Page 14 - GALENIKA MEDICAL JOURNAL

Zaključak

U našem istraživanju kao najznačajniji faktor rizika za pojavu postoperativnih komplikacija izdvojila
se tehnika anestezije, dok nivo obrazovanja, socijalni i ekonomski status nisu uticali na pojavu
komplikacija. Tehnika anestezije značajno utiče na pojavu i intenzitet postoperativnog bola,

postoperativne mučnine i povraćanja, vreme do uspostavljanja laktacije, mobilizaciju pacijentkinja
nakon carskog reza, kao i na varijacije vrednosti krvnog pritiska i saturacije hemoglobina kiseonikom.
Primena regionalnih tehnika anestezije, spinalne, a naročito epiduralne, ima prednosti u odnosu
na opštu endotrahealnu anesteziju jer smanjuje postoperativni bol i pojavu neželjenih dejstava i
komplikacija, povoljno utiče na hemodinamsku stabilnost, ranu mobilizaciju, kraći početak oralnog
unosa hrane i brže uspostavljanje laktacije.

Abstract

Introduction: Although vaginal birth has several advantages over surgical termination of pregnancy, we are witnessing
that more and more parturients and obstetricians decide to have a cesarean section, which is not always related to
medical indications, but to the desire of the mother. The negative sides of surgical termination of pregnancy are delayed
mobilization, and often oral intake, lactation, and especially, the occurrence of postoperative nausea and vomiting (PONV),
blood pressure variations, and especially the occurrence of postoperative pain. This study aims to determine the risk factors
for the occurrence and intensity of postoperative pain and other complications after cesarean section.

Material and method: The prospective randomized study included 533 patients whose pregnancies ended with cesarean
section. Based on the hypothesis that the choice of anesthetic technique affects the occurrence of postoperative
complications, the patients were divided into three groups: the first group received general endotracheal anesthesia (GETA,
n = 284), the second group received spinal anesthesia (SA, n = 162) and the third epidural anesthesia group (EA, n = 87).
The occurrence of other complications (PONV, headache, deviations from normal values of blood pressure and hemoglobin
oxygen saturation), as well as the time until the establishment of lactation, verticalization, and length of hospitalization,
were recorded. The intensity of postoperative pain was assessed with a visual-analog scale (VAS). In addition to the
anesthesia technique, the following were analyzed as possible risk factors for the occurrence of complications: body mass
index, type of cesarean section, primiparous vs. multiparous, the establishment of lactation, and presence of comorbidities.

Results: Significant differences were registered in the intensity of postoperative pain concerning the anesthesia technique,
the highest intensity was in the group with GETA, and the lowest in the group with EA. Statistically significant changes in
systolic and diastolic blood pressure and heart rate two hours after cesarean section were recorded in the GETA group
compared to SA and EA. Measurement of pulse oximetry within 24 hours after cesarean section showed a significant
difference between the GETA and EA groups. The establishment of lactation when using GETA was 36-48 hours after
delivery (86.3%), in the group with SA after 18 hours (46.9%) and after 24 hours (40.7%), while in patients with EA lactation
in most patients (73.6%) established after 18 hours. Oral intake was established faster in patients who received regional
anesthesia techniques, 95.8% of GETA patients established oral intake 24-36 hours after delivery, with SA 88.9% after 18
hours, while in EA patients 16.1% oral intake established after 12 hours and in 82.8% of female patients after 18 hours.
Verticalization of patients was faster with regional anesthetic techniques: after OETA, 85.9% of patients established
mobilization 24-48 hours after delivery, in patients with SA - 77.2% mobilization was established after 18 hours, while in
patients with EA - 49.4% mobilization established after 6 hours, and in 49.4% of female patients after 12 hours.

Conclusion: Anesthetic technique significantly affects the occurrence of postoperative complications and intensity of pos-
toperative pain. The application of regional, spinal, and especially epidural anesthesia techniques has advantages over ge-
neral endotracheal anesthesia because it reduces postoperative pain, side effects and complications, has a favorable effect
on hemodynamic stability, early mobilization, shorter initiation of oral food intake, and faster establishment of lactation.

Keywords: Cesarean section, risk factors, complications, postoperative pain, general anesthesia, regional anesthesia

12 DOI: 10.5937/Galmed2308007M