Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage

Bonis, Maria De; Torricelli, Michela; Leoni, Licia; Berti, P; Ciani, Valentina; Puzzutiello, Rosa; Severi, Filiberto Maria

doi:10.3109/14767058.2011.587920

“…Therefore, the oxytocin seems to act as an antidiuretic hormone, mimicking the short-term action of vasopressin on water permeability, albeit with somewhat lower potency (25) and an administration of oxytocin for a longer period may cause antidiuresis, resulting in water intoxication (20,21). In literature there is only one other study that compares the effects of carbetocin and oxytocin on the diuresis, which shows that the carbetocin has a moderate antidiuretic effect without statistically significant difference in urine output between women treated with carbetocin or oxytocin (26). In contrast with these results, in our study we report in the oxytocin group (group B) an important diuresis contraction both 2 hours and 12 hours after caesarean section, whereas in carbetocin group (group A) we observe a significant higher diuresis than observed in the oxytocin group, especially 12 hours after caesarean section.…”

Section: History Of Pph 0mentioning

confidence: 99%

Carbetocin versus oxytocin in caesarean section with high risk of post-partum haemorrhage

Larciprete

¹

,

Montagnoli²,

Frigo³

et al. 2013

JPM

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SummaryObjectives: the aims of the present study were to compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in caesarean section at high risk of primary post-partum haemorrhage. Methods: women in the carbetocin group (group A) received a bolus of 100 µg IV; women in the control group (group B) received 20 IU of oxytocin in 1000 ml of 0,9% NaCl solution IV (150 mL/ hour). The main parameter evaluated was the haemodynamic effects of drugs and the need for additional uterotonic agents. In addition we compared the drop in haemoglobin level, the uterine tone, the uterine fundal state and the diuresis. Results: regarding the haemodynamic effects, both drugs have a hypotensive effect, but we found a greater reduction in blood pressure within the oxytocin group. Significantly more women needed additional uterotonic agents in the oxytocin group (23,5% vs 0%, p<0.01), though there was no significant difference in estimated blood loss and in the drop haemoglobin level (p>0.05). There was a significant difference in the diuresis, higher in carbetocin group (1300 ml ± 450 ml vs 1100 ml ± 250 ml, p=0.01). Conclusions: a single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to prevent the PPH, with a similar haemodynamic profile and minor antidiuretic effect.

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“…PO=postoperative; PCIA=patient controlled intravenous analgesia. (11,20) 11 (7,16) Moving incision pain VAS at PO 4h 29 (21,39) 23 (13,30) Visceral pain VAS at PO 4h 22 (6,32) 27 (17,36) Rest incision pain VAS at PO 8h 13 (9,19) 9 (4,13) Moving incision pain VAS at PO 8h 25 (21,34) 22 (12,29) Visceral pain VAS at PO 8h 21 (8,28) 20 (11,30) Rest incision pain VAS at PO 12h 12 (6,15) 9 (3,12) Moving incision pain VAS at PO 12h 24 (21,32) 15 (10,26) Visceral pain VAS at PO 12h 13 (0, 25) 11 (0, 24)…”

Section: Resultsmentioning

confidence: 99%

Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

Duan

¹

,

Yang

²

,

Peng

³

et al. 2019

Preprint

0

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Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: A prospective cohort study was carried out, and only women who underwent cesarean deliveries under spinal anesthesia were included. Postoperative patient-controlled intravenous analgesia was performed for all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen, and the pump was programmed as 2.0 mL/h background infusion, and loading dose of 1 mL with a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using visual analogue scale, and inadequate analgesia was defined as visual analogue scale ≥40 during the postoperative 48 hours. Additionally, the patients’ pain statuses on postoperative week 1 and week 4 were also assessed during follow-up via telephone. Results: From January to May 2017, a total of 168 patients (67 primipara and 101 multipara) were included. The relative risk for multipara to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primipara. In patients under 30 years old, inadequate analgesia on visceral pain in the multipara was higher than that on the primipara (RR, 3.56 [1.05 to 12.04], P=0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multipara and primipara (33.7%vs.40.2%, P=0.381). No difference was found in PCIA consumption between two groups. (111.1 ± 36.0mL vs. 110.9 ± 37.3mL, P=0.979) Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (62.2%vs.37.7%, P=0.011). Conclusions: Multipara who underwent first repeat cesarean section have lower risk to experience inadequate analgesia on incision pain during the first 48 hours after surgery compared to primipara. While multipara under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain. Trail Registration: ClinicalTrial.gov: NCT03009955, Date registered: December 30, 2016.

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“…Group P and R mean patients who received primary and repeated cesarean delivery, respectively; Data were presented as Means±SD, median (interquartile range) or as numbers (percentage); BMI=body mass index; HADS-A=Hospital anxiety scale; HADS-D=Hospital depression scale. Rest incision pain VAS at PO 4h 18 (11,20) 11 (7,16) Moving incision pain VAS at PO 4h 29 (21,39) 23 (13,30) Visceral pain VAS at PO 4h 22 (6,32) 27 (17,36) Rest incision pain VAS at PO 8h 13 (9,19) 9 (4,13) Moving incision pain VAS at PO 8h 25 (21,34) 22 (12,29) Visceral pain VAS at PO 8h 21 (8,28) 20 (11,30) Rest incision pain VAS at PO 12h 12 (6,15) 9 (3,12) Moving incision pain VAS at PO 12h 24 (21,32) 15 (10,26) Visceral pain VAS at PO 12h 13 (0, 25) 11 (0, 24)…”

Section: Availability Of Data and Materialsmentioning

confidence: 99%

Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

Duan

¹

,

Yang

²

,

Peng

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: A prospective cohort study was carried out, and only women who underwent cesarean deliveries under spinal anesthesia were included. Postoperative patient-controlled intravenous analgesia was performed for all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen, and the pump was programmed as 2.0 mL/h background infusion, and loading dose of 1 mL with a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using visual analogue scale, and inadequate analgesia was defined as visual analogue scale ≥40 during the postoperative 48 hours. Additionally, the patients’ pain statuses on postoperative week 1 and week 4 were also assessed during follow-up via telephone. Results: From January to May 2017, a total of 168 patients (67 primipara and 101 multipara) were included. The relative risk for multipara to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primipara. In patients under 30 years old, inadequate analgesia on visceral pain in the multipara was higher than that on the primipara (RR, 3.56 [1.05 to 12.04], P=0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multipara and primipara (33.7%vs.40.2%, P=0.381). No difference was found in PCIA consumption between two groups. (111.1 ± 36.0mL vs. 110.9 ± 37.3mL, P=0.979) Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (62.2%vs.37.7%, P=0.011). Conclusions: Multipara who underwent first repeat cesarean section have lower risk to experience inadequate analgesia on incision pain during the first 48 hours after surgery compared to primipara. While multipara under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain.

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Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage

Abstract: A single carbetocin injection is efficacious and safe on the maintenance of uterine tone and on the limitation of blood losses, in peri- and in postoperative period. In addition, carbetocin was able to reduce pain perception during postoperative days improving quality life of women.

Cited by 36 publications

References 20 publications

Carbetocin versus oxytocin in caesarean section with high risk of post-partum haemorrhage

Carbetocin versus oxytocin in caesarean section with high risk of post-partum haemorrhage

Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

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