Kodi Opioids Amafunikiradi Pambuyo pa C-Gawo?

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Dziko la ntchito ndi kubereka likusintha, mofulumira. Sikuti asayansi apeza njira yofulumizitsa ntchito yofulumira, koma amayi akusankhanso njira zochepetsera za C-gawo. Ngakhale magawo a C samavomerezedwa ndi World Health Organisation pokhapokha ngati akuwoneka kuti ndi ofunikira kuchipatala, nthawi zina amatero ndi zofunikira. Ndipo zomwe asayansi apanga posachedwa zitha kuchititsa kuti kuchira kukhale kwachangu, kosapweteka, komanso kosasokoneza.

Zachidziwikire, magawo a C okha sali oledzeretsa, koma mankhwala omwe amagwiritsidwa ntchito nthawi zambiri pochira-opioids monga Percocet kapena Vicodin-ndi. Ndipo lipoti latsopano lochokera ku QuintilesIMS Institute linapeza kuti 9 mwa odwala opaleshoni a 10 amalandira opioid RXs kuti athetse ululu wa pambuyo pa opaleshoni. Amapatsidwa pafupifupi mapiritsi a 85 aliyense-chiwerengero chomwe chingakhale chokwera kwambiri, monga lipotilo linapezanso kuti opioid yowonjezereka pambuyo pa opaleshoni inachititsa kuti mapiritsi 3.3 biliyoni asagwiritsidwe ntchito mu 2016 yokha.

Kafukufuku watsopano wofalitsidwa mu Obstetrics & Gynecology kumbuyo kwa azimayi omwe akuchira kuchokera kumagawo a C. Pambuyo pofufuza odwala 179, adapeza kuti ngakhale 83% adagwiritsa ntchito ma opioid kwa masiku asanu ndi atatu atachira, 75% akadali ndi mapiritsi osagwiritsidwa ntchito. Ndizowopsa kwa azimayi, monga momwe lipoti la QuintilesIMS lidapeza kuti akazi anali ndi mwayi wokwanira 40% wogwiritsa ntchito opioid pambuyo powonekera.

Kotero, ngati amayi ali okonzeka kutengeka ndi opioid, funso limodzi likubuka: Kodi pali njira yosiya kudalira iwo pamene akuchira kuchokera ku gawo la C? Dokotala-Richard Chudacoff, MD, ob-gyn ku Dumas, TX-akuganiza kuti yankho lake ndi lomveka inde.

Dr. Chudacoff akuti wakhala akugwiritsa ntchito njira zina zothanirana ndi ululu kwa zaka makumi angapo zapitazi, popeza akuwona kuti odwala omwe akupita kukadzipeza atha kumwa ma opioid. "N'zodabwitsa kuti mpira wa chipale chofewa ukhoza kukhala nawo," akufotokoza motero. "Ma opioid samachotsa zowawa, amangokupangitsani kuti musasamale kuti kupweteka kulipo, zomwe zikutanthauza kuti simusamala za china chilichonse." Koma ngati mutachotsa ma opioid mu equation, a Dr. Chudacoff akuti odwala amamva bwino m'maganizo akabereka.

Pamwamba pa izo, Dr. Chudacoff akuyerekeza kuti ambiri mwa omwe ali ndi vuto la opioid kapena heroin anayamba ndi kumwa mapiritsi opweteka, mwina pambuyo pa opaleshoni ngati gawo la C, chifukwa nthawi zambiri munthu amayamba kukumana nawo. "Mumapita kunyumba ndi botolo la mapiritsiwa ndipo n'zosavuta kuwagwiritsa ntchito kuti akuthandizeni kugona, kusuntha, ndi kukuthandizani kuti mukhale bwino ngati mukuvutika maganizo pang'ono." (Matenda a Postpartum ndiofala kuposa momwe mukuganizira.)

Komabe, magawo a C ndi a kwambiri Kuchita opaleshoni yayikulu ndipo mufuna kupumula ngati mungafunike. (Werengani zambiri pa Parents.com: Akatswiri Amayesa Ubwino ndi Kuipa Kwake Kutenga Opioids Pambuyo C-Gawo) Ndipo kunena zowona, azimayi ambiri amatenga mankhwala opha ululu kuti apumule kwakanthawi kochepa popanda vuto. Kugwiritsa ntchito kwakanthawi ndi komwe mumayamba kulowa m'mavuto - koma mavutowa ndi akulu. Centers for Disease Control and Prevention (CDC) idapeza kuti kuchuluka kwa anthu opitilira mankhwala opioid kwadutsa kanayi kuyambira 1999, kuwerengera anthu pafupifupi 15,000 mu 2015.

