Effect Of Esketamine Combined With Sufentanil PCIA On Maternal Pain After Cesarean Section With Pressure On The Fundus

Objective:The effect of esketamine combined with sufentanil PCIA on maternal pain after cesarean section by pressing the fundus of the uterus was observed to explore the best analgesic protocol to promote early recovery after cesarean section.Methods:Eighty cases of women who attended elective cesarean delivery at the Women and Children’s Hospital of Chengde Central Hospital between November 2021 and March 2022 were selected.According to the random number table method,they were divided into control group（Group F）,experimental group（Group EF）,40 cases in each group.Both groups were anesthetized with subarachnoid block,and ultrasound-guided bilateral transversus abdominis plane blocks were performed in the anesthesia recovery room after surgery.40 ml of ropivacaine 0.375%was used in both groups,and an intravenous self-administered analgesia pump（PCIA）was connected after completion of the block.PCIA protocol:Group F sufentanil 100μg+granisetron 6 mg;Group EF esketamine 50 mg+sufentanil 50μg+granisetron 6 mg,both groups diluted to 100 ml with 0.9%sodium chloride injection,PCIA setting parameters were:continuous dose 2 ml/h,additional dose 1 ml/time,lock time 20 min.The VAS scores at rest and at fundus compression were recorded at 0.5h（T₁）,1.0h（T₂）,1.5h（T₃）,2.0h（T₄）,4.0h（T₅）and 6.0h（T₆）.Basic vital signs were recorded at T₀ before surgery and 0.5h（T₁）,1.0h（T₂）,1.5h（T₃）,2.0h（T₄）,4.0h（T₅）,6.0h（T₆）after surgery.The related indexes of the postoperative intravenous analgesic pump were recorded in the two groups.The EPDS scores before and 48 hours after surgery and the postoperative recovery were recorded in the two groups.The related adverse reactions were recorded 24h after surgery in the two groups.Results:1.Comparison of general informationThere were no statistically significant difference between the two groups in terms of maternal age,height,BMI,gestational week,and time of surgery（P>0.05）.2.Comparison of VAS scores at rest and during compression of the fundusComparison between groups:There was no significant difference in the VAS scores at rest or at fundus compression between the two groups at any time point between T₁-T₅（P>0.05）,and the VAS scores at rest and at fundus compression were lower in the EF group than in the F group at T₆（P<0.05）.Intra-group comparison:The difference between the VAS scores at rest and fundal compression at T₂ and T₁ was not statistically significant in group F（P>0.05）;The VAS scores of resting and fundal compression at different time points from T₃ to T₆ were statistically significant compared with T₁（P<0.05）.There was no statistically significant difference in VAS scores at rest and compression of the fundus at T₂ compared with T₁ in the EF group（P>0.05）;There was a statistically significant difference in VAS scores at rest and compression of the fundus at all times from T₃ to T₆ compared with T₁（P<0.05）.3.Comparison of maternal vital signs between the two groupsVital signs in this study included mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）,and pulse oxygen saturation（SpO₂）.The were no significant differences in MAP,HR,RR,and SpO₂between the two groups at T₀（P>0.05）.Comparison of indicators at rest:Comparison between groups:There was no statistically significant difference between the two groups in MAP,HR,RR and SpO₂ at each time point from T₁ to T₆ at rest（P<0.05）.Intra-group comparison:The differences in MAP,RR and SpO₂ at each time point from T₂ to T₆ in group F were not statistically significant compared with those at T₁（P>0.05）;the HR at each time point from T₄ to T₆was higher than that at T₁,and the differences were statistically significant（P<0.05）;The differences in MAP,RR and SpO₂ at each time point from T₂to T₆ in group EF were not statistically significant compared with those at T₁（P>0.05）;the HR at each time point from T₄ to T₆ was higher than that at T₁,and the differences were statistically significant（P<0.05）Comparison of indicators when the fundus was pressedComparison between groups:The differences between the two groups in MAP,HR and RR at each time point from T₁ to T₄ when pressing the fundus were not statistically significant（P>0.05）.The MAP and HR at time points T₅ and T₆ in the EF group were lower than those in the F group when pressing the fundus,and RR was higher than that in the F group,and the differences were statistically significant（P<0.05）.The differences between the two groups in SpO₂ at each time point from T₁ to T₆ were not statistically significant statistically significant（P>0.05）.Intra-group comparison:The differences in MAP,RR and SpO₂ at each time point from T₂ to T₆ in group F were not statistically significant compared with those at T₁（P>0.05）;the HR at each time point from T₄ to T₆was higher than that at T₁,and the differences were statistically significant（P<0.05）;The differences in MAP,RR and SpO₂ at each time point from T₂to T₆ in group EF were not statistically significant compared with those at T₁（P>0.05）;the HR at each time point from T₄ to T₆ was higher than that at T₁,and the differences were statistically significant（P<0.05）4.Related indicators of postoperative analgesia pump in the two groupsCompared with group F,the first time of analgesic pump compression within 24h after operation was significantly longer in group EF（P<0.05）,the consumption of analgesic pump and the total number of analgesic pump compressions 24h after operation were not statistically significant between the two groups（P>0.05）.There was no significant difference in the total number of rescue analgesia within 24 hours after operation between the two groups（P>0.05）.5.Comparison of preoperative and postoperative 48h EPDS scores between the two groupsThe preoperative EPDS scores of the two groups were not statistically significant（P>0.05）,and the EPDS scores of the EF group were lower than those of the F group at 48h postoperatively,with statistically significant differences（P<0.05）.6.Comparison of postoperative recovery between two groupsThe first exhaust time after obstetric surgery,the first urination time after catheter removal,and the first postoperative ambulation time in EF group were lower than those in F group,and the differences were statistically significant（P<0.05）.7.Comparison of postoperative adverse reactions between the two groupsWhen comparing the incidence of adverse reactions such as postoperative dizziness,nausea,vomiting and skin pruritus between the two groups,the differences were not statistically significant（P>0.05）.Conclusions:Esketamine combined with sufentanil PCIA reduces pain during fundal pressure after cesarean delivery and promotes early postoperative recovery.