Spinal anesthesia during caesarean section in parturients with gestational diabetes: prospective controlled non-randomized study

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Abstract

BACKGROUND: Gestational diabetes mellitus (GDM) increases the incidence of cesarean section (CS) to 57.4%. Chronic high blood glucose levels can affect opioid receptors and neurotransmitter metabolism. Pregnant women with GDM require more analgesics and consumed more opioids in the immediate postoperative period after CS than patients without GDM. Thus, in parturients with GDM, the features of the spinal anesthesia (SA) course during CD surgery and the postoperative course remain not fully understood.

OBJECTIVE: To assess SA during CS in parturients with GDM.

METHODS AND METHODS: A prospective controlled study was conducted. The study group included patients with compensated GDM, excluding the criteria for “manifest” diabetes. The control group included patients without carbohydrate metabolism impairment. The inclusion criteria were as follows: SA, full-term and singleton pregnancy, elective CS, age 15–25 years, normal venous blood glucose levels in the morning before surgery, parity of pregnancy, and childbirth. The exclusion criteria were as follows: patients with American Society of Anesthesiologists class ≥IV, inadequate SA requiring the administration of drugs for general anesthesia, severe extragenital pathology, preeclampsia and eclampsia, insulin therapy, and use of oral hypoglycemic agents. After SA induction, Bromage motor block and sensory block were assessed.

RESULTS: Sensory block was achieved in 53% after 3 min, 84% after 4 min, and 100% of the patients in the control group after 5 min. In the GDM group, the threshold of 50% was reached after 7 min, and in all patients, sensory block was noted after 10 min. In the assessment of motor block by Bromage, all patients in the control group achieved motor block after 5 min, whereas in the GDM group, only 77.5% achieved motor block.

CONCLUSION: Our results suggest that with SA during CS in patients with GDM, compared with parturients without carbohydrate metabolism alteration, the rates of sensory and motor block development decreased. Differences in pain intensity were noted after the early postoperative period, and significant pain sensations in the GDM group are manifested on average 60 min earlier than that in the non-GDM group.

About the authors

Evgeny N. Degtyaryov

Mukhin City Clinical Hospital

Author for correspondence.
Email: dormicumtrade@gmail.com
ORCID iD: 0000-0002-7472-3733
SPIN-code: 4926-0550

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Efim M. Shifman

Vladimirsky Moscow Regional Research Clinical Institute

Email: dormicumtrade@gmail.com
ORCID iD: 0000-0002-6113-8498
SPIN-code: 4582-8494

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Vera D. Snezhko

Vishnevsky National Medical Research Center of Surgery

Email: dormicumtrade@gmail.com
ORCID iD: 0000-0001-6623-9637

anesthesiologist-resuscitator

Russian Federation, Moscow

Irina V. Zhukоvets

Amur State Medical Academy

Email: dormicumtrade@gmail.com
ORCID iD: 0000-0002-0555-848X
SPIN-code: 5924-3146

MD, Dr. Sci. (Med.), associate professor

Russian Federation, Blagoveshchensk

Sergey V. Khodus

Amur State Medical Academy

Email: dormicumtrade@gmail.com
ORCID iD: 0000-0001-5138-3791
SPIN-code: 9435-3196

