Visceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine

Abstract

In a randomized study, the incidence of visceral pain was evaluated in 46 patients undergoing elective caesarean section under spinal or epidural anaesthesia with 0.5% bupivacaine. If the patient experienced pain during the operation, a standard visual analogue scale ranging from 0 to 10 was used to assess the degree of pain. Visceral pain occurred in 12/23 patients in the spinal group and in 13/23 patients in the epidural group. In neither group was a correlation found between the cephalad level of analgesia or the intensity of cutaneous analgesia in the sacral region, and the presence of visceral pain.

A comparison of spinal and epidural anesthesia for cesarean section following epidural labor analgesia: A retrospective cohort study

“…In our hospital, anesthesiologists do not routinely use neuraxial lipophilic opioids with CS parturients to prevent visceral pain. 13,14 Once a patient complains of pain during surgery, especially mild and poorly localized visceral pain (VAS < 3), anesthesiologists may add an adjuvant analgesic or sedative medication such as fentanyl, midazolam, or both. Thus, less use of additional intraoperative analgesics and sedatives may indicate better anesthetic quality, as well as a lower intraoperative pain score in the SA group.…”

At caesarean section under regional anaesthesia, it is essential to test sensory block with light touch before allowing surgery to start

“…Many dose-finding studies have used pin-prick or cold as the block assessment method. When the data in such studies [22][23][24][25][26][27][28][29][30] are examined it can be observed that between 0% and 95% of women require intravenous supplements, even though all blocks to pinprick (or cold) are T4/5 or above. Quite clearly, in these studies [22][23][24][25][26][27][28][29][30] pin-prick (or cold) blocked to T4/5 or above gave no indication of whether pain would be experienced.…”

“…When the data in such studies [22][23][24][25][26][27][28][29][30] are examined it can be observed that between 0% and 95% of women require intravenous supplements, even though all blocks to pinprick (or cold) are T4/5 or above. Quite clearly, in these studies [22][23][24][25][26][27][28][29][30] pin-prick (or cold) blocked to T4/5 or above gave no indication of whether pain would be experienced. In several of these studies two or more doses were compared [24][25][26][27][28][29][30] and the authors noted that the groups receiving the larger doses had much lower supplementation rates, despite similar levels of block to pinprick (or cold) between the groups: a level of block to pin-prick (or cold) to T4/5 and above was unable to identify the good quality blocks from the poor quality blocks.…”

A comparison of cold, pinprick and touch for assessing the level of spinal block at caesarean section

“…[16][17][18][19][20][21][22] However, the results of these investigations indicate that pinprick to T4 is very unreliable in predicting the adequacy of spinal anaesthesia for caesarean section: the need for intraoperative supplements ranged from 0 to 95%. [16][17][18][19][20][21][22] Several of these authors noted that increasing the dose of local anaesthetic reduced the incidence of intraoperative pain, 17;18;20 despite there being no significant change in the levels of block to pinprick. Although these authors recommended the use of the larger dose of spinal local anaesthetic for the "improved quality of block," none of them commented on the obvious implication of their results: assessing the block by pinprick was not capable of detecting the improved quality of block provided by the higher doses.…”