Ngaba iiOpioids ziyimfuneko ngokwenene emva kweC-C?

Umxholo

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Ihlabathi lezabasebenzi kunye nokuhanjiswa kuyatshintsha, ngokukhawuleza. Izazinzulu azifumananga nje indlela yokukhawulezisa umsebenzi, kodwa abasetyhini bakhetha iindlela ezithambileyo zecandelo le-C. Ngelixa amacandelo e-C engakhuthazwa nguMbutho wezeMpilo weHlabathi ngaphandle kokuba kubonakale kunyanzelekile ngokwezonyango, ngamanye amaxesha kunjalo zi iyimfuneko. Yaye impumelelo yamva nje yenzululwazi inokwenza inkqubo yokuchacha ikhawuleze, ingabi buhlungu kwaye ingakhoboki.

Ewe kunjalo, amacandelo e-C ngokwabo awanazo iziyobisi, kodwa iziyobisi zihlala zisetyenziswa kwinkqubo yokubuyisela kwimeko yesiqhelo-iiopioid ezinjengePercocet okanye iVicodin-zi. Kwaye ingxelo entsha evela kwi-QuintilesIMS Institute yafumanisa ukuba i-9 kwizigulane ze-10 zotyando zifumana i-opioid RXs ukulawula intlungu emva kokuhlinzwa. Banikwa umndilili weepilisi ezingama-85 nganye-inani elinokuba phezulu kakhulu, njengoko ingxelo ikwafumanise ukuba ngaphezulu kwe-opioids emva kotyando kukhokelele kwiipilisi ezingasetyenziswanga ezi-3.3 zezigidigidi ngo-2016 kuphela.

Uphononongo olutsha olupapashwe kwi I-Obstetrics & Gynecology ixhasa abafazi abachacha kumacandelo e-C. Emva kokuhlalutya abaguli abali-179, bafumanisa ukuba ngelixa iipesenti ezingama-83 zisebenzisa i-opioid ngokomyinge weentsuku ezisibhozo emva kokukhutshwa, iipesenti ezingama-75 ziseneepilisi ezingasetyenziswanga. Kuyingozi ngakumbi kwabasetyhini, njengoko ingxelo ye-QuintilesIMS ifumene ukuba abantu basetyhini banamathuba angama-40 epesenti okuba ngabasebenzisi be-opioid abaqhubekayo emva kokuvezwa.

Ke, ukuba abasetyhini kunokwenzeka ukuba babe ngamakhoboka eeopioid, umbuzo omnye uyavela: Ngaba ikhona indlela yokuyeka ukuthembela kubo xa bechacha kwicandelo le-C? Ugqirha-Richard Chudacoff, MD, ob-gyn eDumas, TX-ucinga ukuba impendulo iyangxola Ewe.

Ugqirha Chudacoff uthi ebesebenzisa ezinye iinkqubo zolawulo lwentlungu kule minyaka ingamashumi idlulileyo, njengoko ebonile ukuba izigulana eziyehla ezantsi zinokuzifumana xa zithatha iiopioids. “Iyamangalisa impembelelo yekhephu abanokuba nayo,” uyacacisa. "Iiopioids azisusi iintlungu, zenza nje ungakhathali ukuba iintlungu zikhona, oko kuthetha ukuba awukhathali malunga nayo yonke enye into." Kodwa ukuba ususa i-opioids kwi-equation, uDkt. Chudacoff uthi izigulane ziva ngakumbi ukucaca kwengqondo emva kokubeleka.

Ngaphezulu koko, uGqr. Chudacoff uqikelela ukuba uninzi lwabo bane-opioid okanye umlutha we-heroin baqala ngokuthatha iipilisi zentlungu, mhlawumbi emva kotyando olufana necandelo le-C, kuba kudla ngokuba yinto yokuqala yokuvezwa komntu kubo. "Uya ekhaya kunye nale bhotile yeepilisi kwaye kulula ukuyisebenzisa ukukunceda ulale, ushukume, kwaye uzive ungcono xa ucinezelekile." (Ukudakumba emva kokubeleka kuqhelekile kunokuba ucinga.)

Sekunjalo, amacandelo C a kakhulu utyando olukhulu kwaye uya kufuna isiqabu seentlungu xa ufuna olunye. (Funda ngakumbi ku-Parents.com: Iingcali zilinganisa i-Pros and Cons of ukuthatha i-Opioids Emva kwe-C-Section) Kwaye ukuba nobulungisa, abaninzi abafazi bathatha i-painkillers ukukhululeka kwexesha elifutshane ngaphandle komcimbi. Ukusetyenziswa okungapheliyo kulapho uqala ukungena kwiingxaki-kodwa ezi ngxaki ziphambili. AmaZiko oLawulo lweSifo kunye noThintelo (CDC) afumene ukuba ukugqithisa okubulalayo kwi-opioids ye-opioids kuye kwaphindaphinda kane ukususela ngo-1999, kubalelwa kuqikelelo lokufa kwe-15,000 kwi-2015.

