Peri-medullary anesthesia is the preferred anesthetic technique for Caesarean surgery. Compared with general anesthesia, it reduces maternal and fetal morbidity and mortality, as well as postoperative pain. However, this technique exposes the patient to the adverse effects of peri-medullary morphine, particularly the risk of postoperative urinary retention. Urinary retention during the first 72 hours after Caesarean section affects around 33% of parturients.
This is a particularly debilitating event for parturients, exposing them to the risk of further urinary catheterization, increased theoretical risk of urinary tract infection, traumatic urethral injury, hindered accelerated rehabilitation and altered maternal satisfaction.
Several studies have demonstrated the benefits of adding magnesium sulfate to epidural anesthesia for Caesarean sections, notably by reducing postoperative pain.
Magnesium sulfate may also have a facilitating effect on postoperative micturition, thanks to its sympathicolytic effect.
This hypothesis is supported by a retrospective study carried out in our maternity hospital, which showed a 15% reduction in post-Caesarean urinary retention when women were given magnesium sulfate in addition to the drugs traditionally used for epidurals.
This little-known property needs to be clarified
Patients who have undergone scheduled or emergency Caesarean section surgery under extended epidural anesthesia or combined epidural and spinal anesthesia at the Reims University Hospital.
Patients who have just undergone caesarean section and have the epidural catheter in place in the post-interventional monitoring room (SSPI).
Patients who agree to take part in the research and have signed the informed consent form
Patients of legal age
Minor patients
Patients protected by law
Patients allergic to local anesthetics, morphine or magnesium sulfate
Patients with severe renal insufficiency (GFR < 30 ml/min)
Parallel
Injection of 500 mg magnesium sulfate + 2 mg morphine into the epidural space
DrugWhen the patient agrees to enter the protocol, the investigators randomize the patient and proceed to the injection of morphine 2 mg into the epidural catheter + magnesium sulfate 500 mg
Injection of Isotonic saline + 2 mg morphine into the epidural space
DrugWhen the patient agrees to enter the protocol, the investigators randomize the patient and proceed to Injection of morphine 2 mg into the epidural catheter + isotonic saline. This is the protocol the investigators use in daily practice for parturients who have undergone Caesarean section, in line with the French recommendations of anesthesia societies
diuresis
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