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

Objective: The aim of this study is to compare the effects of general and spinal anesthesia on postoperative pain intensity and analgesic agent requirements in patients scheduled for emergent or elective cesarean sections.Patients and Methods: This was a prospective, observational study conducted in patients who underwent emergent or elective cesarean delivery under spinal or general anesthesia. Postoperative pain intensity and analgesic agent requirements, postoperative complications and patients’ satisfactions were evaluated during the first 48 h postoperatively.Results: A total of 212 parturients were enrolled; 104 (53 elective, 51 emergent) patients received general and 108 (54 elective, 54 emergent) patients received spinal anesthesia. Preoperatively, patients who underwent emergent cesarean section under spinal or general anesthesia had higher Numeric Rating Scale (NRS) scores than the patients who underwent elective cesarean delivery (p

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1. Practice Guidelines for Obstetric Anesthesia: An updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016 Feb;124:270-300. doi:10.1097/ALN.000.000.0000000935
2. Cyna AM, Dodd J. Clinical update: obstetric anaesthesia. Lancet 2007;370:640-2. 10.1016/S0140-6736(07)61320-8 3. Ismail S, Shahzad K, Shafiq F. Observational study to assess the effectiveness of postoperative pain management of patients undergoing elective cesarean section. J Anaesthesiol Clin Pharmacol 2012 ;28:36-40. doi: 10.4103/0970-9185.92432.
4. Hobson JA, Slade P, Wrench IJ, Power L. Preoperative anxiety and postoperative satisfaction in women undergoing elective caesarean section. Int J Obstet Anesth 2006;15:18-23.
5. Gorkem U, Togrul C, Sahiner Y, Yazla E, Gungor T. Preoperative anxiety may increase postcesarean delivery pain and analgesic consumption. Minerva Anestesiol 2016 ;82:974-80.
6. Kessous R, Weintraub AY, Wiznitzer A, et al. Spinal versus general anesthesia in cesarean sections: the effects on postoperative pain perception. Arch Gynecol Obstet 2012 ;286:75-9. doi: 10.1007/s00404.012.2265-y.
7. Powell R, Scott NW, Manyande A, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev 2016 26:CD008646. doi: 10.1002/14651858
8. Sutton CD, Carvalho B. Optimal pain management after cesarean delivery. Anesthesiol Clin 2017;35:107-24. doi: 10.1016/j.anclin.2016.09.010.
9. Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999 ;27:1325-9.
10. Kessous R, Wiznitzer A, Polachek H, et al. Preoperative analgesia with local lidocaine infiltration for post cesarean delivery pain management. J Matern Fetal Neonatal Med 2012 ;25:1131-4. doi:10.3109/14767.058.2011.624222.
11. Wang JJ, Ho ST, Liu HS, Tzeng JI, Tze TS, Liaw WJ. The preemptive effect of regional anesthesia on post-cesarean section pain. Acta Anaesthesiologica Sinica 1995 ;33:211-6.
12. Fassoulaki A, Staikou C, Melemeni A, Kottis G, Petropoulos G. Anaesthesia preference, neuraxial vs general, and outcome after caesarean section. J Obstet Gynaecol 2010;30:818-21. doi: 10.3109/01443.615.2010.518650
13. Acikel A, Ozturk T, Goker A, Hayran GG, Keles GT. Comparison of patient satisfaction between general and spinal anaesthesia in emergency caesarean deliveries. Turk J Anaesthesiol Reanim 2017;45:41-6. doi: 10.5152/ TJAR.2017.38159.
14. Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. The Cochrane Database Syst Rev 2012 ;10:CD004350. doi: 10.1002/14651858.