Egyptian Journal of Anaesthesia

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MATERNAL SATISFACTION TOWARDS SPINAL

ANAESTHESIA FOR CAESAREAN SECTION

M Babajide Adegboye, I Kayode Kolawole, K. Adewale Adegboye, C Iyabo

Oyewopo & O Oyewole Oladosu

To cite this article: M Babajide Adegboye, I Kayode Kolawole, K. Adewale Adegboye, C

Iyabo Oyewopo & O Oyewole Oladosu (2022) MATERNAL SATISFACTION TOWARDS SPINAL
ANAESTHESIA FOR CAESAREAN SECTION, Egyptian Journal of Anaesthesia, 38:1, 236-241, DOI:
10.1080/11101849.2022.2069345

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EGYPTIAN JOURNAL OF ANAESTHESIA
2022, VOL. 38, NO. 1, 236–241
https://doi.org/10.1080/11101849.2022.2069345

MATERNAL SATISFACTION TOWARDS SPINAL ANAESTHESIA FOR CAESAREAN

SECTION
M Babajide Adegboyea, I Kayode Kolawolea, K. Adewale Adegboyeb, C Iyabo Oyewopoc
and O Oyewole Oladosub
a
Department of Anaesthesia, Faculty of Clinical Sciences, College of Health Sciences University of Ilorin, Nigeria; bDepartment of
Anaesthesia, university of Ilorin teaching hospital, Ilorin, Nigeria; cDepartment of Anaesthesia, University of Ilorin Teaching Hospital, Ilorin,
Nigeria

ABSTRACT ARTICLE HISTORY

Background: There has been an increase in the use of spinal anaesthesia for Caesarean section Received 11 May 2020
(CS) in Nigeria in the past decades. There is, therefore, a need to evaluate the level of Revised 29 June 2020
satisfaction among patients that had spinal anaesthesia, as an index of the quality of repro­ Accepted 18 April 2022
ductive health care. KEYWORDS
Methodology: A prospective observational study of 380 consenting parturients in ASA classes Cesarean section; spinal
I, II, and III, who underwent CS under spinal anaesthesia between January and December 2019. anaesthesia; maternal
Satisfaction score was assessed using a three-point Likert scale. Data were analysed using [IBM satisfaction
SPSS software version-22]. The level of statistical significance was set at p-value <0.05.
Results: A total of 380 consenting patients underwent spinal anaesthesia within the study
period with 219 (57.6%) aged ≥30 years. Most were emergency CS 267 (70.3%). Most patients
294 (77.4%) expressed satisfaction for being involved in decision-making about the choice of
anaesthesia technique. The majority of the patients 333 (87.6%) were satisfied with pain relief
during the operation. The complications experienced by the patients intraoperatively included
dizziness, 50 (13.2%), shivering, 139 (36.6%), and intraoperative nausea and vomiting, 48
(12.6%). Overall, 295 (77.6%) of the patients expressed willingness to have spinal anaesthesia
again in the future, out of the 295, 293 (99.4%) were satisfied with the current spinal anaes­
thesia. P = 0.000
Conclusion: Maternal satisfaction to spinal anaesthesia in this study was high. This could be
attributed to patient’s participation in decision-making, prompt treatment of complications,
and overall good anaesthetic care.

