| PART 1 Effect of Patient-Controlled Intravenous Analgesia(PCIA)with Dezocine on Changes of Milk Composition after Cesarean SectionBackground : Breastfeeding can provide infants with comprehensive nutrition,enhance their immunity to diseases,and promote healthy growth and development.However,delayed lactation and shortened lactation time may occur after cesarean delivery,which will adversely affect maternal and infant health and cause damage to economic interests.Pain after cesarean section will cause maternal sympathetic excitement and inhibit the secretion of prolactin accompanied by physical and psychological discomfort resulting in lactation delay,which seriously affects the success rate of breastfeeding.Postoperative analgesia with different methods and drugs is becoming more and more popular in cesarean section.Patient-controlled intravenous analgesia(PCIA)with dezocine is one of them.However,there have been no reports on the effect of dezocine PCIA on lactation by the analysis of the changes in milk composition.The aim of this study was to evaluate the effect of dezocine PCIA on lactation by comparing the clinical and biochemical data of lactation between parturients who received dezocine PCIA after cesarean section and those who gave birth naturally.Methods:40 parturients in Baoshan Branch of Shanghai First People's Hospital from January 2018 to January 2021 were selected,including 20 cases of vaginal delivery(Group V)and 20 cases of cesarean delivery(Group C).After the delivery,Group C was given dezocine PCIA(dezocine 0.8mg/kg + droperidol 2.5mg + normal saline to prepare 100 ml solution,background dose 2ml/h,PCA 2ml/20min).The age,gestational weeks,maternal weight and infant birth weight of the two groups were recorded.The dosage of dezocine after cesarean delivery in Group C was recorded.Neonatal neurologic and adaptive capacity(NACS)scores were assessed in both groups.The lactation activation time and milk secretion data of the two groups at 24,48 and 72 hours after delivery were recorded.Protein,lactose,fat and mineral concentrations in breast milk at 0-216 h postpartum were determined and compared.Results: 1.18 cases in Group V and 19 cases in Group C were enrolled in the study finally.There was no significant difference between the two groups in age,gestational weeks,maternal weight and infant birth weight(P>0.05).The total amount of dezocine used in Group C was 53.20±7.73mg(42.21~71.92mg).There was no statistically significant difference in NACS scores between the two groups at 48 h postpartum(P>0.05).2.There was no significant difference in lactation activation time between the two groups(P>0.05).The breast milk in the two groups was insufficient at 24 h postpartum.The number of parturients with adequate lactation in Group V was higher than that in Group C at 48 h and 72 h after delivery(P(27)0.01).3.Milk composition analyses(1)Comparison of protein concentrations: At 0-72 h postpartum,both groups showed downward trends and the difference between the two groups was not statistically significant(P>0.05).At 72-144 h postpartum,the concentrations in both groups were decreased and lower than that at 0-72 h postpartum(P(27)0.01),and the concentrations in Group V were higher than that in Group C(P(27)0.01).At 144-216 h postpartum,the concentrations of both groups continued to decline and lower than that at 0-72 h and 72-144 h.(P(27)0.01),and there was no significant difference between the two groups(P>0.05).(2)Comparison of lactose concentrations: At 0-72 h postpartum,both groups showed upward trends and the concentrations in Group V were higher than that in Group C(P(27)0.01).At 72-144 h postpartum,the concentrations in both groups were increased and higher than that at 0-72 h postpartum(P(27)0.01),and there was no significant difference between the two groups(P>0.05).At 144-216 h postpartum,the concentrations of both groups continued to rise and higher than that at 0-72 h and 72-144 h.(P(27)0.01),and there was no significant difference between the two groups(P>0.05).(3)Comparison of fat concentrations: At 0-72 h post-partum,both groups showed upward trends and there was no significant difference between the two groups(P>0.05).At 72-144 h postpartum,the concentrations in both groups were increased and higher than that at 0-72 h postpartum(P(27)0.01),and there was no significant difference between the two groups(P>0.05).At 144-216 h postpartum,the concentrations in Group V continued to rise and higher than that at 0-72 h and 72-144 h postpartum(P(27)0.01,P(27)0.05),while the concentrations of Group C continued to rise and higher than that at 0-72 h and 72-144 h postpartum(P(27)0.01).There was no significant difference between the two groups at 144-216 h postpartum(P>0.05).