| Pain is the subjective feeling of the body to noxious stimulation. From timeimmemorial, humans have been suffering all kinds of attacks and felt painful. At thesame time, they have been continuously exploring the various methods to relieve pain.In2001, IASP defines pain as a feeling of unhappiness and a reaction of emotioncaused by tissue damage or potential tissue damage. Postoperative pain differs fromusual physiological pain. Apart from noxious stimulation caused by surgical trauma,the main reason resulting in postoperative pain is the change of sensibility ofperipheral and central nervous system. The moment when the operation is completed,the organism will lead to a series of complicated physiological and psychologicalchange because of the noxious stimulation caused by surgical trauma. Whereas,postoperative pain mainly concentrates for4to48hours after the operation, normallyno more than7days, which brings the patients both mental and physical trauma, andcan affect the recovery of diseases. Due to various damage of pain, new perspectiveof modern and international medicine lists pain as the fifth vital sign of organism.Puerperae, as a special group of patients, is special both in physiological andpsychological aspects. After cesarean section, the pain of cut leads to parturient’sspiritual anxiety and mental block, which has effect on their postpartum milksecretion, bringing huge pain to puerperae in perinatal stage. A set of thoroughpostoperative analgesia scheme can effectively improve the life quality of puerperaein perinatal stage, and reduce postoperative complications at the same time. Currently,many kinds of intravenous analgesia medicine are used after parturient’s cesareansection. Dezocine, tramadol, butorphanol as opioid analgesia medicine are used toclinic commonly after operation. The three kinds of medicine action mechanism ofcertain differences, but there are evidences show that they are safe and effective forobstetric postoperative analgesia.This research aims to comparing the analgesia effectand relative untoward effect of these three kinds of analgesia medicine which areused for PCIA after cesarean section, and seeks excellent analgesia medicine after obstetric operation, in order that reasonable clinical pharmacy can be guided.ObjectiveTo observe and compare the analgesic effect of dezocine, tramadolhydrochloride and butorphanol tartrate for intravenous analgesia after cesareansection.Materials and Methods1Research Object1.1Research sourcesParturients who underwent selective cesarean section with single ton termmaternity from January2013to May2013, conducted in the third affiliated hospitalof Zhengzhou University were selected as maternal study. It was standards ofinclusion and exclusion criteria, and eliminated criteria that was strictly implemented.1.1.1Inclusion criteria(1)The single full-term birth, whether for first-time parturients.(2) Age of20~38years.(3) Height155~178cm.(4) Weight60~80kg.(5) The gestation age38~41weeks(6) The ASA rating of I~II levels.(7) No hypertension, diabetes.(8) No history of drug allergy.(9)The preoperative examination of liver and kidney of patients were normal.(10) Routine blood test and blood coagulation analyses of patients were normal.(11) No contraindications of combined spinal-epidural anesthesia.(12) The patients were willing to meet and sign consent form. 1.1.2Exclusion criteria(1)History of Mental illness.(2) History of opioid dependence.(3) The patients or their families were unwilling to cooperate and anesthetic effect notsatisfactory.(4) The level of anesthesia was too high.1.1.3Eliminated criteria In the course of the study(1) A different medication was used to relieve pain after surgery.(2) VAS score was not completed.(3)The patients asked to quit for other reasons.1.2Study groupIt was standards of inclusion and exclusion criteria, and eliminated criteria thatwas strictly implemented.150cases of parturients were selected ultimately asresearch subjects. All cases were randomly divided into dezocine group (A), tramadolhydrochloride group (B) and butorphanol tartrate group (C)(n=50in each group) bythe random numbers table. They were observed on double-blind.2Methods of anesthesiaAfter the parturients without preoperative medication entered into the operatingroom, they were inhaled oxygen, opened venous pathways, quickly dripped liquid tocontain colloid, and non-invasive maternal blood pressure, ECG, heart rate and SpO2were monitored. All cases were under combined spinal and epidural anesthesia(CSEA). After routine disinfection and flapped operation towel, diluted localanesthetics1%ropivacaine1.5~1.7ml