Application Of Dexmedetomidine Mixed With Ropivacaine For Patient-controlled Epidural Analgesia During Delivery

Objective To evaluate the application of dexmedetomidine mixed with ropivacaine and its effect on maternal stress response,lactation and neonatal for patient-controlled epidural analgesia?PCEA?during delivery.Methods Ninety nulliparous women with a single baby at full term in vertex presentation required for labor analgesia,22-36 years old,ASA grade I or II,were randomly divided into 3 groups according to the random digital table.After identification of the epidural space,insert the catheter toward head in epidural cavity with length of 4 cm and connect the analgesic pump.R group received 0.1%ropivacaine,RF group received 0.1%ropivacaine mixed with 2?g/ml fentanyl,RD group received 0.1%ropivacaine mixed with 2?g/ml dexmedetomidine.The PCEA settings were as follows:10 ml initial bolus,8 ml/h basal infusion,15 min lockout interval and 4ml bolus dose.PCEA was stopped at complete cervical dilatation among the groups.Recording the vital signs and VAS scores before analgesia?T₀?,10 min?T₁?after the load dose of epidural administration,30 min?T₂?after the load dose of epidural administration,and full cervical dilatation?T₃?,at the end of the second stage?T₄?and 2 hours postpartum?T₅?,as well as the modified Bromage degrees and sedation scores at T_2.Recording the number of PCA,the satisfaction scores of analgesia,the duration of labor,bleeding volume within 2 hours postpartum,the mode of delivery,the cases of using oxytocin,the neonatal Apgar scores and the side effects.Drawing maternal venous for blood gas analysis at point of T₀?T₄?T₅,the remaining blood sample was centrifuged then determine the concentration of TNF-?and prolactin and record the beginning time of lactation.Results The VAS scores of all nulliparous women were lower after PCEA?P<0.05?.The VAS scores were higher in R group than those in group RF and RD at T₁,T₂,T₃ and T₄?P<0.05?.More PCA in group R and higher satisfaction scores in groups RF and RD?P<0.05?.Compared with group R,the level of sedation were better at T₂,the concentration of prolactin was higher at T₅,the beginning time of lactation was advanced in groups RD and RF?P<0.05?.Compared with group RF,the level of sedation and cooperation were better,the incidence of drowsiness and pruritus were lower in group R and RD?P<0.05?.There were no statistics differences about the modified Bromage degrees,blood gas analysis results,the duration of labor,bleeding volume within 2 hours postpartum,the rate of using oxytocin,the mode of delivery,the concentration of TNF-?and the Apgar scores at 1and 5 min after delivery among the groups.Conclusion Epidural dexmedetomidine 2?g/ml significantly optimize the efficacy of 0.1%ropivacaine and with higher satisfaction,less side effects,without adverse neonatal effects,can promote the secretion of prolactin and the beginning time of lactation was advanced when used for patient-controlled epidural analgesia during delivery.