The Study On The Effect Of Dexmedetomidine Combined With Sufentanil For Post-caesarean Section Intravenous Analgesia On Mothers And Infants

ObjectiveTo evaluate the effect of dexmedetomidine combined with sufentanil for post-caesarean section intravenous analgesia on milk yield and neonatal neurobehavioral ability.MethodsSelection criteria:Sixty women who were scheduled to undergo a caesarean section under combined spinal and epidural anesthesia,required 48 hours patient-controlled intravenous analgesia after operation.They are 18 to 35 years old,150 to 170 cm tall,50 to 85 kg,American Society of Anesthesiologists Physical Grading?ASA Grading?I-II.They want breast-feeding and have no breast development defects.Before surgery,sixty termed parturients scheduled for selective caesarean section under combined spinal epidural anesthesia were randomly divided into three groups.Group A:Patients in the Group received 20 ml intravenous physiological saline immediately after the delivery of the baby.Their PCIA protocol consisted of 1.0 ug/kg sufentanil diluted into 120 ml.Group B:Patients in the Group received 20 ml intravenous physiological saline immediately after the delivery of the baby.Their PCIA protocol consisted of 1.0 ug/kg sufentanil and 1.0 ug/kg dexmedetomidine.This cocktail was diluted into 120 ml by physiological saline.Group C:Patients in the Group received 20 ml intravenous dilution liquid of dexmedetomidine?0.5 ug/kg dexmedetomidine diluted into 20 ml by physiological saline,pumping time>10 minutes?.Their PCIA protocol consisted of 1.0 ug/kg sufentanil and 1.0 ug/kg dexmedetomidine.This cocktail was diluted into 120 ml by physiological saline.All pregnant women were routinely prepared for preoperative fasting and drinking.These patients were not given drugs before anesthesia.After building venous channel,ECG monitoring and non-invasive blood pressure monitoring,the lying-in women were placed in the left lateral position and combined spinal-epidural anesthesia was performed between L2 and L3.The operation was started when the sensory block level?SBL?achieved T4-T6,which was measured by pinprick.PCIA was used at the end of the operation.We recorded MAP,HR,SPO _2,VAS score and Ramsay sedation score at 6,9,24 and 48 hours after operation.The patient's milk output of 24 and 48 hours after operation was judged,and their adverse reactions during PCIA application were recorded.Neonatal neurobehavioral assessment?NBNA score?was performed at 24,48 and 72 hours after operation.Results:There was no significant statistical difference in MAP,HR and SPO₂ among the three groups at each time point?P>0.05?.The VAS score of resting pain after surgical incision in group A was significantly higher than group B and C at 6,9 and24 hours?P<0.05?,but there was no significant statistical difference between groups B and C.At 48 hours,there was no significant statistical difference in the VAS score of resting pain after surgical incision among the three groups?P>0.05?.At 24h and48h after operation,the consumption of liquid in analgesic pump in group B and C was obviously less than group A?P<0.05?.The incidence rate of adverse drug reactions in group A was distinctly higher than group B and C?P<0.05?.There was no significant statistical difference in Ramsay sedation score,first exhaust time and lactation volume among the three groups at 6,24 and 48 hours after operation?P>0.05?.There was no abnormality in the NBNA scores of all neonates at 24,48 and 72hours after operation.Conclusion:Using dexmedetomidine combined with sufentanil for intravenous analgesia after cesarean section can enhance the sedative and analgesic effect,reduce the dosage of sufentanil,and have no significant adverse reactions to parturient's lactation volume and neonatal neurobehavioral score.