| BackgroundChronic post-cesarean section pain is one of the most common complications after cesarean section,with a 1%～23% incidence within 12 months after operation.Chronic post-cesarean section pain will not only prolong postpartum recovery time,interferes with breast-feeding,affect mother-infant relationship,but also weaken maternal ability to cope with stress,lead to maternal anxiety and even depression,bring many negative effects on their physiology and psychology,and seriously affect postpartum quality of life.Chronic post-cesarean section pain rarely exists alone,often accompanied by other symptoms,and has a high comorbidity with postpartum depression.How to effectively reduce the incidence of chronic pain and postpartum depression and improve the quality of life of parturients has become a topic of common concern for anesthesiologists and obstetricians.A good analgesic regimen is the key to the prevention and treatment of chronic pain.Different analgesic methods and different types of analgesic drugs may have different effects on chronic pain and postpartum depression.Intrathecal morphine analgesia is used as the gold standard for postoperative analgesia.However,it has been reported in foreign literature that intrathecal morphine does not reduce the incidence of postpartum chronic pain.Some studies have found that epidural analgesia is similar to intravenous analgesia in chronic pain.However,there are relatively few reports on the effects of different analgesia regimens on chronic pain and postpartum depression.This study retrospectively compared the effects of three different analgesia regimens,epidural continuous analgesia(hydromorphone or morphine + local anesthetics),intravenous continuous analgesia(pure opioids),and intravenous continuous analgesia(opioids + NSAIDs),on chronic pain and postpartum depression after cesarean section.ObjectiveTo compare the effects of three different analgesic schemes on chronic pain and postpartum depression after cesarean section.MethodsA total of 1099 cases of postoperative pain relief for cesarean section in the Third Affiliated Hospital of the Guangzhou Medical University from September 2020 to August 2021 were selected.According to different analgesic schemes,the patients were divided into three groups: group E(hydromorphone or morphine + local anesthetics),group I(pure opioids)and group IN(opioids + NSAIDs).The patients were followed up by telephone within 12 months after surgery to ask whether they had chronic pain problems:chronic pain(duration more than 3 months),and the pain score was given by digital scoring method(NRS),record the location,nature,duration,treatment and relief of chronic pain.The Pittsburgh Sleep Quality Index(PSQI),Self-rating Anxiety Scale(SAS)and Edinburgh Postnatal Depression Scale(EPDS)were sent to the parturients by SMS.The sleep quality,anxiety and depression of the parturients were collected the next day.Results1.The incidence of postoperative acute pain in group IN was lower than that in group I,and the difference was statistically significant(P<0.05).There was no significant difference between group E and group I and between group E and group IN(P>0.05).However,there was no significant difference in NRS pain scores at 24 h and 48 h after operation among the three groups(P>0.05).2.The incidence of chronic pain in group IN was lower than that in group E and group I,and the difference was statistically significant(P<0.01).There was no significant difference in the incidence of chronic pain between group E and group I(P>0.05).3.Comparison of chronic pain NRS Score: The median pain score of group IN was lower than that of group E and group I,and the difference was statistically significant(P<0.05).There was no significant difference between group E and group I(P>0.05).4.Comparison of chronic pain duration: The median of pain duration in group I was longer than that in group E and IN,and the difference was statistically significant(P<0.05).There was no significant difference between group E and group IN(P>0.05).5.Comparison of depression : The incidence of postpartum depression in the group IN was lower than that in the group E and the group I,and the difference was statistically significant(P<0.05).There was no significant difference between group E and group I(P>0.05).The median of depression score in group IN was lower than that in group E and group I,and the difference was statistically significant(P<0.05).There was no significant difference between group E and group I(P>0.05).6.The depression score of patients with chronic pain was significantly higher than that of patients without chronic pain(P<0.05).7.NRS scores for chronic pain were positively correlated with postpartum depression scores with(r=0.2699,P<0.01,)while chronic pain duration was positively correlated with postpartum depression scores moderately,(r=0.4076,P<0.01).Conclusion1.Chronic post-cesarean section pain is significantly correlated with postpartum depression.2.The combined use of opioids and NSAIDs intravenous analgesia is beneficial to reduce the incidence of acute pain and chronic pain after cesarean section,reduce the scores of chronic pain,shorten the duration of chronic pain;it is helpful to improve the degree of depression and reduce the occurrence of postpartum depression. |
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