| Objective Postoperative pain and fatigue are two major reasons for delayed postoperative recovery.Postoperative pain is acute nociceptive pain occurred immediately after cesarean section,which causes a series of changes in physiological,behavioural and psychological.Most of the parturients suffer from the acute pain undergoing cesarean section,which interfere their daily activities,delay postpartum lactation and hinder the communication bwtween the mother and the newborn.What is more,acute postoperative pain is also considered a risk factor for postoperative chonic pain,and it may increase postoperative morbidity,delay postoperative recovery and prolong hospital stay.Other than postoperative pain,surgery related fatigue has not attracted wide attention for a long period.The previous study confirmed that the degree of fatigue was directly related to postoperative recovery.The present study was designed to investigate the safety and efficacy postoperative analgesia and effects on postoperative recovery of intraoperative and postoperative infusion of dexmedetomidine combined with butorphanol for patient-controlled intravenous analgesia(PCIA)in parturients undergoing cesarean section.Methods Eighty-four parturients scheduled for elective caesarean section under epidural anesthesia were randomly allocated into two groups(n=42).Experimental group(group DB)applied a continuous dexmedetomidine infusion of 0.5 ?g/kg for more than 10 minutes by intravenous pumping and dexmedetomidine was prepared in a 50-ml syringe mixed with normal saline;While control group(group B)applied physiological saline bolus after delivery.All of the recruited patients received butorphanol(1mg)and palonosetron(0.25 mg)when the skin was began to suture.At the end of surgery,both of the two groups were attached to PCIA.In group DB,the 100 ml solution in the PCIA reservoir bag contained 200 mg dexmedetomidine plus 10 mg butorphanol;While group B only 10 mg butorphanol with normal saline reservoir bag.Two groups of PCIA pumps were programmed to deliver a patient controlled bolus of 0.5 ml with a lockout time 15 minutes and infusion rate 2 ml/h.Perioperative hemodynamic variables,the scores of visual analogue scale(VAS),the sedation score,side effects,the pump-press number,additional analgesics cases were recorded at 24 h after operation.A 40-item quality of recovery questionnaire(QoR40)and a 9 questions fatigue scale(FFS)were used to evaluate the quality of postoperative recovery.Results There was no significantly difference between the two groups as regard to clinical characteristics and perioperative hemodynamic variables.Compared with group B,the VAS scores of group DB was significantly lower during postoperative period(P <0.05)and the mean total number of button pressing of PCIA in the 24 h postoperatively(7.98±2.14 times/each vs 19.43±4.13 times/each)and the consumption of butorphanol was decreased significantly(P <0.05;Besides,there was no parturients need additional analgesics for pain relief.The sedation scores at each observational time point were not significantly different between two groups(P >0.05).The incidence of dizziness and postoperative nausea and vomiting(PONV)in group DB was lower(P <0.05)compared to group B.There was no delirium,itch,hypotension or bradycardia.The FSS score of the two groups at POD 1 and POD 3 was significantly increased than the baseline,however when compared that with group B,the FSS score in group DB was significantly decreased(P <0.05);In addition,the FSS score in group DB at POD 5 showed no difference when compared that with baseline(P >0.05),while that in group B was significantly increased than the baseline(P <0.05).The QoR-40 score in group DB was significantly increased at POD 3(P <0.05)when compared to group B(P <0.05),while there was no difference(P >0.05)at POD 1 and POD 5.Conclusion Dexmedetomidine combined with butorphanol for PCIA after caesarean section promotes postoperative analgesia,decreases the consumptions of butorphanol,reduces fatigue,and improves postoperative recovery. |
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