1. INTRODUCTION
for postoperative analgesia, fewer thromboembolic events,
There is a rise in the trend of caesarean section rate for both higher Apgar scores, and, more importantly, earlier onset of
emergency and elective surgical deliveries in Nigeria [1,2] postoperative oral nutrition in the mother [8–10].
and spinal anaesthesia as the anaesthetic technique of A prospective evaluation of maternal satisfaction to
choice has also been on the increase [1–3]. Regional anaes­ spinal anaesthesia is important in order to ascertain
thesia for caesarean delivery has generally been on the rise the changes required to improve on the overall quality
globally. In the United Kingdom, a survey by Jenkins and of health-care delivery to the patient.
Khan [4] showed a 95% spinal anaesthesia rate for cesarean Patient satisfaction is a subjective and complex con­
section in 2002. While in the West Indies by December 2001 cept involving physical, emotional, psychological,
more than eight out of ten cesarean sections were being social, and cultural factors [11]. It is an experience of
done under spinal anaesthesia [5]. Imarengiaye et al. [6] the quality of care and a difficult outcome to measure,
reported that over 85% of the caesarean sections in some mainly because it is a subjective multidimensional con­
hospitals in Nigeria were conducted under spinal anaesthe­ cept based on patient expectation [12]. The complica­
sia. Anaesthetists usually prefer spinal anaesthesia for cae­ tions of spinal anaesthesia, such as inadequate block,
sarean delivery because it is safe and comfortable for the pain, shivering, nausea, and vomiting, as well as the
mother and is associated with the least fetal depression, as spinal anaesthesia procedure itself, can be uncomfor­
well as providing the best surgical conditions for the sur­ table to the patients [13]. Portal et al. [14] concluded
geon[7]. Spinal anaesthesia also has other advantages when that anaesthesia was the single most important factor
compared to general anaesthesia, such as the reduced need that leads to unsatisfactory memories of childbirth.

CONTACT M Babajide Adegboye [email protected] Department of Anaesthesia, Faculty of Clinical Sciences, College of Health Sciences
University of Ilorin, Nigeria
This article has been corrected with minor changes. These changes do not impact the academic content of the article.
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
 EGYPTIAN JOURNAL OF ANAESTHESIA 237

