Clinical Study Of Different Doses Of Dexmedetomidine On Postoperative Analgesia After Cesarean Section

Objective:To observe the effect of dexmedetomidine on maternal postoperative analgesia during cesarean section who used sufentanil intravenous analgesia,and provide a reference for multimodal analgesia after cesarean section.MethodsChoice in our hospital,elective ASA I-II,ages 20 to40 years old,height 150 to170cm term full-term,single fetus,required spinal cesarean section primipara 80cases who volunteered postoperative analgesia in venous.According the time of surgery they were randomly divided into saline control group?groupC?,dexmedetomidine 0.5ug/kg group?group D₁?,dexmedetomidine 1.0ug/kg group?group D₂?,dexmedetomidine 1.5ug/kg group?group D₃?.All mothers strictly follow the requirement of fasting and drinking before surgery and did not use preoperative dr?gs.After enter the operating room,opening up the venous pathway,indwelling catheter,routine monitoring then intravenous injection colloidal 500ml in 20min before anesthesia puncture,maternal left supine down L3-4 clearance single spinal anesthesia puncture,when cerebrospinal fluid was flowed out stop enter the needle,then injecting 0.5%bupivacain which made from 5%glucose.If necessary we can surgical bed 20-30 degrees to the left,adjusting the sensory block plane up to T6before surgery,surgical incision are used on the suprapubic transverse incision.No intraoperative spinal anesthesia was applied to the spinal canal after the operation started,and the vein did not have any sedative and analgesic dr?gs.After the fetus is born,give a loading does 5ml and connect the intravenous analgesia pump.Formulation:group C:Sufentanil 1.5?g/kg plus Oubei 24mg plus physiological saline total 100ml,group D₁:dexmedetomidine 0.5?g/kg plus sufentanil 1.5?g/kg plus Oubei 24mg plus physiological saline total 100ml,group D₂:dexmedetomidine1.0?g/kg plus sufentanil 1.5?g/kg plus Oubei 24mg plus physiological saline total100ml,group D₃:dexmedetomidine 1.5?g/kg plus sufentanil 1.5?g/kg plus Oubei24mg plus physiological saline total 100ml.The PCA devices were identical in both groups:2ml/h continuous pumping.The changes of MAP,HR and SpO₂ were recorded at preoperativel postoperative 6h,12h,24h,48h;recored the VAS scores and Ramsay scores of the four groups at various time points after operation;the AIS scores at preoperative postoperative 24h and 48h;the PRL content in venous blood at preoperative postoperative 24h and 48h;record the first time of lactation and depression happened in 48h.Results:1?The general situation,the MAP?HR?SpO₂,Ramsay score and the depression happened during postoperative analgesia were no significant differences among four groups?p>0.05?.2?The postoperative incision pain of resting state VAS scores of group D₂ and group D₃ were significantly lower than group C and group D₁ at postoperative 12h,24h?p?0.05?;compared with group D₂,in group D₃ the VAS were decreased at postoperative 12h?p?0.05?;the VAS were no significantly differences among four groups at postoperative 6h and 48h?p>0.05?.3?The sleep quality AIS scores at postoperative 24h and 48h group D₂ and group D₃ were significantly lower than that of group C and group D₁?p?0.05?;at postoperative 24h the AIS scores group D₃ were lower than group D₂?p?0.05?.4?PRL content were increased at postoperative 48h than those of preoperative and postoperative 24h?p?0.05?;the PRL content and the first time of lactation were no significantly differences among four groups?p>0.05?.Conclusion:The use of dexmedetomidine 1.0ug/kg or 1.5ug/kg in combination with sufentanil intravenous anesthesia after cesarean section can significantly improve maternal pain,enhance analgesia,and improve the quality of sleep for two days after surgery.There were no significantly differences in hemodynamic,lactation and adverse events increased.Considering the analgesic effect and the sleep of maternal,we consider that the D3 group?1.5ug/kg?is more suitable for intravenous analgesia after cesarean secion.