Application Of Dexmedetomidine Combined With Ropivacaine For Posterior Lumbar Quadratus Block In Postoperative Analgesia After Cesarean Section

Objective:To observe the application effect and adverse reactions of dexmedetomidine hydrochloride combined with ropivacaine for posterior lumbar quadratus muscle block in postoperative analgesia after cesarean section.Methods:A total of 90 women with ASAI or II grade were selected for cesarean section of lower uterine segment under subarachnoid block.According to the random number table method,the puerpera were divided into control group(group C),observation group 1(group Q)and observation group 2(group QD),with 30 patients in each group.Patients in the three groups received intravenous self-controlled analgesia after surgery.Patients in the Q group and the QD group received bilateral posterior quadratus lumbosus muscle block under ultrasound guidance on the basis of intravenous selfcontrolled analgesia immediately after surgery.The drug formula for each side of quadratus lumbosum muscle block was 0.25% ropivacaine 20 ml in group Q,and the drug formula for each side of quadratus lumbosum muscle block in group QD was 0.25%ropivacaine + dexmedetomidine 0.5ug/kg,20 ml in total.The age,height,weight and other general information of the three groups were recorded.The pain scores and sedation scores at different time points and states at the 4th,8th,12 th,24th,36 th and48h after operation were assessed and recorded.The effective times of pressing the analgesic pump within 48 hours after operation were recorded in the three groups.The satisfaction scores and adverse reactions of the three groups of women were recorded within 48 hours after the operation.Results:(1)Comparison of general data of three groups of parturient women: there was no significant difference in age,height,weight and other general information among the three groups,and the difference was not statistically significant(P>0.05).(2)Comparison of pain scores at different time points within 48 h after obstetrics in the three groups:At the 4th,8th,12 th and 24 h after surgery,the pain scores of patients in the Q group and the QD group were significantly lower than those in the C group,no matter in the resting state or in the exercise state,the difference was statistically significant(P<0.05);At the 24 th,36th and 48 h after surgery,the pain scores of patients in the QD group were also lower than those in the Q group and the C group,no matter in the resting state or in the exercise state,the difference was statistically significant(P<0.05);However,at the 36 h and 48 h after surgery,there was no statistically significant difference in pain scores between group Q and group C,whether in the resting state or in the exercise state(P>0.05).(3)Sedation scores of the three groups at different time points within 48 h after surgery showed that both QD group and Q group were higher than C group,and the difference was statistically significant(P<0.05);However,there was no statistically significant difference between QD group and Q group(P>0.05).(4)Comparison of effective pressure times of intravenous analgesia pump and satisfaction score of analgesia effect in three groups within 48 hours:Compared with group C and group Q,the effective times of pressing analgesia pump within 48 h in group QD were significantly decreased,and the difference was statistically significant(P<0.05).The satisfaction score of analgesia in QD group was also significantly higher than that in Q group and C group,and the difference was statistically significant(P<0.05).(5)Comparison of adverse reactions within 48 h after obstetrics in the three groups:There were no adverse reactions such as abdominal organ injury,hematoma at the puncture site,infection,lower limb movement disorder or numbness,sinus bradynia and hypotension in both the Q group and the QD group.However,there were 1 case of pruritus and 4 cases of nausea and vomiting in group C,2 cases of nausea and vomiting in group Q,and only 1 case of nausea and vomiting in group QD.Therefore,compared with the Q group and the C group,the total adverse reaction rate of the QD group was significantly reduced,and the difference among the three groups was statistically significant(P<0.05).Conclusion:The combination of dexmedetomidine and ropipiaine for posterior lateral lumbar muscle block combined with intravenous controlled analgesia can provide longer and more complete analgesic effect for patients after cesarean section,reduce the dosage of opioids and side effects,and improve patient satisfaction.