Regain of Gastrointestinal Motility after General Anesthesia versus Spinal Anesthesia in Cesarean Section

Abstract

SUMMARY P ostoperative ileus (POI) is a common problem after major abdominal surgery and may lead to significant postoperative morbidity, prolonged hospitalization, and increased health care costs. Several mechanisms are thought to play a role in POI, including sympathetic neural reflexes, local and systemic inflammatory mediators, and changes in various neural and hormonal transmitters. Many potential treatment options exist for POI, but data regarding the efficacy of various therapies are generally limited. The objective of this study is to compare the effect of general anesthesia versus spinal analgesia on gastrointestinal motility regain after cesarean section. The study included 193 patients in each group. All patients had elective lower segment C.S and subdivided into 2 groups according to randomization scale. These two groups were group (A) which had general anesthesia and group (B) which had spinal anesthesia. The included patients set for planned C.S under either general or spinal anesthesia their ages ranged from 18 to 37 years with singleton, full term pregnancy (37-41 weeks), and HB level>11gm/dl. Patients were excluded if there is any medical disorder as DM, cardiac or thyroid diseases, contraindication to regional analgesia i.e. (parturient refusal, coagulopathy, significant hypovolemia, systemic or local sepsis, increased intracranial pressure, severe stenotic valvular heart disease, pre existing neurologic conditions and local anaesthetic or fentanyl allergy, high risk pregnancies as pre eclampsia or eclampsia, and previous intestinal surgery, previous CS and previous gynecological operations. Auscultation for intestinal sound started 2hours after operation and was performed at one hour interval. Postoperative data as administration of NSAIDs and /or opioids were recorded. Our study result showed statistically significant effect of spinal anesthesia versus general anesthesia in term of shorter mean time interval to normal intestinal sound (12.93 hours difference), passage of flatus (13.39 hours difference), first motion (14.06 hours difference), and discharge from hospital (21.77 hours difference) (9.93 hours difference) in spinal group. Also our study showed beneficial effect of spinal anesthesia versus general anesthesia in term of less use of opioids, less use of non steroidal anti inflammatory drugs, less incidence of distension and less incidence of ileus. Our study showed that there was a highly statistically significant difference between the two studied groups and BMI regarding to fever, opioid use, Distension, ileus, 1stSound, 1stFlatus, 1stMotion and hospital stay.