Chinsinsi ndikuwunika zomwe mungachite ndi dokotala pasadakhale. Mosiyana ndi izi, Dr. Chudacoff wakhala akugwiritsa ntchito Exparel, jakisoni wosagwira opioid yemwe amaperekedwa panthawi yochita opaleshoni ndipo amachepetsa pang'onopang'ono kupweteka kwa maola 72. Anadziŵa za mankhwala oletsa ululu pamene bwenzi lake lapamtima, mkulu woyang’anira malo opangira opaleshoni, anamuuza za kugwiritsidwa ntchito kwa maopaleshoni amtundu wa zilonda za m’mimba amene anali kuthandiza odwala otupa m’mimba, limodzi ndi madokotala ochita maopaleshoni a mawondo. Odwalawo anali kunena za kusowa kwa ululu kwa masiku opitirira anayi, kotero Dr. Chudacoff anachita kafukufuku wowonjezera kuti awone ngati angagwire ntchito mu C-gawo ndi hysterectomy.

Pamapeto pake, adachita gawo lake loyamba la opioid wopanda opioid ndipo akuti wodwalayo sanafune kuti amupatse mankhwala obwera pambuyo pake. Zomwezo zimapitilira chilichonse chomwe wakhala akuchita kuyambira pamenepo. "Sindinalembe malangizo a opioid pambuyo pa opaleshoni m'miyezi itatu," akutero, akufotokoza kuti muyezo wake wa chisamaliro m'malo mwake umasinthasintha pakati pa acetaminophen (Tylenol) kapena ibuprofen (Motrin) kuti "ayambe kuchiritsa ululu m'njira yopanda opioid; kuthetsa chiopsezo chomwa mankhwala osokoneza bongo. "

Kuphatikiza apo, a Dr. Chudacoff ati odwala ake a Exparel, pafupifupi, atagona pabedi ndikuyenda patadutsa maola atatu kuchitidwa opareshoni, ndipo "99% ayenda, kutsekula, ndikudya mkati mwa maola asanu ndi limodzi. Masiku 1.2. " American Congress of Obstetricians and Gynecologists (ACOG) akuti pafupifupi chipatala chokhala m'chigawo cha C masiku awiri kapena anayi, ndiye kusiyana kwakukulu.

Ngakhale izi zikumveka ngati yankho la pemphero lopweteka la mayi aliyense amene akugwira ntchito, mankhwalawa samabwera popanda chenjezo. Choyamba, ndiokwera mtengo. Dr. Chudacoff akunena kuti chipatala chomwe akugwira ntchito pano chimalipira mtengo wa mankhwalawa kwa odwala, koma izi sizomwe zimagwiritsidwa ntchito, ndipo mtengo wamtengo wapatali wa 20-mL vial wa Exparel ndi pafupifupi $285. "Izi ndi zaposachedwa kwambiri zamankhwala, makamaka a magawo a C, kotero kuti ambiri mwa ma ob-gyns sadziwa nkomwe," akutero. Sizili ndi inshuwaransi, akuwonjezera, ndichifukwa chake akukulimbikitsani kuti muyang'ane ndi chipatala chapafupi kwanuko za ndalama zowonjezera zachipatala zomwe mungakhale nazo musanasaine pamzere wamadontho.

Mtengo siwo wokha nkhawa, komabe. Kafukufuku awiri adapeza kuti mankhwalawa sanali othandiza kuthana ndi kupweteka kwa maondo kuposa bupivacaine, mankhwala opatsirana a msana omwe anali muyezo wosamalira ma opaleshoni osiyanasiyana, kuphatikiza ma C-magawo. Koma izi sizikutanthauza kuti sizothandiza kuchepetsa kugwiritsa ntchito opioid. Pamene ofufuza kutumikiridwa Exparel kwa odwala opaleshoni mawondo-m'malo muyezo bupivacaine-okwana opioid kumwa kunachepa ndi 78 peresenti mu oyambirira 72 maola opaleshoni, ndi 10 peresenti anakhalabe opioid wopanda, malinga ndi kafukufuku lofalitsidwa. Journal of Arthroplasty. Izi ndizomveka poganizira kuti Exparel imatha pafupifupi maola 60.

"Ichi ndi chiyambi cha kupambana kwakukulu komwe kungatheke," akutero. "Ngati mukuwona kuti magawo a C ndi imodzi mwanjira zofala kwambiri ku United States, pa 1.2 miliyoni pachaka, zikutanthauza kuti mutha kusiya kuchuluka kwa mankhwala opioid opitilira miliyoni miliyoni, zomwe zingakhale zazikulu polimbana ndi miliri yomwe tikukhalamo."

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