Remifentanil for Carboprost-Induced Adverse Reactions During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia

Abstract

Purpose: Carboprost may induce adverse reactions when used to treat postpartum hemorrhage. We aimed to explore the effects of intravenous infusion of low-dose remifentanil to prevent such reactions. Methods: We enrolled parturient patients scheduled for elective cesarean section. Anesthesiologist administered combined spinal epidurals at the L3/4 interspace, with 0.5% hyperbaric bupivacaine subarachnoid space injections (1.5-2.5 ml). We randomly divided parturient patients, administered carboprost during surgery, into the remifentanil group (group R) and the control group (group C). Patients in group R received an intravenous targetcontrolled infusion of remifentanil (target effect-site concentration, 1.5 ng/ml) simultaneously with a carboprost tromethamine injection (250 µg). Patients in group C received a normal saline infusion with carboprost. We recorded and analyzed the incidence of carboprostrelated adverse reactions (vomiting, nausea, chest congestion, flushing, hypertension, tachycardia, cough, and shivering), and assessed patient comfort using a numerical rating scale ([NRS], on which 0 was very uncomfortable and 10 was very comfortable). Results: After applying inclusion and exclusion criteria, we conducted statistical analysis of the data from 70 women. The incidence of vomiting was significantly lower in group R than in group C (14.3 vs. 51.4%, p < 0.01); and the incidence of nausea, chest congestion, facial flushing, and hypertension were significantly lower in group R than in group C (all p < 0.01). Furthermore, the patients' comfort scores were significantly higher in group R than in group C (8.0 ± 1.8 vs. 3.6 ± 2.1, p < 0.01). Conclusion: Our results demonstrate that an intravenous low-dose remifentanil infusion can effectively prevent carboprost-related adverse reactions during cesarean delivery under combined spinal and epidural anesthesia. Clinical Trial Registration: We pre-registered this study at http://www.chictr.org.cn/ showproj.aspx?proj=27707 (ChiCTR1800016292).

Effect of carboprost tromethamine and carbetocin on coagulation factors and prognosis in puerpera with postpartum hemorrhage due to uterine inertia

“…Compared with traditional prostaglandin drugs, carboprost tromethamine uses methyl to replace 15-hydroxy and it has stronger biological activity and a longer half-life. In addition, it is widely used in the prevention and treatment of postpartum hemorrhage [18]. Numerous studies have indicated that carboprost tromethamine is more effective than oxytocin in the prevention and treatment of postpartum hemorrhage due to uterine inertia [19][20][21].…”

Spiral Computed Tomography Imaging Analysis of Positioning of Lumbar Spinal Nerve Anesthesia under the Concept of Enhanced Recovery after Surgery

“…According to the different injection positions, it can be divided into epidural anesthesia, combined spinal epidural anesthesia, and subarachnoid anesthesia (also known as spinal anesthesia/lumbar anesthesia) [ 1 – 3 ]. Lumbar spinal nerve anesthesia is widely used in cesarean section, lower limb surgery, hemorrhoidectomy, and the supplementary treatment of cardiovascular diseases [ 4 , 5 ]. The positioning of lumbar spinal nerve anesthesia has always been the focus of clinical attention because the correct lumbar space positioning is crucial to ensure the effect of anesthesia and reduce nerve injury.…”