Observation On Effect Of Dexmedetomidine Combined With Ropivacaine For Transverse Abdominal Muscle Plane Block Analgesia After Cesarean Section

Objective:Within 48 hours after the cesarean section,Parturients experience severe pain,and the postoperative pain drop parturients in anxiety,depression,insomnia ect,which will cause neuroendocrine stress response,hypercoagulable state,gastrointestinal disorder and immune function inhibition.If the postoperative acute pain cannot well controlled,it may be converted into chronic pain,lasting for several years or even decades,which will seriously reduce the quality of life of the parturients.Stress reaction caused by postoperative pain can also lead to a large release of the sympathetic nervous excitement and catecholamine,inhibit prolactin secretion,and lead to insufficient milk secretion.Therefore,the analgesic treatment after cesarean section is particularly important.The purpose of this study is to provide a better analgesic mode and a better drug formulation for postoperative analgesia after cesarean section by observing the application of dexmedetomidine combined with ropivacaine in transverse abdominal muscle plane block analgesia after cesarean section.Methods:60 primiparas,aged 20-40 years old,weighing 50kg-80 kg,standing155-175 cm,who underwent elective caesarean section in Laoshan Hospital Affiliated Hospital of Qingdao University from July 2018 to December 2018 were involved into the research subjects.The patients were randomly divided into control group(group TP,n=30)and the observation group(group TD,n=30)According to ASA grade I-II,group TP were treated with ropivacaine TAPB alone and the group TD were treated with dexmedetomidine combined with ropivacaine TAPB.All the patients were instructed to strictly abstain from food and drink before the operation,there was no preoperative drugs used.All the patients’ cesarean section were performed under combined spinal-epidural anesthesia,and were given intravenous self-controlled analgesia pump(PCIA).Bilateral TAPB were performed underwent ultrasound-guided after operation in all the primiparas.TAPB on each side of TP group was given 20 ml ropivacaine concentrated 0.375%.TAPB on eachside of TD group was given dexmedetomidine 50ug+0.375% ropivacaine 20 ml.Observe and record the time from bilateral TAPB to the first pressing of analgesic pump in the two groups.VAS score of resting state of primiparas at 2,4,8,12 and 24 hours after operation(0 ~ 10 points: 0 is painless,10 is unbearable pain.1 ~ 3 points for mild pain;4 ~ 6divided into moderate pain;7 ~ 10 is divided into severe pain)and VAS score in active state;BCS Comfort Score(0 for continuous pain;1:Painless when quiet,severe pain when breathing deeply or coughing;2: slight pain when deep breathing or coughing.3:painless when deep breathing;4: painless when deep breathing and coughing),the number of times the analgesic pump was pressed within 24 hours after the operation,the cumulative usage of sufentanil and the incidence of adverse reactions such as bradycardia,hypotension,local anesthetic poisoning,intestinal injury,etc.Results:There was no significantly difference in terms of age,weight,height,operation time,blood loss and other basic conditions between the two groups.There was no significant difference between TD group and TP group in VAS score in resting state and active state at 2h and 4h after operation(P>0.05),but the difference was statistically significant at 8h,12 h and 24 h after operation,TD group was lower than TP group(P<0.05).There was no significant difference in BCS comfort score2 h and 4h after operation between TD group and TP group(P>0.05),but the difference was statistically significant at 8h,12 h and 24 h after operation,TD group was higher than TP group(P<0.05).Compared with TP group,the cumulative usage of sufentanil and the number of self-controlled presses of analgesic pump within 24 hours in TD group were significantly lower(P<0.05).There was no adverse reactions such as organ injury,infection and hemorrhage related to transverse abdominal muscle plane block were found in TP group and TD group,and no adverse reactions such as dizziness and skin pruritus were found.However,there was 1 case of vomiting in TP group,1 case of nausea and 2 cases of excessive sedation occurred in TD group,with no significant difference(χ2=1.071,P>0.05).Conclusion:The results of this study show that 100μg dexmedetomidine combined with 0.375%ropivacaine(40ml)for ultrasound-guided TAPB after cesarean section can obviously prolong the action time of TAPB,strengthen the analgesic effect of TAPB,and provide more ideal postoperative multimodal analgesic effect for primiparas.As a result,thedosage of postoperative opioid drugs is reduced,which is safe and effective,and worthy of clinical application.