Clinical Research Of Low-dose Ketamine After Cesarean Section Multimodal Analgesia

BackgroundPain is the complex physiological and psychological reactions to the disease and trauma involving a series of extremely complex and interactive mechanisms.A complex set of interacting mechanisms.The International Association for the Study Pain(IASP)defines pain as "a body-like or overall unpleasant subjective feeling or emotional experience." Pain includes two parts: pain sensation and pain response.Postoperative pain results from general mechanical injury,more by the sensitive changes of peripheral and central nervous system.Postoperative pain not only causes the body's physiological functional damage,but also causes the tension and anxiety,resulting in a vicious cycle of pain.Cesarean section as a common obstetric surgery is an effective means to solve dystocia or high-risk pregnancy.Postoperative analgesia is an important concern for medicine.Postoperative pain has a severe negative impact on the quality of maternal milk secretion and neonatal normal signs.Therefore,choosing a reasonable and safe analgesic program to improve maternal postoperative life and reduce side effects of the newborn is extremely essential.In recent years,the analgesic study of ketamine,sufentanil,ropiper used in cesarean section has achieved good results.On this basis,we investigated the effects and adverse events of low-dose ketamine combined with sufentanil on postoperative analgesia in cesarean section for providing an important basic clinical treatment.Patients could achieve a more safe,effective and high-quality life after surgery.ObjectiveTo observe and compare the clinical effect including the analgesic effects and adverse reactions of multimodal analgesia of low-dose ketamine in patients undergoing cesarean section.MethodsSelect the singleton full-term primipara undergoing transverse incision cesarean section 187 cases in the Zhumadian Chinese Hospital from October 2015 to October 2016.Among them,37 cases were screened out for various reasons,such as the ansthetic level exceeded T6,the use of other analgesics,the failure to complete the VAS and MMSE scores and other reasons for withdrawal,and finally 150 cases were selected.Patients were randomly divided into group A,group B,and group C,50 cases in each group.All patients were treated with the same single anesthesia performed on primipara.Analgesia after delivery of fetus were as follows: Group A : Intravenous 0.5mg/kg ketamine and 2mg midazolam + PCIA;Group B: Intravenous 0.5mg/kg ketamine and 2mg midazolam combine local infiltration of 0.2% ropivacaine hydrochloride + PCIA;Group C: 0.2% hydrochloric acid ropivacaine local infiltration + PCIA.All patients received Patient-controlled intravenous after the end of procedure.Sufentanil(2ug/kg)and Glasgow(3mg)were injected to analgesic solution(100ml)for providing continues pump infusion in a rate of 2ml/h.Patients pressed pump bottom to get a bolus dose of 0.5 ml each time,with lockout time of 15 min.Intraoperative anesthesia satisfaction and visual analogue scales(VAS)were observed and recorded at 6h?12h?24 h?48h after procedure,respectively.Meanwhile record the postoperative adverse reactions and the first time to press the analgesic pump time after surgery.ResultsThere were no significant differences among three groups in vital sign at each time-point(P>0.05).The anesthesia effect of A and B group in surgery were better than that of group C;Time of first pressing analgesic pump of B,C were later than group A.6 hours after cesarean section,rest pain,uterine contraction pain VAS scores of B,C group were lower than group A.There were no significant differences of VAS scores of other periods during these groups(P>0.05).A certain degree of adverse reactions were performed on three groups of patients after surgery,but no significant difference(P>0.05).Statistical MethodAll data were analyzed using SPSS 22.0 statistical software,homogeneity test of variance,count data using mean±standard deviation(mean±s),comparison between groups using ANOVA,with P<0.05 as the difference was statistically significant.ConclusionApplication of low-dose intravenous ketamine combined with sufentanil in cesarean section can increase the patient's satisfaction with anesthesia,obtain good analgesic effect,and not increase postoperative adverse reactions.