帝王切開術におけるオピオイド添加脊髄くも膜下麻酔の検討

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  • Review of Spinal Anesthesia Using Opioids for Cesarean Section
  • テイオウ セッカイジュツ ニ オケル オピオイド テンカ セキズイク モ マク カ マスイ ノ ケントウ

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Background and Objective: The cesarean section is preformed commonly in modern society, where safety is regarded as of utmost importance and maternal age at childbirth is on the rise. While the risk of pulmonary embolism is high and getting out of sickbed early is recommended after a cesarean delivery, a woman in labor suffers wound pain and uterine contraction pain. We reviewed several reports that spinal anesthesia with opioids offered a good analgesic effect and inquired the validity and safety of this procedure.<br>Methods: Subjects were 88 full-term pregnant women ronging in age from 19 to 41 years. They recieved a cesarean section without complications and nonreassuring fetal status. The subjects were divided into 2 groups: Group A underwent spinal anesthesia with 0.5% high-density bupivacaine (n＝51) and Group B is received bupivacaine with 0.1mg morphine and 0.01mg fentanyl added (n＝37). Comparison was made between the two groups with respect to the amount of intravenous ephedrine for hypotention, revelation of nausea, the frequency of use of a postoperative painkiller, NRS (Numerical Rating Scale) and Apgar score of newborns.<br>Results: In Group B, the quantity of ephedrine used was significantly less than in Group A to assure anesthesia. The significant difference was observed in the occurrence of nausea. (p＝0.002). The times in Group B. the painkiller was used could be reduced. The pain was reduced by half or over from the average value of NRS. There was no difference in Apgar score.<br>Conclusions:In the rural area which is short of medical workers, high-quality care during the perioperative period can be obtained performed only by spinal anesthesia with the addition of opioids.

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