EMERGENCY NON-OBSTETRIC SURGERY DURING PREGNANCY: ANESTHETIC AND PAIN MANAGEMENT IN OVARIAN CYST TORSION

Authors

  • Peter Leonardo Anesthesiology and Intensive Therapy Specialist Medical Education Program, Faculty of Medicine, Riau University, Indonesia
  • Novita Anggraeni Puri Husada Regional Hospital, Indragiri Hilir, Riau, Indonesia
  • Diana Masjkur Arifin Achmad Regional Hospital, Pekanbaru, Riau, Indonesia

DOI:

https://doi.org/10.21460/bikdw.v9i2.1036

Keywords:

Ovarian Cyst Torsion, Pregnancy, Postoperative Pain, Regional Anesthesia, Ropivacaine

Abstract

The management of non-obstetric emergency surgeries during pregnancy presents unique challenges that necessitate careful consideration of both maternal and fetal health. This case report outlines the management of a pregnant patient (G3P2A0H2, 10-11 weeks gestation) who presented with acute abdominal pain due to a suspected ovarian cyst torsion. The patient underwent exploratory laparotomy under spinal anesthesia with bupivacaine, morphine, and fentanyl. Postoperative pain was managed using a multimodal analgesic strategy including surgical wound infiltration with 0.25% ropivacaine combined with dexamethasone. This technique was used to minimize opioid use and enhance recovery. The patient experienced stable hemodynamics and minimal postoperative pain (VAS 1-2), and was discharged on the third postoperative day. This case highlights the importance of effective pain management, particularly during non-obstetric surgeries during pregnancy. Regional anesthesia, along with local infiltration of ropivacaine and dexamethasone, provides an effective pain control strategy, contributing to faster recovery and enhanced patient satisfaction while minimizing systemic opioid exposure.

References

Rasmussen AS, Christiansen CF, Ulrichsen SP, Uldbjerg N, Nørgaard M. Non?obstetric abdominal surgery during pregnancy and birth outcomes: A Danish registry?based cohort study. Acta Obstet Gynecol Scand. 2020;99(4):469-476. doi:10.1111/aogs.13775

Choi HN, Ng BRJ, Arafat Y, Mendis BAS, Dharmawardhane A, Lucky T. Evaluation of safety and foeto?maternal outcome following non?obstetric surgery in pregnancy: a retrospective single?site Australian study. ANZ J Surg. 2021;91(4):627-632. doi:10.1111/ans.16617

Upadya M, Saneesh P. Anaesthesia for non-obstetric surgery during pregnancy. Indian J Anaesth. 2016;60(4):234. doi:10.4103/0019-5049.179445

Godara J, Pratap Godara S, Makhdoom T, Yehya AlSayari S. The Impact of Anesthesia for Non-Obstetric Procedures During Pregnancy on Maternal and Fetal Wellbeing. Vol 5.; 2023. www.ijfmr.com

Wonte MM, Bantie AT, Tadesse M. A pregnant lady with compound bowel obstruction managed with thoracic epidural as sole anesthesia in a resource-restricted setting: a case report. J Med Case Rep. 2023;17(1):231. doi:10.1186/s13256-023-03962-6

Bonnet MP. Sedation and anaesthesia for non-obstetric surgery. Anaesth Crit Care Pain Med. 2016;35:S35-S41. doi:10.1016/j.accpm.2016.06.009

Sukmono R, Ramlan A, Andy A, Satoto D, Septica R. Pre-emptive 600 mg oral gabapentin reduces morphine requirements and postoperative pain following non-obstetric lower abdominal surgery. Anaesthesiol Intensive Ther. 2022;54(1):42-47. doi:10.5114/ait.2022.113750

Garmi G, Parasol M, Zafran N, Rudin M, Romano S, Salim R. Efficacy of Single Wound Infiltration With Bupivacaine and Adrenaline During Cesarean Delivery for Reduction of Postoperative Pain. JAMA Netw Open. 2022;5(11):e2242203. doi:10.1001/jamanetworkopen.2022.42203

Ijarotimi OA, Omitinde OAA, Omitinde SO, Ubom AE, Ibrahim M, Adeyemi AB. Right ovarian torsion and oophorectomy in second trimester of pregnancy with subsequent live birth at term. Journal of Clinical Images and Medical Case Reports. 2021;2(4). doi:10.52768/2766-7820/1239

Nia GK. Torsion of a large ovarian dermoid cyst in the second trimester of pregnancy and its management: a case report. International Journal of Pregnancy & Child Birth. 2020;6(3):51-53. doi:10.15406/ipcb.2020.06.00196

Raza R, Hassan M, Ahmed A. Torsion of Para-Ovarian Cyst: Case Report and Review of Literature. Journal of Perioperative Medicine. 2017;01(01). doi:10.35248/2684-1290.18.1.102

Cho S, Chung RK, Jin SH. Factors Affecting Maternal and Fetal Outcomes of Non-Obstetric Surgery and Anesthesia during Pregnancy: a Retrospective Review of Data at a Single Tertiary University Hospital. J Korean Med Sci. 2020;35(17). doi:10.3346/jkms.2020.35.e113

Sachs A, Guglielminotti J, Miller R, Landau R, Smiley R, Li G. Risk Factors and Risk Stratification for Adverse Obstetrical Outcomes After Appendectomy or Cholecystectomy During Pregnancy. JAMA Surg. 2017;152(5):436. doi:10.1001/ jamasurg.2016.5045

Zachariah SK, Fenn M, Jacob K, Arthungal SA, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. Int J Womens Health. 2019;Volume 11:119-134. doi:10.2147/IJWH.S151501

Braito M, Dammerer D, Schlager A, Wansch J, Linhart C, Biedermann R. Continuous Wound Infiltration After Hallux Valgus Surgery. Foot Ankle Int. 2018;39(2):180-188. doi:10.1177/1071100717736292

Durrani HD, Sadaf S, Naqvi SAA, Bajwa MH, Ahmad MS, Khalid M. The effect of local tramadol infiltration in post pyelolithotomy pain. The Professional Medical Journal. 2021;28(7):1022-1027. doi:10.29309/TPMJ/2021.28.07.5742

Biomy NR, Fathelbab A, Abdel-Fattah A, Farhat AE. Ketamine versus Dexmedetomidine in Local Wound Infiltration for Postoperative Pain Relief in Cesarean Section. International Journal of Medical Arts. 2021;3(3):1570-1575. doi:10.21608/ ijma.2021.185126

Kristensen BB. High-Volume Infiltration Analgesia in Major Lumbar Spine Surgery. A Randomized, Placebo-Controlled, Double-Blind Trial. J Anesth Clin Res. 2014;05(09). doi:10.4172/2155-6148.1000450

Chen Y, Wu J, Xu J, Chen Y, Huang C. A Bioinformatics Study of Ropivacaine plus Dexamethasone Prolonging the Duration of Nerve Block. Comput Intell Neurosci. 2022;2022:1-11. doi:10.1155/2022/5869103

Gulati N, Garg I, Arora D. A prospective, randomised, double blind study comparing dexamethasone and dexmedetomidine as adjuvants to 0.2% ropivacaine for post-operative analgesia in ultrasound guided brachial plexus block. Indian Journal of Clinical Anaesthesia. 2022;9(4):485-489. doi:10.18231/j.ijca. 2022.097.

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Published

2024-12-30

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