|Title:||The use of tenoxicam to prevent symptoms of discomfort induced by vagotonia during uterus manipulation in cesarean sections||Authors:||CHI-HSIANG HUANG
|Keywords:||cesarean section; tenoxicam; uterus manipulation; vagotonia||Issue Date:||2017||Journal Volume:||96||Journal Issue:||30||Source:||Medicine (United States)||Abstract:||
Purpose:Symptoms such as nausea, vomiting, tightness of the chest, bradycardia, and shoulder or abdominal discomfort, caused by vagotonia occurring during uterus manipulation, have concerned healthcare professionals for some time. Patients sometimes report these symptoms when undergoing spinal anesthesia for cesarean sections (CSs). We designed a prospective, double-blind study to investigate the effectiveness of tenoxicam in preventing these symptoms of discomfort. Methods:A total of 105 American Society of Anesthesiologists (ASA) class I-II nulliparous pregnant women, who were scheduled for a CS, were enrolled into this prospective, double-blind study. Spinal anesthesia was conducted to reach a peak dermatome level of no more than T3. The 100 patients were randomly divided into 2 groups having completed study course: Group T (N = 50) received a 20 mg dose of tenoxicam in 5 mL of normal saline (NS) immediately after skin incision and Group N (N = 50) only received 5 mL NS. The incidence and severity of the symptoms experienced by the patients were recorded by a nurse anesthetist who was blinded to the injection regimen the patients were receiving. A chi-square test was used for statistical analysis t test and P < .05 was defined as significant. Results:The incidence and degree of severity of nausea and vomiting were same in both the groups. The incidence and degree of severity of bradycardia, nausea, vomiting, tightness of the chest, shoulder discomfort, and abdominal discomfort were lower in Group T than in Group N. Conclusion:Tenoxicam might theoretically block the parasympathetic vagus pathway and decrease the visceral pain or visceral-specific symptoms, alleviating the symptoms caused by vagotonia. However, the prophylactic effect of tenoxicam in reducing the incidence and severity of nausea and vomiting was not statistically significant. This could be because nausea and vomiting are not solely caused by vagotonia, but also by other mechanisms. ? 2017 the Author(s). Published by Wolters Kluwer Health, Inc.
|DOI:||10.1097/MD.0000000000007624||SDG/Keyword:||bupivacaine; ephedrine; ergometrine; midazolam; oxytocin; placebo; propofol; sodium chloride; tenoxicam; cholinergic receptor blocking agent; piroxicam; tenoxicam; abdominal discomfort; adult; American Society of Anesthesiologist score; Article; bradycardia; cesarean section; chest tightness; clinical evaluation; controlled study; dermatome; disease severity; double blind procedure; drug efficacy; elective surgery; female; functional status assessment; human; incidence; major clinical study; nausea and vomiting; nullipara; nurse anesthetist; obstetric anesthesia; personal experience; pilot study; pregnant woman; priority journal; prospective study; randomized controlled trial; shoulder discomfort; shoulder disease; skin incision; spinal anesthesia; uterus manipulation; uterus surgery; vagotonia; vagus nerve disease; adverse effects; analogs and derivatives; bradycardia; nausea; pain; pathophysiology; severity of illness index; surgery; treatment failure; uterus; vomiting; Adult; Anesthesia, Spinal; Bradycardia; Cesarean Section; Double-Blind Method; Female; Humans; Incidence; Nausea; Nurse Anesthetists; Pain; Parasympatholytics; Piroxicam; Severity of Illness Index; Treatment Failure; Uterus; Vomiting
|Appears in Collections:||醫學院附設醫院 (臺大醫院)|
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