PROSPECT Working Group* of the European Society of Regional Anaesthesia and Pain Therapy and supported by the Obstetric Anaesthetists’ Association
剖腹产与中度至重度术后疼痛有关，这会影响术后恢复和患者满意度以及母乳喂养的成功和母子关系。本系统综述的目的是更新现有文献，并为椎管内麻醉下选择性剖腹产术后最佳疼痛管理提出建议。利用特定手术术后疼痛管理 (PROSPECT) 方法进行了系统评价。从 MEDLINE、Embase 和 Cochrane 数据库中检索了 2014 年 5 月 1 日至 2020 年 10 月 22 日期间以英文发表的评估镇痛、麻醉和手术干预效果的随机对照试验。评估紧急或计划外手术分娩或全身麻醉下进行剖腹产的疼痛管理的研究被排除在外。共有 145 项研究符合纳入标准。对于在椎管内麻醉下进行选择性剖腹产的患者，建议术前鞘内注射吗啡 50–100 µg 或二吗啡 300 µg；扑热息痛;非甾体类抗炎药；以及分娩后静脉注射地塞米松。如果未鞘内注射阿片类药物，单次注射局麻药伤口浸润；伤口持续输注局麻药；和/或推荐筋膜平面阻滞，例如腹横肌平面或腰方肌阻滞。术后治疗方案应包括常规服用扑热息痛和非甾体类抗炎药以及阿片类药物进行抢救。手术技术应包括 Joel-Cohen 切口；腹膜未闭合；和腹部粘合剂。经皮神经电刺激可作为镇痛辅助手段。一些干预措施虽然有效，但存在风险，因此在建议中被省略。由于证据不足、不一致或缺乏，一些干预措施未被推荐。值得注意的是，这些建议可能不适用于计划外分娩或全身麻醉下进行的剖腹产。
Caesarean section is associated with moderate‐to‐severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother‐child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50–100 µg or diamorphine 300 µg administered pre‐operatively; paracetamol; non‐steroidal anti‐inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single‐injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non‐steroidal anti‐inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel‐Cohen incision; non‐closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.
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