Analgesic effect of multimodal analgesia technique in transverse incision cesarean section of singleton pregnancy
LI Jia1 SHEN Mingkun2
1.Department of Anesthesiology, the Third People’s Hospital of Huishan District of Wuxi City, Jiangsu Province, Wuxi 214000, China;
2.Department of Anesthesiology, Wuxi Maternal and Child Health Care Hospital, Jiangsu Province, Wuxi 214000, China
Abstract：Objective To study the analgesic effect of multimodal analgesia (MMA) technique in transverse incision cesarean section of singleton pregnancy. Methods Ninety-four patients with selective transverse incision cesarean section of singleton pregnancy admitted to WuXi Maternal and Child Health Care Hospital from October 2016 to October 2018 were divided into control group and observation group by random number table method, with 47 cases in each group. Control group was given traditional mode analgesia, observation group was given MMA. The visual analogue scales (VAS) at 2, 12 h and 24 h after operation were observed in two groups. The levels of β-endorphin (β-EP) and neuropeptide Y (NPY) were measured at before and 24 h after operation in two groups. The initial lactation time and satisfaction scores were compared in two groups, and the incidence of adverse reactions in two groups was recorded. Results There were significant differences in VAS of both resting-pain and exercise-pain between groups, time point comparison and interaction between the two groups (all P ＜ 0.05). Further intra-group comparison showed that the VAS of resting-pain and exercise-pain at 12 h after operation in two groups were significantly higher than those of at 2 h after operation, and the VAS of resting-pain and exercise-pain at 24 h after operation were significantly lower than those of at 2 h after operation and the differences were statistically significant (all P ＜ 0.05). Comparison between groups showed that the VAS of resting-pain and exercise-pain in the observation group were lower than those in the control group at 12 h and 24 h after operation, and the differences were statistically significant (all P ＜ 0.05). The initial lactation time in observation group was shorter than that in control group, and the satisfaction score was higher than that in control group (all P ＜ 0.05). Twenty-four hours after operation, the levels of β-EP and NPY in both groups were higher than those before operation, and the observation group were lower than the control group, and the differences were statistically significant (all P ＜ 0.05). The adverse reaction rate in the observation group was lower than that in the control group (P ＜ 0.05). Conclusion The MMA technique is safe and effective in cesarean section with transverse incision of singleton pregnancy.
[1] 刘静，孟志鹏，赵燕.超声引导下腹横肌平面阻滞用于剖宫产术后多模式镇痛对母乳喂养的影响[J].浙江医学，2017，39（9）：753-755.
[2] 林蓉，徐振东，刘志强.剖宫产术后镇痛的研究进展[J].国际麻醉学与复苏杂志，2018，39（11）：1091-1096.
[3] 齐丰军，杨小立，廖华山，等.氯胺酮在剖宫产术后多模式镇痛中的应用[J].陕西医学杂志，2017，46（11）：1600-1601.
[4] Triunfo S，Ferrazzani S，Draisci G，et al. Role of maternal characteristics and epidural analgesia on caesarean section rate in groups 1 and 3 according to Robson’s classification：a cohort study in an Italian university hospital setting [J]. Bmj Open，2018，8（4）：e020011.
[5] 世界医学会.赫尔辛基宣言[J].医学与哲学，2001，22（4）：60-61.
[6] 李莉，吕艳，翟翔隽，等.全产程多模式分娩镇痛对母婴安全的影响[J].国际妇产科学杂志，2018，45（2）：145-149.
[7] Herreragómez A，De LE，Ramostorrecillas J，et al. The Effect of Epidural Analgesia Alone and in Association With Other Variables on the Risk of Cesarean Section [J]. Biol Res Nurs，2017，19（4）：109980041770602.
[8] 张富杰，夏俊龙，孟凡浩.腰硬联合麻醉与连续硬膜外麻醉在潜伏期分娩镇痛中应用的比较[J].中国医药导报，2019，16（16）：112-115.
[9] 应泽华，孙德友，徐鹏，等.不同术后镇痛方式对剖宫产产妇产后微循环与疼痛指标的影响比较[J].四川医学，2017，38（5）：554-556.
