Pharmacoepidemiology and pharmacoeconomics of pain management in caesarean section in a chronological aspect

Abstract

Background. For pain management during caesarean section, the correct choice of anesthesia and adequate analgesia are of great importance. Aim. To study pain management methods for caesarean section, to develop their pharmacoepidemiological and pharmacoeconomic characteristics in a chronological aspect. Material and methods. A retrospective pharmacoepidemiological and pharmacoeconomic analysis of 1025 birth histories of women after caesarean section with a detailed assessment of the use of local anesthetics, central deprecating agents, opioid and non-opioid analgesics in 20072009 (523) and 20162017 (502) was carried out. Frequency of use, total consumption and cost of drug therapy during and after surgery were analyzed. The significance of differences in relative indicators was assessed by Pearson (2). Results. In the first time period, regional methods of anesthesia were used in 98.5% of cases: epidural anesthesia in 428 (82%) cases, spinal anesthesia in 87 (16.5%) cases (p=0.001). In the second period, regional methods of anesthesia were used in 97.5% of cases: epidural anesthesia in 157 (31%) cases, spinal anesthesia in 334 (66.5%) cases (p=0.001). Intraoperatively, in the second period, trimeperidine for spinal anesthesia, fentanyl for epidural anesthesia (p=0.001; p=0.001) were prescribed 2 times more often; intraoperative consumption of opioid analgesics was greater than in the first period. After surgery in the first period with epidural anesthesia more often than in the second, trimeperidine (45%), ropivacaine (96%); for spinal and epidural anesthesi paracetamol, ketorolac (p=0.001), were prescribed. Spinal anesthesia in both periods was characterized by a greater consumption of adjuvants than epidural anesthesia. In the first period, 12 drugs for pain management from 5 pharmacotherapeutic groups were used, in the second 10 drugs from 5 groups. The cost of epidural anesthesia was 4 times higher in the first period, and 7 times higher in the second. Conclusion. Between 2007 and 2017, there was a transition from epidural to spinal anesthesia, and opioid analgesics were more often added to local anesthetics to manage pain during surgery in the second period; the cost of epidural anesthesia was high due to the price of ropivacaine.