As in other settings across the world, the use of anaesthesia, parturients who were delivered through
spinal anaesthesia for caesarean delivery has also other methods of anaesthesia, for example, epidural
increased in University of Ilorin teaching hospital. anaesthesia and parturients who delivered per vagina.
Adegboye et al. [15] reported in 2019 that 88.9% of
cesarean delivery was by spinal anaesthesia in their
institution. However, despite the high rate of spinal 3. Sample size determination
anaesthesia for caesarean delivery in our institution,
The following formula, described by Cochran, was used
there has been no study to assess the level of mater­
to calculate the sample size [19].
nal satisfaction after the administration of spinal
n = Z [2](1 – ∝/2) x P (1 – P)/d [2]
anaesthesia. Does this choice of spinal anaesthesia
Where; Z [2](1 – ∝/2) is the standard error of the
for parturients undergoing caesarean delivery meet
mean corresponding to a 95% confidence interval and
the patient’s satisfaction? Patient satisfaction is an
the corresponding value from a t-table is 1.96
objective way to provide feedback to the healthcare
P = the proportion of the target population, that is,
givers on the aspects that need improvement. It is the
incidence of spinal anaesthesia at 48% [3].
most important element in healthcare organizations
d = is the target margin of error at 0.05
and the top goal for any health-care delivery strat­
n = sample size
egy [16].
n = 379
Studies conducted on maternal satisfaction follow­
Therefore a sample size of 380 patients was used for
ing spinal anaesthesia for caesarean delivery revealed
the study.
variations in the rate of satisfaction, while most devel­
oped countries reported higher satisfaction rates, most
developing African countries showed a relatively lower 4. Procedure
maternal satisfaction rate [17,18].
Therefore, this study aimed to ascertain the level of The study included all parturients scheduled for cesar­
maternal satisfaction following spinal anaesthesia for ean delivery under spinal anaesthesia. During the pre-
caesarean delivery and to identify the predictors of anaesthetic review, all patients with ASA I, II, and III
dissatisfaction associated with spinal anaesthesia for physical status between the ages of 18–49 years sched­
caesarean delivery in order to improve on the quality uled for cesarean section under spinal anaesthesia
of health-care delivery and to meet the patient needs. were enrolled in the study. The spinal anaesthetic
technique to be used was carefully explained to the
patient by the investigators, as well as the complica­
2. Materials and methods tions, and other outcomes related to the procedure
during the pre-anaesthetic review. Patients were pre­
The study was a prospective observational study carried loaded with 15 ml/kg of 0.9% normal saline over 15
out by the department of Anaesthesia University of min before spinal anaesthesia. A sterile tray for spinal
Ilorin Teaching Hospital (UITH) on women who under­ anaesthesia was set up. Standard asepsis was main­
went cesarean delivery under spinal anaesthesia. The tained. The patient was positioned seated for the sub­
University of Ilorin Teaching Hospital (UITH) is located in arachnoid block with the feet placed on a stool so that
Ilorin metropolis, which is the capital of Kwara State in the hips and knee were in a flexed position and the
the north-central region of Nigeria. The hospital pro­ neck flexed. The skin over the lower back was cleaned
vides primary, secondary, and tertiary health services to with povidone-iodine. The spinal anaesthesia was per­
the population. It also serves as a major referral centre formed using the L4/L5 or L3/L4 interspace. The spinal
for all areas in Kwara state and parts of the neighbour­ puncture site was infiltrated with 2mls of 1% lidocaine
ing states of Kogi, Ekiti, Osun, Oyo, and Niger. Institution using a 25 G 30 mm hypodermic needle before the
ethical approval was obtained (ERC/2019/ 05/1508), introduction of a 26 G Quinkes spinal needle (TAE-
and the study was performed in accordance with the CHANG, Kongu city, Korea) using a midline approach
ethical standards laid down in the 1964 Declaration of and following a continuous free flow of cerebrospinal
Helsinki and its later amendments fluid, 12.5 mg of 0.5% hyperbaric bupivacaine
Inclusion criteria were all parturients aged between 18 (Duracaine myungmoon pharmco Ltd South Korea)
and 49 years with American Society of Anesthesiologist was injected slowly without barbotage.
(ASA) physical status class I, II, and III who consented to Postoperatively in the recovery room patients’ satisfac­
participate in the study. While the exclusion criteria were tion with anaesthesia was assessed using
parturients who did not consent to participate in the a questionnaire sheet consisting of the five-point
study, parturients with communication problem with Likert scale (Very dissatisfied, Dissatisfied, Neither satis­
the investigator, parturients who had failed spinal anaes­ fied nor dissatisfied, Satisfied, Very satisfied) [20].
thetic technique and had to be converted general Provision for an interpreter was made available by
238 ADEGBOYE ET AL.

investigators who assisted in interpretation during the 45 years, respectively. The parturients were mostly
interview in cases of patients who could not commu­ university graduates 239 (62.9%). Majority of the par­
nicate in English language. turients were multiparous 313 (82.4%). About half of
The sampling method was purposive sampling in the parturients had previous exposure to anaesthesia
which all consenting patients who satisfied the inclu­ 187 (49.2%) out of which 144 (77%) had spinal anaes­
sion criteria were recruited into the study. The study thesia. The ASA physical status of most of the parturi­
was carried out between January 2019 and ents was ASA II 228 (75.8%), 58 (15.2%) were ASAIII in
December 2019. which 24 (41.4%) of them were patients with severe
All information obtained during the conduct of the preeclampsia. Most of the cesarean section was done
study were handled with confidentiality and used only as emergency 267 (70.3%). About 182 (49.2%) of the
for the study. parturients had previous exposure to anaesthesia, out
of which 144 (77.0%) had spinal anaesthesia.
Preoperatively 102 (90.3%) parturients out of the 113
5. Data analysis
(29.7%) who had their caesarean section performed as
The data were analysed using the statistical package elective were satisfied with the explanation of spinal
for social sciences (IBM SPSS Statistics for Windows, anaesthesia and 209 (78.3%) parturients out of the 267
Version 22.0. Armonk, NY. IBM Corp). Demographic (70.3%) who had their caesarean section performed as
data such as age groups, parity, education level, and an emergency procedure were satisfied with the expla­
previous exposure to anaesthesia are presented as nation of spinal anaesthesia.
frequency distribution. The five-point Likert scale [20] Table 2 shows that a total of parturients 294 (77.4%)
was compressed to three-point Likert scale (Satisfied, were satisfied for being involved in the decision-
Neither satisfied or dissatisfied, Dissatisfied) for ease of making of the choice of spinal anaesthesia as the
analysis to measure patients satisfaction. The results anaesthetic technique. Out of the 294 parturients, 94
are expressed as means and percentage and presented (31.97%) of them had elective caesarean deliveries and
in tables and figures as appropriate. The level of sig­ 200 (68.03%) had emergency deliveries. The majority
nificance for comparative analysis was p-value <0.05. of the mothers (94%) were satisfied with the absence
of pain during lumbar puncture. Most of the parturi­
ents 333 (87.6%) were satisfied with the intraoperative
6. Result
pain relief. While 364 (95.8%) of the parturients were
A total of 380 parturient were enrolled in the study. satisfied with the overall conduct of the spinal
Table 1 shows a summary of the socio-demographic anaesthesia.
aspects of the parturients. Most of the parturients were Table 3 shows that out of the 380 parturients that
above 30 years of age with a mean age of 30.58 years had cesarean section performed under spinal anaes­
and minimum and maximum age being 18 and thesia 48 (12.6%) had intraoperative nausea and

