کنترل تهوع و استفراغ در زنان تحت عمل جراحی سزارین با بیحسی اسپاینال: یک مطالعه مروری نقلی در مورد نقش داروها

نوع مقاله : مروری

نویسندگان

1 کارشناس ارشد مراقبتهای ویژه نوزادان، دانشکده پرستاری و مامایی حضرت فاطمه (س)، دانشگاه علوم پزشکی شیراز، شیراز، ایران.

2 استادیار گروه بیهوشی و مراقبتهای ویژه، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران.

3 دانشیار گروه بیهوشی و مراقبتهای ویژه، مرکز تحقیقات بیهوشی، مراقبت‌های ویژه و کنترل درد، دانشگاه علوم پزشکی هرمزگان، بندرعباس، ایران.

4 استادیار گروه بیهوشی و مراقبتهای ویژه، مرکز تحقیقات بیهوشی، مراقبت‌های ویژه و کنترل درد، دانشگاه علوم پزشکی هرمزگان، بندرعباس، ایران.

5 استادیار گروه بیهوشی و مراقبتهای ویژه، مرکز تحقیقات بیهوشی و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

6 استادیار گروه جراحی، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

7 استادیار گروه زنان و مامایی، مرکز تحقیقات سلامت و بیماریهای زنان، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

8 مربی گروه هوشبری، مرکز تحقیقات مؤلفه های اجتماعی نظام سلامت، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

9 استادیار گروه فارماکولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان، گیلان، ایران.

10 دانشجوی پزشکی، کمیته تحقیقات دانشجویی، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

چکیده

مقدمه: بی­حسی اسپاینال رایج‌ترین روش بی‌دردی برای سزارین الکتیو می­باشد. تهوع و استفراغ پس از عمل جراحی، یکی از شایع‌ترین شکایات بیماران در جراحی سزارین تحت بی­حسی اسپاینال می­باشد، لذا مطالعه حاضر با هدف بررسی نقش داروها در کنترل تهوع و استفراغ در زنان تحت عمل جراحی سزارین با بی­حسی اسپاینال انجام شد.
روشکار: در این مطالعه مروری روایتی یا نقلی جهت یافتن مطالعات مرتبط، پایگاه­های اطلاعاتی SID، Magiran و Google Scholar با کلید واژه‌های بی­حسی نخاعی، بی­حسی اسپاینال، تهوع، استفراغ و سزارین جستجو شدند. بازه زمانی جستجوی مقالات از سال 1380 تا سال 1400 بوده است.
یافته‌ها: مطالعات مختلف از داروهای متفاوتی جهت پیشگیری از تهوع و استفراغ پس از عمل جراحی سزارین استفاده کرده بودند. تهوع و استفراغ پس از بی­حسی نخاعی، هدف اختصاصی مطالعات بسیار زیادی با طراحی کارآزمایی بالینی بود. مداخلات انجام شده در این راستا شامل: استفاده از داروهایی مانند دگزامتازون، کتامین، لیدوکائین، اندانسترون، متوکلوپرامید،گرانیسترون، پروپوفول، گاباپنتین و میدازولام بود.
نتیجه‌گیری: کتامین علی‌رغم اینکه در مطالعات اثر ضدتهوع و استفراغی آن اثبات شده است، اما به‌دلیل عوارض هالوسینیشن و نیستاگموس و اینکه ممکن است شیردهی مادر را به تأخیر بیاندازد، بهتر است انتخاب اول متخصص بیهوشی نباشد. پروپوفول نیز اثرات ضدتهوع و استفراغی آن اثبات شده است، اما باید مراقب اثرات دپرشن تنفسی بیمار بود. دگزامتازون اثر تأخیری بر روی تهوع و استفراغ دارد، بنابراین شاید انتخاب مناسبی برای متخصص بیهوشی نباشد. داروهای آنتاگونیست گیرنده 5-HT3 (اندانسترون و گرانیسترون)، به‌نظر می­رسد بهترین انتخاب برای خط اول درمان تهوع و استفراغ باشند، زیرا این داروها عوارض اکستراپیرامیدال متوکلوپیرامید را ندارند و می­توانند به‌عنوان داروهای مناسب جهت تهوع و استفراغ بیماران تحت عمل جراحی سزارین با بی­حسی نخاعی مورد استفاده قرار بگیرند.

کلیدواژه‌ها


عنوان مقاله [English]

Control of nausea and vomiting in women undergoing cesarean section with spinal anesthesia: A narrative review study on the role of drugs

نویسندگان [English]

  • Hamed Ghasemloo 1
  • Seyed Ebrahim Sadeghi 2
  • Hashem Jarineshin 3
  • Hashem Jarineshin 4
  • Ahmad Rastgarian 5
  • Lohrasb Taheri 6
  • Athar Rasekh Jahromi 7
  • Farideh Mogharab 7
  • Navid Kalani 8
  • Davoud Roostaei 9
  • Naser Hatami 10
  • Majid Vatankhah 4
1 M.Sc. of Neonatal Intensive Care, Hazrate Fatemeh School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
2 Assistant professor, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
3 Associate professor, Department of Anesthesiology and Intensive Care, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4 Associate professor, Department of Anesthesiology and Intensive Care, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
5 Assistant professor, Department of Anesthesiology and Intensive Care, Anesthesiology and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
6 Assistant professor, Department of Surgery, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
7 Assistant professor, Department of Obstetrics and Gynecology, Women's Health and Diseases Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
8 Instructor, Department of Anesthesia, Research Center for Social Determinants of Health, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
9 Assistant Professor, Department of Pharmacology, Faculty of Medicine, Guilan University of Medical Sciences, Guilan, Iran.
10 Medical Student, Student Research Committee, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
چکیده [English]

Introduction: Spinal anesthesia is the most common method of analgesia for elective cesarean section. Postoperative nausea and vomiting is one of the most common complaints of patients in cesarean section under spinal anesthesia, so this study was performed with aim to investigate the role of drugs in controlling nausea and vomiting in women undergoing cesarean section with spinal anesthesia.
Methods: In this narrative review study, to find the related articles, databases of SID, Magiran, and Google Scholar were searched with the keywords of spinal anesthesia, nausea, vomiting, and cesarean section. The time period for searching articles was from 2001 to 2021.
Results: Different studies have used different medications to prevent nausea and vomiting after cesarean section. Nausea and vomiting after spinal anesthesia has been the specific goal of many studies with clinical trial design. The performed interventions in this regard included: use of drugs such as Dexamethasone, Ketamine, Lidocaine, Ondansetron, Metoclopramide, Granistron, Propofol, Gabapentin and Midazolam.
Conclusion: Although the anti-nausea and anti-emetic effect of ketamine has been approved in the studies, it is best not to be the first choice of an anesthesiologist because of the effects of hallucinations and nystagmus and the fact that it may delay breastfeeding. Propofol has also been shown to have anti-nausea and anti-emetic effects, but we must be careful about the effects of the patient's respiratory depression. Dexamethasone has a delaying effect on nausea and vomiting, so it may not be a good choice for an anesthesiologist. 5-HT3 receptor antagonists (ondansetron and granisetron) seem to be the best choice for first-line treatment of nausea and vomiting. Because these drugs do not have the extrapyramidal side effects of metoclopyramide and can be used as appropriate drugs for nausea and vomiting in patients undergoing cesarean section with spinal anesthesia.

کلیدواژه‌ها [English]

  • Cesarean section
  • Nausea
  • Spinal anesthesia
  • vomiting
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