[10] Klasen F，Bourgoin A，Antonini F，et al. Postoperative analgesia after caesarean section with transversus abdominis plane block or continuous infiltration wound catheter：a randomized clinical trial [J]. Anaesth Crit Care Pa，2017，1（4502）：544.
[11] 李燕，朱桃花，李如霞，等.分娩镇痛在剖宫产后阴道试产中的应用效果[J].中国妇幼健康研究，2018，29（9）：1167-1171.
[12] 汤莉莉，顾尔伟.静脉注射利多卡因在无痛胃镜检查中的临床应用[J].中国医药导报，2019，16（35）：139-142.
[13] 李建春.腰硬麻醉联合地佐辛静脉自控镇痛对剖宫产术后镇痛及泌乳素的影响[J].中国妇幼保健，2017，32（22）：266-269.
[14] 郝丹丹，穆峰，王保国，等.地佐辛单次静脉注射对患者痛阈、自主呼吸及意识的影响[J].中国医药导报，2019， 16（1）：114-118.
[15] 卢德强，高敏捷.盐酸纳布啡联合舒芬太尼用于妇产科开腹手术后患者清醒镇痛的临床观察[J].中国妇幼保健，2018，33（9）：213-215.
[16] 陈美霞，刘慧华.罗哌卡因联合舒芬太尼在分娩镇痛过程中对产妇的影响[J].中国医药科学，2019，9（5）：108-110，148.
[17] Weigl W，Biery?覥o A，Wielgus M，et al. Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section：A randomized controlled study [J]. Medicine （Baltimore），2017，96（48）：e8892.
[18] 苗晓茹，小辉.地佐辛与舒芬太尼用于剖宫产术镇痛效果比较[J].陕西医学杂志，2017，46（10）：1459-1460.
[19] Zhao Y，Xin Y，Liu Y，et al. Effect of Epidural Dexmedetomidine Combined With Ropivacaine in Labor Analgesia： A Randomized Double-Blinded Controlled Study [J]. Clin J Pain，2016，33（4）：319-324.
[20] Mieszkowski MM，Mayzner-Zawadzka E，Tuyakov B，et al. Evaluation of the effectiveness of the Quadratus Lumborum Block type Ⅰ using ropivacaine in postoperative analgesia after a cesarean section- a controlled clinical study [J]. Ginekol pol，2018，89（2）：89-96.
[21] Bonnal A，Dehon A，Nagot N，et al. Patient-controlled oral analgesia versus nurse-controlled parenteral analgesia after caesarean section：a randomised controlled trial [J]. Anaesthesia，2016，71（5）：535-543.
[22] Sumikura H，Niwa H，Sato M，et al. Rethinking general anesthesia for cesarean section [J]. J Anesth，2016，30（2）：268-273.
[23] 黄珍.右美托咪定复合舒芬太尼自控镇痛对剖宫产产妇镇痛效果及应激反应的影响[J].医学临床研究，2018， 35（5）：936-937.
[24] 王成夭，咸淑悦，马敏，等.腹横肌平面阻滞在产科加速康复中的应用价值[J].武汉大学学报：医学版，2019，40（2）：284-287.
[25] 赵辉，周文，邓清华，等.右美托咪定PCIA在产科多模式镇痛的疗效观察[J].黑龙江医药，2018，31（4）：800-802.
[26] 张素晶，吴希珠，周敏，等.多模式镇痛对重度子痫前期患者剖宫产术后早期按压宫底疼痛的影响[J].福建医药杂志，2018，40（5）：23-26.
[27] 李林佶，李顺洪，袁卫国，等.右美托咪定复合罗哌卡因腹横平面阻滞用于剖宫产术后镇痛的效果[J].西部医学，2018，30（5）：707-710.
[28] 陈培伟，李杰伟，田雨.右美托咪定联合低浓度罗哌卡因在产程早期分娩镇痛的临床应用[J].中国医药科学，2020，10（6）：114-119.
[29] 袁蕾.MMA对重度子痫前期患者剖宫产术后母体应激反应程度及胎盘内质网应激、细胞凋亡的影响[J].海南医学院学报，2017，23（9）：1226-1229.
2021, Vol. 18 
京公网安备 11010502046598号