Minimally invasive spinal anesthesia for cesarean section in maternal anticoagulation therapy: a randomized controlled trial

Dan Huang, Linjie Zhu, Jie Chen, Jie Zhou, Dan Huang, Linjie Zhu, Jie Chen, Jie Zhou

Abstract

Background: Anticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section.

Methods: This was a randomized, controlled study conducted in 239 parturients using anticoagulants and undergoing selective cesarean section. 37 parturients withdrew, and finally parturients received spinal anesthesia using 27gauge pen type fine spinal needles (experimental group, n = 110) and 22gauge traditional spinal needles (control group, n = 92). The primary efficacy outcomes included low back pain (LBP) and postdural puncture headache (PDPH) after delivery. Secondary efficacy outcomes included visual analogue scale during subarachnoid puncture (VASdural), difference between visual analogue scale (VAS) during peripheral venipuncture and VASdural (∆VAS), VAS of back puncture point 24, 48 and 72 h after operation (VASdural-24 h, VASdural-48 h and VASdural-72 h, respectively), maternal satisfaction and hospitalization stay.

Results: No parturient had PDPH and was suspected with spinal or intracranial haematoma in two groups. There was no significant difference in VASlbp-24 h, VASlbp-48 h and VASlbp-72 h (P = 0.056; P = 0.813; P = 0.189, respectively) between two groups. In experimental group, VASdural (P = 0.017), ∆VAS (P = 0.001) and VASdural-24 h (P < 0.0001) were lower, whereas maternal satisfaction was higher (P = 0.046). There was no significant difference in VASdural-48 h, VASdural-72 h, urination function, strength recovery and hospitalization stay (P = 0.069; P = 0.667; P = 0.105; P = 0.133; P = 0.754, respectively) between the two groups.

Conclusions: Minimally invasive spinal anesthesia provided lower VASdural, VASdrual-24 h and a higher maternal satisfaction. Hence, it is considered as a safe, reliable and reasonable option for cesarean section parturients during maternal anticoagulation therapy with normal platelet count and coagulation time.

Trial registration: This study was registered at www.ClinicalTrials.gov at November 11th, 2016 ( NCT02987192 ).

Keywords: Anticoagulants; Cesarean section; Low back pain; Minimally invasive; Postdural puncture headache; Spinal anesthesia.

Conflict of interest statement

Ethics approval and consent to participate

The Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiaotong University reviewed the study protocol and the ethical approval was granted in March 2016 (No. 2016–033). Written informed consents were obtained either from the patients or legal representatives.

Consent for publication

All included patients or their family members signed the informed consent form to report individual patient data. All authors have confirmed the manuscript and approved the publication of the manuscript.

Competing interests

No conflict of interest was declared by any of the authors.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of a trial comparing low back pain, postdural puncture headache, pain of puncture point, maternal satisfaction and hospitalization days between 22 and 27guage needles

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