and normal saline to2~2.5ml alternateddepending on the height and weight of patients. Next,the clearance of puncture waslocated. Generally speaking,vertebra L3-4gap is the best choice, and after sawcerebrospinal fluid outflow spinal anesthetic was quickly injected. Upon completionof anesthesia patient in supine position, made operating table left leaning15~30°[3].Patients with oxygen up taking were observed, and block level of patients T6upper and lower was controlled. If systolic blood pressure in patients was below100mmHgor basic blood pressure dropped by more than20%of basic blood pressure,Methoxamine2~3mg［4］was intravenous injected instantly. Close observation ofchanges in blood pressure of patients, such as blood pressure fall again in theoperation once was found, then Methoxamine again. Patients of each group with thesame Cesarean section surgical procedures,were not additional to other sedative andanalgesic drugs. If there were such as nauseating and vomiting in patients withabdominal organ dragging reaction, the operation was suspended immediately.Antiemetic agents was used whether or not, depending on the circumstances. At theend of the surgery, the block plane of patients were tested again before they weretransited back to the ward. The patients whose block plane beyond T4were excludedfrom this study.3Pain relief programmerAll the parturients were given intravenous analgesia after surgery immediately.The liquid was constant pumped into the vein access by speed of2ml/h,PCA0.5ml,and was sustained infusion for48hours totally.Analgesia pump used in drug combinations in three groups of patients: group Aused for dezocine50mg,B tramadol1000mg; C butorphanol tartrate10mg,tropisetron hydrochloride5mg were plused in all groups, and they were diluted to100ml with normal saline chloride injection.4Observation projectAnesthetic effect, time of operation, transfusion volume, bleeding amount andother projects were observed and recorded during stage of the surgery. After thesurgery, an anesthesia nurse who was not informed visited the patients. To observeresting pain,dynamic pain and conduct the Visual Analogue pain Score (VAS) scoringat postoperative4,12,24,36,48h and record various adverse reactions (nauseavomiting, dizzy headache, addicted to sleep, skin itching, dysuria, breathinginhibition). Night-time visits were completed by duty nurses. The hypnagogic patients were scored according to the quality of patients’ sleep (less than4scores).The soberpatients were scored according to the actual analgesia rate。5Statistical analysisData processing was performed by SPSS17.0.analysis of statistical softwarepackage;All values data were presented as mean±standard deviation(X±s).ANOVA was used for statistical analysis to compare values data among all groups.The count data were expressed on the number of cases and percentage,and Ｘ2testwas used for statistical analysis to compare them among all groups.The inspectionlevel is α=0.05.Results1.There was no statistical difference(P>0.05) that General data of three groupsof women, operation time, intraoperative rehydration capacity, the bleeding amongall groups.2. The resting pain VAS scores at4,12h in the group A were lower than those inthe group B and C with statistical difference (P<0.05).There was no statisticaldifference (P>0.05) at each time point between the group B and group C.Thedynamic pain VAS scores at4,12,24h in the group A were lower than those in thegroup B and C with statistical difference (P <0.05). There was no statistical difference(P>0.05) at each time point between the group B and C.The incidence rate of nausea,vomiting, dizziness, headache,and drowsiness in the group C was higher than that inthe group A,and the difference was statistically significant (P <0.05).3. Each group patients were visited to find that there was no respiratorydepression, dysuria, skin itching and other adverse reactions occurred. The incidencerate of adverse reactions as follows: compared between the three groups,thedifference was statistically significant, Ｘ2=6.498, P=0.039. Group A comparedwith group C, Ｘ2=6.250, P=0.012, the difference was statistically significant.Group B compared with group A,Ｘ2=1.329, P=0.249, there was no statisticallysignificant difference. Group B compared with group C,Ｘ2=1.974, P=0.160, therewas no statistically significant difference. ConclusionThe three kinds of analgesics for analgesia after cesarean section can achievesatisfactory results, and dezocine tropisetron hydrochloride combination analgesiceffect is good, and relatively less adverse reactions. |
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