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

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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.

作者简介

Evgeny Degtyaryov

Mukhin City Clinical Hospital

编辑信件的主要联系方式.
Email: dormicumtrade@gmail.com
ORCID iD: 0000-0002-7472-3733
SPIN 代码: 4926-0550

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

Efim Shifman

Vladimirsky Moscow Regional Research Clinical Institute

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

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

俄罗斯联邦, Moscow

Vera Snezhko

Vishnevsky National Medical Research Center of Surgery

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

anesthesiologist-resuscitator

俄罗斯联邦, Moscow

Irina Zhukоvets

Amur State Medical Academy

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

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

俄罗斯联邦, Blagoveshchensk

Sergey Khodus

Amur State Medical Academy

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

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

俄罗斯联邦, Blagoveshchensk

参考

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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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版权所有 © Degtyaryov E.N., Shifman E.M., Snezhko V.D., Zhukоvets I.V., Khodus S.V., 2022

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