(4)Comparison of mineral concentrations: At 0-72 h postpartum,the trend of the two groups was not obvious and there was no significant difference between the two groups(P>0.05).At 72-144 h post-partum,there was no change in the two groups(P>0.05),however,the concentrations in Group V was higher than that in Group C(P(27)0.05).At 144-216 h postpartum,the concentrations of Group V decreased and lower than that at 0-72 h and 72-144 h postpartum(P(27)0.05),while the concentrations of Group C decreased and lower than that at 0-72 h postpartum(P(27)0.05).There was no significant difference between the two groups at 144-216 h postpartum(P>0.05).Conclusions: Parturients receiving dezocine PCIA after cesarean section could initiate lactation on time and establish lactation successfully.The concentrations of protein,lactose,fat and mineral in their breast milk are comparable to that of parturients delivered vaginally at 6-9d postpartum.Dezocine PCIA does not affect NACS scores of the infants and can be safely used for postoperative analgesia after cesarean section.PART 2 Evaluation on Effectiveness of Patient-Controlled Intravenous Analgesia(PCIA)with Dezocine and its Influence on Breastfeeding Relative Infant Dosage(RID)after Cesarean SectionBackground:Pain after cesarean section is not benefit for normal breastfeeding and physical and psychological health of parturients and infants.At present,intravenous continuous analgesia is one of the most commonly used postoperative analgesia methods,however,the commonly used analgesics all have some risks and adverse reactions.In recent years,dezocine has been widely used in postoperative analgesia due to its mild effect on cardiopulmonary function in parturients.The effects of dezocine on prolactin,lactation and metabolism in breast milk have not been reported.The aim of this study was to find a safe and effective way of postoperative analgesia after cesarean section by evaluating the lactation condition,serum prolactin level and the concentration of dezocine in serum and breast milk.Methods:150 parturients undergoing secondary optional cesarean section in Baoshan Branch of Shanghai First People's Hospital were selected for this study from January 2018 to January 2021.Parturients were randomly divided into 3 groups with 50 cases in each group: patient control intravenous analgesia(PCIA)with dezocine(Group D),PCIA with fentanyl(Group F)and patient control epidural analgesia(PCEA)with fentanyl and ropivacaine(Group E).All the parturients underwent cesarean section under combined spinal-epidural anesthesia.After the delivery of the fetus,the parturients in Group D were given dezocine PCIA(dezocine 0.8mg/kg + droperidol 2.5mg + normal saline to prepare 100 ml solution,background dose 2ml/h,PCA 2ml/20min).The parturients in Group F were given fentanyl PCIA(fentanyl 16?g/kg + droperidol 2.5mg + normal saline to 100 ml,background dose 2ml/h,PCA 2ml/20min).The parturients in Group E were given fentanyl PCEA(fentanyl 3?g/kg + ropivacaine 150 mg + droperidol 2.5mg + normal saline to 100 ml,background dose 2ml/h,PCA 2ml/20min).The analgesia effect,adverse reaction,lactation condition and neonatal NACS scores of the three groups were assessed.Maternal prolactin(PRL)concentration of serum,dezocine concentration of serum and milk were measured,and relative infant dosage(RID)was calculated.Results:There was no statistically significant difference among the three groups in incision pain 24 h after delivery(P>0.05).The cases of postoperative uterine contraction pain in Group D were less than that in Group F and Group E(P(27)0.05).The incidence of nausea,vomiting and dizziness in Group D was lower than that in Group F(P(27)0.05).There was no statistically significant difference among the three groups in the number of parturients breastfeeding adequately at 24 h,48h and 72 h postpartum and in neonatal NACS scores at 48 h postpartum(P>0.05).There was no statistically significant difference in serum PRL concentration among the three groups at 30 min before operation,24 h and 48 h after operation(P>0.05).The daily dosage of dezocine in Group D was 24.47±2.71 mg.The concentrations of dezocine in serum and breast milk were 34.77±5.18ng/ml and 33.85±4.30ng/ml respectively,and the RID value of infant was 0.09±0.01%.There was a significant correlation between dezocine concentration of breast milk and dezocine concentration of serum at 48 h postpartum(P(27)0.01).The dezocine concentration in breast milk was 0.499 times of that in serum.There was a significant correlation between dezocine concentration in serum and the daily dosage of dezocine(P(27)0.05).There was no correlation between dezocine concentration in breast milk and the daily dosage of dezocine(P>0.05).Conclusions:Dezocine PCIA is more conducive to relieving uterine contraction pain after cesarean section.PCIA with dezocine might increase the level of serum prolactin and the amount of breast milk at 72 h postpartum,which is beneficial to postpartum breastfeeding.Dezocine PCIA does not affect the neonatal NACS scores and it is not easy to transfer to the breast milk.The RID value of breastfeeding is low.In conclusion,PCIA with dezocine could be safely used for postoperative analgesia after cesarean section. |
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