Isitshixo kukujonga ukhetho lwakho nogqirha wakho kwangaphambili. Njengenye indlela, uGqr. Chudacoff ebesebenzisa i-Exparel, inaliti engeyo-opioid esetyenziswa ngexesha lotyando kwaye ithomalalisa iintlungu kancinci kwiiyure ezingama-72. Weva ngeyeza lokuthomalalisa iintlungu xa umhlobo wakhe osenyongweni, umalathisi oyintloko kwiziko lotyando, wamxelela ngalo kusetyenziswa ngoogqirha botyando oluphuma emadolweni ababeqhubana nezigulana ezinehemorrhoid, kunye noogqirha abenza utyando edolweni. Izigulana bezixela ukunqongophala kwentlungu ngaphezulu kweentsuku ezine, ke uGqirha Chudacoff wenze uphando olongezelelekileyo ukubona ukuba ingasebenza kumacandelo e-C kunye nee-hysterectomies.

Ekugqibeleni, wenza i-C-section yakhe yokuqala ye-opioid kwaye uthi isigulane asizange sifune umyalelo wokuhlinzwa. Kuyafana nakwinto nganye ayenzileyo ukusukela. "Andizange ndibhale imigqaliselo ye-opioid emva kokusebenza emva kweenyanga ezintathu," uyaphawula, echaza ukuba umgangatho wakhe wokunyamekela endaweni utshintsha phakathi kwe-acetaminophen (iTylenol) okanye ibuprofen (Motrin) ukuya "kunyanga iintlungu ngendlela engeyiyo-opioid; ukuphelisa umngcipheko wokuba likhoboka. "

Ngaphezulu, uGqirha Chudacoff uthi izigulana zakhe ze-Exparel, ngokomndilili, ziphuma ebhedini kwaye zihamba kwisithuba seeyure ezintathu zoqhaqho, kwaye "iipesenti ezingama-99 ziye zahamba, zachama, zaza zatya kwisithuba seeyure ezintandathu. Iintsuku eziyi-1.2. I-American Congress of Obstetricians kunye neGynecologists (ACOG) ithi i-avareji yokuhlala esibhedlele kwi-C-section yientsuku ezimbini ukuya kwezine, ngoko ke umahluko omkhulu.

Ngelixa oku kuvakala njengempendulo kumthandazo obuhlungu womfazi ngamnye osebenzayo, iyeza alizi ngaphandle kwemiqolomba. Okokuqala, kuyabiza. Ugqirha Chudacoff uthi isibhedlele asebenza kuso ngoku sigubungela indleko zamachiza ezigulana, kodwa ayisiyo protocol esemgangathweni, kwaye ixabiso elithengiswayo le-vial ye-20-mL ye-Exparel imalunga ne- $ 285. “Oku kutsha nje kweyeza, ubuncinci kumacandelo e-C, kangangokuba uninzi lwe-ob-gyns alwazi nto ngalo,” utshilo. Ikwagutyungelwanga yi-inshurensi, uyongeza, yiyo loo nto ecebisa ukuba ujonge kwisibhedlele sakho sendawo malunga neendleko zonyango ezongezelelekileyo onoxanduva lwakho ngaphambi kokuba usayine kumgca ochaziweyo.

Ixabiso ayisiyiyo kuphela inkxalabo, nangona. Izifundo ezibini zifumanise ukuba iyeza alikhange lisebenze ngakumbi ekupheliseni iintlungu zotyando emadolweni kune-bupivacaine, inaliti yokuqaqanjelwa ngumqolo ejoyiweyo ekumgangatho wokunyangwa kotyando olwahlukeneyo, kubandakanya namacandelo e-C. Kodwa oko akuthethi ukuba ayisebenzi ekunciphiseni ukusetyenziswa kwe-opioid. Xa abaphandi babelawula i-Exparel kwizigulana zotyando emadolweni- endaweni ye-bupivacaine-iyonke yokusetyenziswa kwe-opioid kwehle ngeepesenti ezingama-78 kwiiyure zokuqala ezingama-72 emva kotyando, ngeepesenti ezili-10 ezasala ngaphandle kwe-opioid, ngokophando olupapashiweyo Ijenali yeArthroplasty. Iyavakala loo nto xa ucinga ukuba i-Exparel ihlala malunga neeyure ezingama-60 ubude.

“Esi sisiqalo sempumelelo enkulu,” utshilo. "Ukuba ucinga ukuba amacandelo e-C yenye yezona nkqubo zixhaphakileyo e-United States, kwi-1.2 yezigidi ngonyaka, oko kuthetha ukuba ungalahla inani lemimiselo ye-opioid ngaphezulu kwesigidi ngonyaka, oko kunokuba yinto enkulu ukulwa ubhubhane esikukho ngoku. "

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