| BackgroundThe cesarean section rate in our country is about 37%,and the pain after cesarean section can reach moderate to severe pain.The current analgesic method cannot completely solve the pain problem after cesarean section.Multimodal analgesia is a hot research topic in the field of analgesia after cesarean section.It uses a variety of ways and drugs to achieve analgesic complementarity,reduce the dosage of some analgesics and reduce adverse reactions.Ultrasound-guided transversus abdominis fascial block combined with nalbuphine is an ideal multi-mode analgesia,which plays an important role in analgesia after cesarean section.ObjectiveTo explore the effect of ultrasound-guided lower abdominis transversus fascia block combined with nalbuphine in analgesia after cesarean section.Methods60 cases of cesarean section patients admitted to our hospital from December 2018 to January 2020 were selected as the research objects.All the pregnant women aged 20~35years were divided into two groups by random number table.The control group was given sufentanil intravenous controlled analgesia,while the observation group was given ultrasound-guided transversus abdominis fascia combined with nalbuphine.The blood pressure(diastolic blood pressure,systolic blood pressure)and heart rate were observed before and 12h?24h and 48 h after operation.Ramsay sedation score,VAS pain score,BCS comfort score,serum catecholamine level and serum painkiller IL-17 level were observedafter operation.The anxiety score and depression score of the two groups were observed.Result1.The blood pressure and heart rate levels of the two groups of puerpera tended to be stable and within the normal range.Compared with preoperative blood pressure and heart rate,systolic blood pressure,diastolic blood pressure and heart rate in the control group were slightly increased at 12 h and 24 h after operation,with statistically significant difference(P < 0.05).Compared with blood pressure in the observation group,systolic blood pressure,diastolic blood pressure in the control group were slightly increased at 12 h and 24 h after operation,with statistically significant difference(P < 0.05).2.Ramsay sedation score at 48 h after operation in control group was higher than that at 12 h and 24 h after operation,the difference was statistically significant(P < 0.05).Compared with the observation group,Ramsay sedation score in the control group decreased slightly at 12 h and 24 h after operation,with statistically significant difference(P< 0.05).3.Compared with12 h after operation,the VAS pain score of control group parturients at 24 h and 48 h after operation was significantly lower(P < 0.05).Compared with the observation group,the VAS pain score of the control group was significantly higher at each time point after operation(P < 0.05).The VAS pain score at 48 h time point after operation in observation group was lower than that at 12 h and 24 h after operation,the difference was statistically significant(P < 0.05).4.The BCS comfort score of the two groups was significantly higher at 48 h after operation than at 12 h after operation(P < 0.05).The BCS comfort score of the observation group was higher than that of the control group 12 h after operation,and the difference was statistically significant(P < 0.05).5.Compared with 12 h and 24 h after operation,the catecholamine level in blood of parturients in the control group increased significantly(P < 0.05).The levels of catecholamine in the blood of the two groups of parturients at 12 h after operation weresignificantly lower in the observation group(P < 0.05).6.The level of serum pain-causing factor IL-17 in the control group increased 12 h and24h after operation,which was significantly different from that before operation(P < 0.05).The level of serum pain-causing factor IL-17 in observation group was lower than that in control group at 12 h and 24 h after operation,with significant difference(P < 0.05).The level of IL-17 in 48 h serum of parturients in the control group was significantly lower than that in 12 h and 24 h after operation(P < 0.05).7.The incidence of adverse reactions in the control group was 13.33%,slightly higher than that in the observation group(3.33%),but the difference was not statistically significant(P > 0.05).8.The scores of anxiety and depression in the two groups were significantly higher in the control group than in the observation group(P < 0.05).ConclusionThe application of ultrasound-guided lower abdominis transversus fascia block combined with nalbuphine in postoperative analgesia after cesarean section can maintain blood pressure and heart rate at normal levels,and can achieve sedation and appropriate effect.It has outstanding effect in improving postoperative pain degree,provides more comfortable postoperative rehabilitation experience for parturients,helps to maintain blood catecholamine level and serum IL-17 level,has lower incidence of adverse reactions. |
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