The aim of the researchers in this prospective study is to determine the differences, if any, in terms of anesthetic parameters among pregnant women who live at different altitudes and undergo cesarean section under neuraxial anesthesia under elective conditions and to contribute to the literature.
Increased intra-abdominal pressure during pregnancy increases the pressure in the epidural and spinal space and causes enlargement of the epidural veins. This may lead to easier increases in the anesthetic blockage level. For this reason, it is necessary to use the lowest possible dose of local anesthesia in these individuals compared to normal healthy individuals. The literature on the effect of altitude difference on central neuraxial block is limited. Based on studies showing changes in CSF volume and content in hypoxic conditions, According to the researchers, with the same amount of local anesthetic, the duration of sensory and motor blockade at sea level is thought to be equal to or longer than in mid-high regions. This study will be carried out among pregnant women who live in the city center at 3 different altitudes \[0-10 m (Giresun), 810 m (Çorum), 1725 m (Van)\] and undergo cesarean section under elective conditions. It will be performed in a multicenter, prospective, controlled, randomized manner in order to determine the differences, if any, among these pregnant women in terms of anesthetic parameters.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Enrollment
150
The same anesthesia protocol will be applied to the patient group at each altitude. In the sitting position, the spinal space was entered with a 25 gauge Quincke-tipped needle from the L4-5 space and a drop of CSF will be dripped onto the pH paper. Immediately afterwards, 12 mg of 0.5% hyperbaric bupivacaine will be given. The color formed on the pH paper will be noted. Sensory block level will be tested with pinprick test and motor block level will be evaluated with Modified Bromage scale. The number and duration of spinal anesthesia applications, the time of occurrence of sensory block in the T6 dermatome, the time to reach each score of the MB scale, the duration of the operation, the highest level of sensory block and anesthetic complications will be recorded. Sensory block time and motor block time of the patients followed in the service will be recorded.
Gıresun gynecology and children's hospital
Giresun, Turkey (Türkiye)
age
18-40 age frame
Time frame: preoperative period
Body max index
kg/m2
Time frame: preoperative period
heart rate
beats/min
Time frame: during the surgery
American Society of Anesthesiologists (ASA)
ASA I and II
Time frame: preoperative period
mean arterial pressure
mmHg
Time frame: during the surgery
The number and duration of spinal anesthesia applications
second
Time frame: during the surgery
the duration of sensory block formation in the T6 dermatome
second
Time frame: during the surgery
the time to reach each score of the MB(Modified bromage scale) scale 1-2-3
second
Time frame: during the surgery
the duration of the operation (time from the beginning of the surgical incision to the completion of the surgery)
minute
Time frame: during the surgery
the highest level of sensory block
dermatome level
Time frame: during the surgery
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postoperative block parameters
Sensory block time (DBS) (time from local anesthetic injection until S2 dermatome sensation), motor block time (MBS) (time from local anesthetic injection to full motor function recovery) will be evaluated for the patients followed in the service.
Time frame: postoperative first 24 hour
postoperative headache parameter
On the first and seventh days after the operation, the patients will be questioned by the researcher for post-dural puncture headache (PDPH, increased pain intensity when standing up from the supine position) by phone call.
Time frame: postoperative first and 7. day
postoperative nausea and vomiting parameter
the degree of postoperative nausea and vomiting will be checked (Verbal Descriptive Scale).
Time frame: postoperative first 24 hour