carbetocin and Pain--Postoperative

To compare the effectiveness of carbetocin with oxytocin with respect to maintain adequate uterine tone and to reduce the incidence and severity of postpartum haemorrhage. Moreover safety, adverse effects and the need of additional medications were evaluated.. Prospective controlled clinical trial. We compared the effect of a single dose of carbetocin (n = 55) with oxytocin infusion (n = 55) in a women population undergoing to elective caesarean section with regional subarachnoid anaesthesia with at least one risk factor for postpartum haemorrhage.. The mean ± SD of postoperative pain in the day of surgery in carbetocin group was significantly lower than in oxytocin group and remained significant till the third day after caesarean section. In the day of surgery and the first day after surgery, women of carbetocin group who needed analgesic drugs were significantly lower than women of oxytocin group. The differences of diuresis and of diuretic drugs need were not statistically significant between the two groups.. 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.

Topics: Adult; Cesarean Section; Down-Regulation; Drug Administration Schedule; Female; Humans; Infant, Newborn; Oxytocics; Oxytocin; Pain Perception; Pain, Postoperative; Postnatal Care; Postpartum Hemorrhage; Pregnancy; Risk; Treatment Outcome

To assess the performance of a multidisciplinary programme for enhanced recovery after caesarean delivery under neuraxial anaesthesia.. Prospective single-centre study.. Programme in 6 steps including 3 professional practice audits based on clinical records and questioning patients: audit T0, first "existing state", creation of a working group, drafting and implementation of a multidisciplinary rehabilitation procedure, second audit (T0+4 months), information about and implementation of corrective measures and a third audit (T0+8 months). Assessment of the performance of the continuous improvement programmes based on six measures comprising the post-caesarean rehabilitation score: duration infusion, early oral analgesia, time to removal of the urinary catheter, time to return to drinking, eating recovery time, use of carbetocin.. Two hundred and thirty-one patients were included, with 45, 64 and 122 patients at T0, T0+4 months and T0+8 months, respectively. There was a significant increase in patients who received the recovery measures (P<0.0001 for all items) between T0 and T0+8 months: removal of the infusion before 24h (49% versus 93.5%), drinking before 6h (31% versus 55%), eating before 6h (2% versus 38.5%), early oral analgesia before 24h (38% versus 95%), withdrawal of the urinary catheter before 24h (80% versus 95%), use of carbetocin (0% versus 99%).. Improved practices in rehabilitation after caesarean can be obtained by setting up a multidisciplinary programme as part of a quality approach.

Topics: Adult; Anesthesia Recovery Period; Anesthesia, Obstetrical; Cesarean Section; Device Removal; Female; Humans; Infusions, Intravenous; Medical Audit; Nerve Block; Oxytocics; Oxytocin; Pain, Postoperative; Postoperative Care; Pregnancy; Program Evaluation; Prospective Studies; Total Quality Management; Urinary Catheterization