Table 2. Level of satisfaction with, explanation of spinal anaes­

Table 1. Socio-demographic characteristics of the parturients. thesia, pre-operative decision-making, injection of spinal
Variable Frequency Percentage anaesthesia, intraoperative pain relief, and satisfaction with
Age
anaesthetic care.
<30 161 42.4 NS/D
≥30 219 57.6 Variable D (%) (%) S (%) Total
Educational Level Explanation of spinal 8(2.1) 61(16.1) 311 380(100)
Uneducated 7 1.8 anaesthesia 12 74 (81.8) 380(100)
Primary school 21 5.5 Decision making for (3.1) (19.5) 294
Secondary school 113 29.7 choosing spinal (77.4)
Graduate 239 62.9 anaesthesia.
Parity Injection of spinal 23(6.0) 25(6.6) 332 380(100)
Primiparous 67 17.6 anaesthesia (87.4)
Multiparous 313 82.4 Intraoperative pain relief 27(7.1) 20(5.3) 333 380(100)
Type of surgery (87.6)
Emergency 267 70.3 Satisfaction with spinal 5(1.3) 11(2.9) 364 380(100)
Elective 113 29.7 anaesthesia. (95.8)
ASA Status
I 34 8.9 D = Dissatisfied, NS/D = Neither satisfied nor dissatisfied, S = Satisfied
II 288 75.8
III 58 15.3
Previous exposure to anaesthesia Table 3. Intraoperative complication of spinal anaesthesia
Yes 187 49.2 experienced by the parturients.
No 193 50.8
Previous anaesthetic technique Variables Yes (%) No (%) Total (%)
General anaesthesia 40 21.4 Intraoperative nausea and vomiting 48(12.6) 332(87.4) 380(100)
Spinal 144 77.0 Intraoperative dizziness 50(13.2) 330(86.8) 380(100)
Other regional technique 3 1.6 Intraoperative shivering 139(36.6) 241(63.4) 380(100)
 EGYPTIAN JOURNAL OF ANAESTHESIA 239

Table 4. Level of satisfaction with the treatment of intraoperative nausea and vomiting, intraoperative dizziness, and intraopera­
tive shivering.
Variable D (%) NS/D (%) S (%) Total (%)
Intraoperative nausea and vomiting 3(6.3) 8(16.7) 37(77.0) 48(100)
Intraoperative dizziness 3(6.0) 7(14.0) 40(80.0) 50(100)
Intraoperative shivering 20(14.5) 23(16.7) 95(68.8) 138(100)
D = Dissatisfied, NS/D = Neither satisfied nor dissatisfied, S = Satisfied