MD, Cand. Sci. (Med.); associate professor

Russian Federation, Blagoveshchensk

References

  1. Klinicheskie rekomendatsii. Gestatsionnyi sakharnyi diabet. Diagnostika, lechenie, akusherskaya taktika, poslerodovoe nablyudenie. Moscow; 2020. Available from: http://niiomm.ru/attachments/article/523. Accessed: 07.02.2023. (In Russ).
  2. IDF Diabetes Atlas. 10th ed. Brussels, Belgium: International Diabetes Federation; 2019. Available from: https://diabetesatlas.org/en/. Accessed: 07.02.2023.
  3. Valsamakis G, Papatheodorou DC, Chalarakis N, et al. In pregnancy increased maternal STAI trait stress score shows decreased insulin sensitivity and increased stress hormones. Psychoneuroendocrinology. 2017;84:11–16. doi: 10.1016/j.psyneuen.2017.06.008
  4. Albrecht SS, Kuklina EV, Bansil P, et al. Diabetes trends among delivery hospitalizations in the U.S., 1994–2004. Diabetes Care. 2010;33(4):768–773. doi: 10.2337/dc09-1801
  5. DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Prev Chronic Dis. 2014;11:E104. doi: 10.5888/pcd11.130415
  6. Kaplan W, Sunehag AL, Dao H, Haymond MW. Shortterms effects of recombinant human growth hormone and feeding on gluconeogenesis in humans. Metabolism. 2008;57(6):725–723. doi: 10.1016/j.metabol.2008.01.009
  7. HAPO Study Cooperative Research Group; Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002. doi: 10.1056/NEJMoa0707943
  8. Fetita LS, Sobngwi E, Serradas P, et al. Consequences of fetal exposure to maternal diabetes in offspring. J Clin Endocrinol Metab. 2006;91(10):3718–3724. doi: 10.1210/jc.2006-0624
  9. Scholtens DM, Kuang A, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcome follow-up study (HAPO FUS): maternal gestational diabetes mellitus and childhood glucose metabolism. Diabetes Care. 2019;42(3):381–392. doi: 10.2337/dc18-2021
  10. Naylor CD, Sermer M, Chen E, Sykora K. Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? JAMA. 1996;275(15):1165–1170.
  11. Yogev Y, Ben-Haroush A, Chen R, et al. Active induction management of labor for diabetic pregnancies at term; mode of delivery and fetal outcome — a single center experience. Eur J Obstet Gynecol Reprod Biol. 2004;114(2):166–170. doi: 10.1016/j.ejogrb.2003.10.017
  12. Saxena P, Tyagi S, Prakash A, et al. Pregnancy outcome of women with gestational diabetes in a tertiary level hospital of north India. Indian J Community Med. 2011;36(2):120–123. doi: 10.4103/0970-0218.84130
  13. Gascho CL, Leandro DM, Ribeiro E Silva T, Silva JC. Predictors of cesarean delivery in pregnant women with gestational diabetes mellitus. Rev Bras Ginecol Obstet. 2017;39(2):60–65. doi: 10.1055/s-0037-1598644
  14. Abu-Heija AT, Al-Bash M, Mathew M. Gestational and pregestational diabetes mellitus in Omani women: comparison of obstetric and perinatal outcomes. Sultan Qaboos University Med J. 2015;15(4):e496. doi: 10.18295/squmj.2015.15.04.009
  15. McMahon MJ, Ananth CV, Liston RM. Gestational diabetes mellitus. Risk factors, obstetric complications and infant outcomes. J Reprod Med. 1998;43(4):372–378.
  16. Gasim T. Gestational diabetes mellitus: maternal and perinatal outcomes in 220 Saudi women. Oman Med J. 2012;27(2):140. doi: 10.5001/omj.2012.29
  17. Courteix C, Bourget P, Caussade F, et al. Is the reduced efficacy of morphine in diabetic rats caused by alterations of opiate receptors or of morphine pharmacokinetics? J Pharmacol Exp Ther. 1998;285(1):63–70.
  18. Das UN. Hypothesis: Intensive insulin therapy-induced mortality is due to excessive serotonin autoinhibition and autonomic dysregulation. World J Diabetes. 2010;1(4):101–108. doi: 10.4239/wjd.v1.i4.101
  19. Todorovic SM. Is Diabetic Nerve Pain Caused by Dysregulated Ion Channels in Sensory Neurons? Diabetes. 2015;64(12):3987–3989. doi: 10.2337/dbi15-0006
  20. Zhang HH, Hu J, Zhou YL, et al. Promoted interaction of nuclear factor-κB with Demethylated Purinergic P2X3 receptor gene contributes to neuropathic pain in rats with diabetes. Diabetes. 2015;64(12):4272–4284. doi: 10.2337/db15-0138
  21. Park SH, Bahk JH, Oh AY, et al. Gender difference and change of α(1)-adrenoceptors in the distal mesenteric arteries of streptozotocin-induced diabetic rats. Korean J Anesthesiol. 2011;61(5):419–427. doi: 10.4097/kjae.2011.61.5.419
  22. Yang C, Geng WL, Hu J, Huang S. The effect of gestational diabetes mellitus on sufentanil consumption after cesarean section: a prospective cohort study. BMC Anesthesiol. 2020;20(1):14. doi: 10.1186/s12871-019-0925-1
  23. Kulikov AV, Shifman EM, editors. Anesteziya pri operatsii kesareva secheniya. In: Anesteziya, intensivnaya terapiya i reanimatsiya v akusherstve i ginekologii. Klinicheskie rekomendatsii. Protokoly lecheniya. Moscow: Meditsina; 2020. P. 348–382. (In Russ).
  24. Bromage PR, editor. Epidural Analgesia. Philadelphia: WB Saunders; 1978. P. 144.
  25. Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976;2(2):175–184.
  26. Klinicheskie rekomendatsii. Rody odnoplodnye, rodorazreshenie putem kesareva secheniya. Moscow; 2021. Available from: http://minzdravrm.ru/wp-content/uploads/2021/07/Rodi_odnoplodtii_rodorazrechenie_putem_kesareva.pdf. Accessed: 07.02.2023. (In Russ).

Supplementary files

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2. Fig. 1. Study scheme.Note. ГСД — gestational diabetes mellitus.

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3. Fig. 2. Evaluation of motor block in the study groups, 2 min after intrathecal administration of anesthetic (p <0.0001).Note (here and in Fig. 3–7). ГСД — gestational diabetes mellitus, K — control group.

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4. Fig. 3. Evaluation of motor block in the study groups, 3 min after intrathecal administration of anesthetic (p <0.0001).

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5. Fig. 4. Evaluation of motor block in the study groups, 4 min after intrathecal administration of anesthetic (p <0.0001).

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6. Fig. 5. Evaluation of motor block in the study groups, 5 min after intrathecal administration of anesthetic (p <0.0001).

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7. Fig. 6. The time of sensory block registration at the level of ThIV–ThV with and without gestational diabetes mellitus (p <0.0001).

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8. Fig. 7. Visual Analog Scale assessment in the postoperative period (p <0.0001).

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Copyright (c) 2022 Degtyaryov E.N., Shifman E.M., Snezhko V.D., Zhukоvets I.V., Khodus S.V.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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