Application Of Butorphanol With Low Dose Of Nalmefene In Postoperative Analgesia After Second Cesarean Section

Objective:To study the analgesic effect,adverse reactions and postoperative depression and mood after the second cesarean section of the combination of small dose of nalmefen and butorfenol.Methods:From May to November 2019,90 women undergoing elective second-stage cesarean section in the Hospital were selected,and the women were divided into three groups with 30 women in each group by random number table.After routine infusion and monitoring,combined lumbar epidural puncture of L3-4 space was taken,and2 m L ropivacaine hydrochloride of 0.5%gravity(prepared with 10% glucose)was injected into the subarachnoid space in a single injection within 10-15 s.The anesthesia upper boundary level was adjusted at T6-T8,and vasoactive drugs were used to maintain the stability of vital signs.After placenta removal,10 μg/kg butorphanol were given intravenously.10 min before the end of the operation,the corresponding intravenous analgesia pump was connected according to different groups:Group B:Butorphanol 0.15 mg/kg;Group BN1:Butorphanol 0.15 mg/kg+ namafine 0.25 μg/kg;Group BN2:Butorphanol 0.15 mg/kg+ namafine 0.5 μg/kg.Record separately:(1)Age,gestational age and body mass index(BMI)of the three groups.(2)Visual analogue scale(VAS)scores of incision and contractions pain in 2 h,6 h,24 h,and 44 h after cesarean section in the three groups.(3)Additional times of analgesia pump in the three groups within 44 h after cesarean section.(4)The number of maternal cases with adverse reactions after cesarean sectionin three groups was recorded,including drowsiness,nervous excitement(including euphoric feeling,floating,insomnia,neuroticism),chills,itching and respiratory depression.(5)Edinburgh postpartum depression scale(EPDS)and profile of mood states(POMS)scale score on the day before surgery and 44 h after surgery.Results:1 There was no significant difference in maternal age,gestational age or BMI among the three groups(P>0.05).2 VAS score of incision pain in the three groups showed no statistical significance(P>0.05);Compared with group B,VAS scores of contractility pain at 2 h,6 h,24 h and 44 h in group BN2 were significantly lower(P<0.05).VAS scores of contractility pain in BN1 group at all time points were between group B and group BN2,but there was no statistically significant between the two groups(P>0.05).3 There was no significant difference in the number of additional analgesia pump in the three groups within 44 h after cesarean section(P>0.05).4 Compared with group B,the number of sleepiness in Group BN2 was significantly reduced(P<0.05);The incidence of drowsiness in group BN1 was lower than that in group BN2 and higher than that in group B,but the difference was no statistically significant(P>0.05).There was no statistically significant in the incidence of nervous stimulation,chills,pruritus and respiratory depression among the three groups(P>0.05).5 There was no significant difference in preoperative EPDS 与 POMS scores among the three groups(P>0.05);EPDS 与POMS scores of the three groups increased after cesarean section(P<0.05).Compared with group B,EPDS 与 POMS scores in BN2 group were lower(P<0.05).Postoperative EPDS 与 POMS scores of BN1 group were not significantly different from those of group B and group BN2(P>0.05).Conclusion:The combination of 0.5 μg/kg of nalmefen and butorphanol can enhance the inhibition of contractions,reduce adverse reactions of butorphanol,relieve postpartum depression and improve mood in pregnant women undergoing secondary cesarean section.