Comparison Of Three Adjuvants Combined With Ropivacaine Transverse Abdominis Plane Block For Postoperative Analgesia After Cesarean Section

Objective: To retrospectively analyze the analgesic effect of dexamethasone dexmedetomidine and naloxone combined with ropivacaine for Transverse Abdominis Plane Block(TAPB)after Cesarean Section(CS),and to evaluate which adjuvant is more suitable for postoperative analgesia of CS.Methods : This study was a single-center retrospective matched case-control cohort study,which retrieved the clinical data of patients undergoing elective cesarean delivery surgery with Neusoft Surgical Anesthesia Information Management System in the Affiliated Hospital of Guilin Medical University from January 2020 to August 2021.A total of 112 parturients who used TAPB in postoperative analgesia after CS in our hospital were selected.According to the different adjuvants in local anesthetics,they were divided into group C(control group,n=28): 20 ml on each side,10 m L 0.75% ropivacaine+10 m L normal saline;Group D(dexmedetomidine group,n=28): 20 ml on each side,10 ml0.75% ropivacaine +0.5 μg/kg dexmedetomidine diluted to 20 m L normal saline,20 m L on each side;Group S(dexamethasone group,n=28):20 ml on each side,10 ml 0.75% ropivacaine+8 mg dexamethasone diluted to 20 m L normal saline,20 m L on each side;N group(naloxone group,n =28):20 ml on each side,10 ml0.75% ropivacaine+100 ng naloxone diluted to 20 ml normal saline.The general statistical data of age,height,weight,duration of anesthesia and blood loss of parturients in this study were obtained by searching Neusoft Surgical Anesthesia Information Management System.By obtaining the postoperative follow-up records of the same group of researchers in the previous group,the postoperative painless duration of the four groups were collected and compared;NRS pain scores at 2,4,6,8,12 and 24 hours after surgery;sufentanil consumption and times of analgesic pump pressing;Percentage of women requiring acute analgesics;Preoperative and post quality of recovery 40 questionnaire;block complications among the four groups.Results: Compared with group C,the postoperative painless time of group D,group S and group N was significantly longer(P<0.01).The postoperative painless time of group S was longer than that of group D and group N(P<0.01),and there was no statistical significance in the postoperative painless time of group D and group N(P>0.05).The NRS pain scores of groups D,S and N were lower than those of group C at 6,8,12 and 24 hours after surgery(P<0.05),and the NRS pain of group S was lower than that of group D and group N at 24 hours after surgery(P<0.05).Compared with group C,The Times of postoperative analgesic pump pressing and the consumption of sufentanil 24 hours after surgery in group D,group S and group N were reduced(P<0.01).The Qo R-40 scores of group D,S and N were higher than those of group C(P<0.01),and the comfort degree,pain degree and emotional state of group S were higher than those of the other three groups(P<0.01).There was no difference in the percentage of postoperative acute analgesia among the four groups(P>0.05).All of the pregnant woman were discharged and there was no complication of anesthesia.Conclusions:In this retrospective study,the existing results suggest that dexmedetomidine,dexamethasone and naloxone combined with ropivacaine for TAP in CS can prolong the time of postoperative analgesia,enhance the effect of postoperative analgesia,reduce the consumption of postoperative analgesic drugs,promote postoperative recovery,and the efficacy of dexamethasone was more obvious.