Table 5. Comparing parturients level of satisfaction to spinal anaesthesia as the technique in the future were satis­
anaesthesia to the choice of spinal anaesthesia next time. fied with the spinal anaesthesia 293 (99.4%) with
Level of satisfaction a p-value of 0.000.
to spinal anaesthesia Acceptance of spinal anaesthesia in future N (%)
Figure 1 shows the percentage level of satisfaction
Yes No Not Total p value
sure of the parturients to the conduct of anaesthesia, using
D 1(0.3) 2(16.7) 2(2.7) 5(1.3) various variables preoperatively and intraoperatively.
NS/D 1(0.3) 1(8.3) 9(12.3) 11(2.9) 0.000
S 293 9(75) 62(85) 364 Most of the parturients 81.8% were satisfied with the
(99.4) (95.8) preoperative explanation of spinal anaesthesia by the
Total 295(100) 12(100) 73(100) 380(100)
anaesthetist, while 87.6% of the parturients were satis­
D = Dissatisfied, NS/D = Neither satisfied nor dissatisfied, S = Satisfied
fied with intraoperative pain relief.

vomiting, 50 (13.2%) had intraoperative dizziness and 7. Discussion

139 (36.6%) had intraoperative shivering. Table 4 The maternal satisfaction rate of spinal anaesthesia for
shows that 37 (77.0%) parturients were satisfied with caesarean delivery in this study is 95.8%. A recent study
the treatment of intraoperative nausea and vomiting in two Eritrean hospitals also reported a maternal satis­
by administering intravenous metoclopramide. While faction rate of 87.9% in mothers towards spinal anaes­
40 (80.0%) and 95 (68.8%) were satisfied with the thesia for caesarean delivery [21]. These rates are in
treatment of intraoperative dizziness and intraopera­ keeping with several studies that have reported the
tive shivering respectively maternal satisfaction score of spinal anaesthesia to be
Table 5 compares the level of satisfaction of the generally high, ranging from 85% to 100% [17,22,23].
parturients to spinal anaesthesia and if spinal anaes­ The level of satisfaction on the pre-anaesthetic expla­
thesia would be their anaesthetic choice in the future. nation of procedure in this study was 81.8%, which is
Majority of the parturients 295 (77.6%) said they would relatively low compared with that of Dharmalingam
accept spinal anaesthesia for a similar procedure in the and Zainuddin [17] which was 98%, but higher than
future. Most of the parturients that choose spinal that of Uziele et al. [24] (67.1%). The lower level of
satisfaction to the explanation of the procedure in
our study could be attributed to the fact that most of
Theatre atmosphere the caesarean deliveries were performed as emergen­
86.1
cies 267(70.3%) when the parturients were already
intraoperative shivering
68.8 experiencing labour pain and unsure of the ability of
intraoperative dizzness spinal anaesthesia to offer immediate pain relief.
80
Therefore, further breaking it down, the satisfaction
intraoperative nausea and… level to the explanation of the spinal procedure was
77.1
less among the parturients that had emergency cae­
pain during operation
87.6 sarean section 78.3% when compared to those parturi­
spinal injection ents that had elective caesarean section 90.3%. Some
87.4
previous authors who recorded lower pre-anaesthetic
participate in decision…
77.4 level of satisfaction to the explanation of the proce­
complication of spinal… dure are also in agreement with our argument that it is
73.2
because the parturients were experiencing labour
explation of spinal… pains, especially with parturients for emergency cae­
81.8
sarean section, but attributed the reason to the fact
0 20 40 60 80 100
that the parturients may not have concentrated on the
Percentage %
explanation of spinal anaesthesia given by the anaes­
Figure 1. Level of satisfaction in percentage of various vari­ thetist. [17,22] Shisanya and Marema [22] further
ables associated with the conduct of spinal anaesthesia. explained that besides the presence of labour pain
240 ADEGBOYE ET AL.

