Peri-Anaesthesia Profile in Caesarean Section Patients with Regional Anaesthesia Subarachnoid Block and Intraoperative Bleeding Control
Keywords:
Section Caesarea, intraoperative haemorrhage, sub arachnoid blockAbstract
The prevalence of Section Caesarea (CS) use continues to increase globally, and is expected to reach 29% by 2030. SC is a life-saving procedure under certain conditions, but its use without medical indication may increase the risk of health complications for both mother and baby. CS is performed based on absolute and relative indications, with regional anaesthesia (spinal or epidural) recommended to reduce the risk of morbidity. Section Caesarean (CS) surgery is one of the delivery methods currently chosen by many mothers. This trend is shown by data on the increasing trend of CS delivery rates and has become a standard maternity service because of the low risk of death in the mother and foetus, excellent prognosis and easy postoperative care. The patient was given spinal anaesthesia with a combination of bupivacaine, fentanyl, and morphine. Preoperative management included the administration of premedication drugs such as ondansetron, ketorolac, and dexamethasone to prevent nausea and control pain. Intraoperatively, tranexamic acid and oxytocin were administered to manage massive bleeding. Patients are intensively monitored in the postoperative phase with a focus on the risk of bleeding and shivering. The use of spinal anaesthesia, drug combinations, and perioperative pain management approaches have proven effective in improving hemodynamic stability and reducing the risk of postoperative complications in CS surgery.
References
1. Angolile CM, Max BL, Mushemba J, Mashauri HL. Global increased cesarean section rates and public health implications: A call to action. Health Sci Rep. 2023 May 1;6(5).
2. Wang J, Pang Q, Wei W, Cheng L, Huang F, Cao Y, et al. Definition of large niche after Cesarean section based on prediction of postmenstrual spotting: Chinese cohort study in non-pregnant women. Ultrasound in Obstetrics and Gynecology. 2022 Apr 1;59(4):450–6.
3. Sung S, Heba ;, Affiliations M. Cesarean Section Continuing Education Activity [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546707/?report=printable
4. Vargas A, Armin S, Yeomans E. Successful pregnancy with left ventricular assist device failure in the setting of peripartum cardiomyopathy. Baylor University Medical Center Proceedings. 2022;35(1):98–100.
5. Choi SU. General anesthesia for cesarean section: are we doing it well? Vol. 17, Anesthesia and Pain Medicine. Korean Society of Anesthesiologists; 2022. p. 256–61.
6. Sun XX, Qian J, Fan JM, Liu L, Jin XF, Xiao F. Dose-Response Study of Phenylephrine for Preventing Spinal-Induced Hypotension During Cesarean Delivery with Combined Spinal-Epidural Anesthesia Under the Effect of Prophylactic Intravenous Ondansetron. Drug Des Devel Ther. 2024;18:1459–67.
7. Myles PS, Corcoran T. Benefits and Risks of Dexamethasone in Noncardiac Surgery. Vol. 135, Anesthesiology. Lippincott Williams and Wilkins; 2021. p. 895–903.
8. Lee SU, Lee HJ, Kim YS. The effectiveness of ramosetron and ondansetron for preventing postoperative nausea and vomiting after arthroscopic rotator cuff repair: a randomized controlled trial. J Orthop Surg Res. 2020 Dec 1;15(1).
9. Lv Z, Pan T, Zhang H, Wang Y, Matniyaz Y, Tang Y, et al. Safety and efficacy of ketorolac in improving the prognosis of acute type A aortic dissection patients: a protocol of a randomized, double-blinded, and placebo-controlled study. Trials. 2024 Dec 1;25(1).
10. Jiang Q, Huang SQ, Jiao J, Zhou XM. Effect of the combination of ketorolac and bupivacaine on transversus abdominis plane block for postoperative analgesia after gynecological laparoscopic surgery. Medical Science Monitor. 2020 Aug 22;26.
11. Imani F, Rahimzadeh P, Faiz HR, Nowruzina S, Shakeri A, Ghahremani M. Comparison of the post-caesarean analgesic effect of adding dexmedetomidine to paracetamol and ketorolac: A randomized clinical trial. Anesth Pain Med. 2018 Oct 1;8(5).
12. Kiasari A, Aghaei N, Aezzi G, Alipour A, Ghavibonyeh K. Effects of intrathecal and intravenous dexamethasone on complications associated with intrathecal morphine after cesarean section: A comparative study. J Educ Health Promot. 2022 Jan 1;11(1):28.
13. Ferrarezi WPP, Braga A de F de A, Ferreira VB, Mendes SQ, Brandão MJN, Braga FS da S, et al. Spinal anesthesia for elective cesarean section. Bupivacaine associated with different doses of fentanyl: randomized clinical trial. Brazilian Journal of Anesthesiology (English Edition). 2021 Nov 1;71(6):642–8.
14. Citra Barliana P, Zulfariansyah A, Sitanggang RH. Perbandingan Morfin Dosis 0,05 mg dengan 0,1 mg sebagai Adjuvan Bupivakain 0,5% 10 mg Intratekal terhadap Intensitas Nyeri dan Durasi Analgesia Pascaseksio Sesarea. Available from: http://dx.doi.org/10.15851/jap.v8n3.0000
15. Badi T, Sulastri S, Sitorus IR. Gambaran Lama Kerja Analgesi Pada Spinal Anestesi Menggunakan Bupivakain 0,5 % Hiperbarik 12,5mg Dengan Tambahan Morfin 0,2 Mg Terhadap Waktu Respon Nyeri Pasien Pasca Sectio Caesarea Di RS Vita Insani.
16. Wódarski B, Chutkowski R, Banasiewicz J, Moorthi K, Wójtowicz S, Malec-Milewska M, et al. Risk factors for shivering during caesarean section under spinal anaesthesia. A prospective observational study. Acta Anaesthesiol Scand. 2020 Jan 1;64(1):112–6.
17. Jemal B, Mohammed F, Tesema HG, Ahmed S, Mohammed A, Regasa T, et al. Analgesic Efficacy of Spinal Morphine in Comparison With Transversus Abdominis Plane Block for Postoperative Pain Management in Patients Undergoing Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial. Front Med (Lausanne). 2022 Feb 9;9.
18. Trivedi R, John J, Ghodke A, Trivedi J, Munigangaiah S, Dheerendra S, et al. Intrathecal morphine in combination with bupivacaine as pre-emptive analgesia in posterior lumbar fusion surgery: a retrospective cohort study. J Orthop Surg Res. 2022 Dec 1;17(1).
19. Suwarman, Pison OM, Maulana MF, Nugraha P. Comparison of Spinal Morphine and Transversus Abdominis Plane Block on Opioid Requirements After Caesarean Section: An Observational Study. Local Reg Anesth. 2024;17:79–86.
20. Jee Y, Lee HJ, Kim YJ, Kim DY, Woo JH. Association between anesthetic method and postpartum hemorrhage in Korea based on National Health Insurance Service data. Anesth Pain Med (Seoul). 2022 Apr 1;17(2):165–72.
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Copyright (c) 2025 M.Ka'bil Mubarrak, Rahmaya Nova Handayani, Made Suandika (Author)
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