Minimally invasive spinal anesthesia for cesarean section in maternal anticoagulation therapy: a randomized controlled trial

Abstract

BackgroundAnticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section.MethodsThis was a randomized, controlled study conducted in 239 parturients using anticoagulants and undergoing selective cesarean section. 37 parturients withdrew, and finally parturients received spinal anesthesia using 27gauge pen type fine spinal needles (experimental group, n = 110) and 22gauge traditional spinal needles (control group, n = 92). The primary efficacy outcomes included low back pain (LBP) and postdural puncture headache (PDPH) after delivery. Secondary efficacy outcomes included visual analogue scale during subarachnoid puncture (VASdural), difference between visual analogue scale (VAS) during peripheral venipuncture and VASdural (∆VAS), VAS of back puncture point 24, 48 and 72 h after operation (VASdural-24 h, VASdural-48 h and VASdural-72 h, respectively), maternal satisfaction and hospitalization stay.ResultsNo parturient had PDPH and was suspected with spinal or intracranial haematoma in two groups. There was no significant difference in VASlbp-24 h, VASlbp-48 h and VASlbp-72 h (P = 0.056; P = 0.813; P = 0.189, respectively) between two groups. In experimental group, VASdural (P = 0.017), ∆VAS (P = 0.001) and VASdural-24 h (P < 0.0001) were lower, whereas maternal satisfaction was higher (P = 0.046). There was no significant difference in VASdural-48 h, VASdural-72 h, urination function, strength recovery and hospitalization stay (P = 0.069; P = 0.667; P = 0.105; P = 0.133; P = 0.754, respectively) between the two groups.ConclusionsMinimally invasive spinal anesthesia provided lower VASdural, VASdrual-24 h and a higher maternal satisfaction. Hence, it is considered as a safe, reliable and reasonable option for cesarean section parturients during maternal anticoagulation therapy with normal platelet count and coagulation time.Trial registrationThis study was registered at www.ClinicalTrials.gov at November 11th, 2016 (NCT02987192).

Low-dose intranasal dexmedetomidine premedication improves epidural labor analgesia onset and reduces procedural pain on epidural puncture: a prospective randomized double-blind clinical study

“…The standard deviations (SDs) were 2.1 and 2.6, respectively. For a power of 90% and two-sided statistical significance set at 0.05, the minimum sample size was calculated by PASS15.0 software to be 24 patients per group [ 21 ]. Given an expected patient dropout rate of 20%, the total sample size was increased to 60 participants (30 patients per group).…”

Low-Dose Intranasal Dexmedetomidine Premedication Improves Epidural Labor Analgesia Onset and Reduces Procedural Distress on Epidural Puncture: A Prospective Randomized Double-blind Clinical Study

“…The standard deviations (SDs) were 2.1 and 2.6, respectively. For a power of 90% and two-sided statistical signi cance set at 0.05, the minimum sample size was calculated by PASS15.0 software to be 24 patients per group [19]. Given an expected patient dropout rate of 20%, the total sample size was increased to 60 participants (30 patients per group).…”