that is being associated with low satisfaction score, 68.8%. This is similar to the 40.2% reported by Uziele
lack of pre-anaesthetic visit at all to the parturients et al. [24]. Therefore, there is a need for prompt recog­
also leads to low satisfaction to pre-anaesthesia expla­ nition of post-spinal shivering and treatment with the
nation. In the current study, because of the high level appropriate drug, such as opioids, following spinal
of satisfaction with the preoperative explanation of anaesthesia.
spinal anaesthesia, the overall maternal satisfaction The current study showed that 295 (77.6%) of the
level to spinal anaesthesia was significantly influenced. parturients accepted that they would choose spinal
The level of satisfaction of parturients with the anaesthesia for a similar procedure in the future out
opportunity to be involved in decision-making to of this 295, 293 (99.4%) of them were satisfied with the
have spinal anaesthesia for caesarean delivery was conduct of the current spinal anaesthetic technique.
77.4% in this study, which is lower compared to that This was statistically significant p = 0.000. Similar find­
reported by Turnbull et al. [25] who reported 90.9%. ings were reported by Uziele et al. [24] and Sadeghi
However, if we break it down into satisfaction with et al. [11] in which 95% and 78.6% of their parturient
involvement in decision-making in parturients for elec­ who had spinal anaesthesia as their choice of anaes­
tive caesarean section and those for emergency cae­ thesia wished to use spinal anaesthesia for similar
sarean section, the satisfaction score was 83.2% and future surgeries. However, some factors such as dissa­
74.9%, respectively. This is comparable to that tisfaction with the treatment of intraoperative shiver­
obtained by Mould et al. [26] who reported ing, intraoperative nausea, and vomiting, poor
a satisfaction score of 93% for elective caesarean deliv­ explanation of the spinal anaesthetic procedure, parti­
ery and 69% for emergency caesarean delivery. cipation in decision-making and injection site pain are
Therefore, our study demonstrated that parturients variables in the overall satisfaction to spinal anaesthe­
had a good satisfaction score when involved in the sia, which could be simply controlled. The limitation of
decision-making to have their caesarean section by our study was that the level of maternal satisfaction to
spinal anaesthesia. the spinal anaesthesia was done in the immediate
There was a high level of maternal satisfaction with postoperative period in the post-anaesthesia recovery
intraoperative pain control in this study 87.6%. Most room and assessment of complication like post-dual
intraoperative pain is usually a discomfort felt during puncture headache PDPH could not be assessed.
the uterus exteriorization and peritoneal retraction[27].
Once the baby is delivered patients that complained of
pain was given intravenous pethidine and diclofenac 8. Conclusion
sodium according to their body weight. A similar study The overall satisfaction to spinal anaesthesia in our
by Siddiqi and Jafi [23] reported a maternal satisfaction study was high 95.8% that is good because ideally,
score of 74.09% to intraoperative pain control. The a satisfaction level closer to 100% should be the target.
higher satisfaction in our study may be because our This high level of satisfaction could be attributed to
data collection was done in the recovery room patient’s participation in decision-making, prompt
(immediate postoperative period) compared to the treatment of complications and overall good anaesthe­
study by Siddiqi and Jafi [23] in which there was no sia care that are important factors to ensure maternal
limit on the time of data collection after the caesarean satisfaction following spinal anaesthesia for caesarean
delivery. When the analgesic effect of spinal anaesthe­ delivery.
sia wears off, the patient starts having post-operative
pain and if the pain is not managed properly it may be
difficult for some parturients to differentiate between Disclosure statement
intraoperative and post-operative pain, therefore,
resulting in a lower anaesthesia satisfaction score. No potential conflict of interest was reported by the
The high score of maternal satisfaction to pain control author(s).
in this study shows that spinal anaesthesia is effective
in controlling pain during the surgery and in the References
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