Effect Of Butorphanol On Uterine Contraction Pain After Cesarean Section Of Fetus With Broken Umbilical Cord

Objective:Uterine contractile pain is a severe pain in the lower abdomen due to uterine contraction at the early stage of postpartum,the pain appeared on1² day postpartum,lasted for 2³ days before natural disappearance.Uterine contractile pain is more common in parturient.It not only brings strong discomfort to the pregnant women,but also increases the risk of postpartum depression.Therefore,the prevention and treatment of uterine contractile pain after cesarean section is very necessary.However,there are no effective methods and drugs to prevent and treat uterine contractile pain.Recent studies have shown that the mainly activating k-opioid receptor of butorphanol has inhibitory effects on visceral pain,the main objective of this study was to observe the effect of butorphanol on uterine contractile pain after cesarean section of fetus in order to find more effective mode of analgesia for improving the postoperative satisfaction of parturient.Methods:90 cases of healthy full-term maternity with cesarean section selected during October 2016-March2017 were randomly divided into A、B、C groups,each group of 30 cases with mixed liquid of 1%lidocaine and 0.5%ropivacaine for epidural anesthesia（anesthesia level:about T₈）.Group A was slowly injected into saline5ml from venous and epidural cavity after cutting off the umbilical cord,Group B was slowly injected into butorphanol 1 mg from venous and slowly injected into saline 5ml from epidural cavity.Group C was slowly injected into saline5ml from venous and slowly injected into butorphanol 1 mg from epidural cavity.Each group received a venous analgesia pump（sufentanil100ug+butorphanol 10mg+Tropisetron 13.44mg+0.9%NS=200ml）at the end of the operation.The following scores in the three groups were observed at 10、20、30min,1、2、4、6、8、12、24、36 and 48h after cutting off the umbilical cord:VAS score of uterine contractile pain（intermittent abdominal colic）and incision pain（persistent pain）、Ramsay Sedation score、BCS comfort score、vital signs、anesthesia level、adverse reactions、intraoperative traction response assessment（using Prentom method Score）、PCA press times during 48h,postoperative hemorrhage during 24hand uterine instauration at postoperative6、12、24 and 48h.Results:（1）General situation:There were no statistically significant difference in age,height,body weight and gestational week in all groups,and there were no statistically significant difference in blood pressure,heart rate,blood oxygen saturation,24h postoperative hemorrhage,anesthesia level and uterine instauration in Group A、B and C（p>0.05）.（2）Uterine contractile pain condition:In group B,the VAS score of uterine contractile pain at 10、20、30min,1、2 and 4h after administration was lower than that in Group A（p<0.05）,the VAS score of uterine contractile pain at 6、8、12h after administration was higher than that in Group A（p<0.05）;The VAS score of uterine contractile pain at 10、20、30min,1、2、4 and 6h after administration in group C was lower than that in Group A（p<0.05）,the VAS score of uterine contractile pain at 8 and 12h after administration in group C is higher than that in Group A（p<0.05）;The VAS score of uterine contractile pain at 10、20、30min,1、2、4、6 and 8h after administration in group C is lower than that in Group B（p<0.05）.（3）Surgical incision pain VAS score:the incision pain with VAS score less than 3 was obviously relieved,and the VAS score had no statistically significant difference in the 3 groups（p>0.05）.（4）The traction reaction score:in Group A:the traction reaction at 10、20 and 30min after administration was more obvious than that in Group B（p<0.05）,the traction reaction at 10、20 and 30min,1h after administration was more obvious than that in Group C（p<0.05）;The traction reaction at 10、20、30min,1h after administration in group B was more obvious than that in Group C（p<0.05）.（5）Sedation score:The sedative effect of Group B at 10,20,30min,1 and 2h after administration was better than that in Group A（p<0.05）;The sedative effect of Group C at 10、20、30min,1、2、4、6h after administration was better than that in Group A（p<0.05）.The sedative effect at 10、20、30min,1、2、4、6、8、12、24、36、48h had no significant difference between B and C group（p>0.05）.（6）Comfort score:The comfort at 10、20、30min,1、2、4、6、8 and 12h after administration in Group B was better than that in Group A（p<0.05）;The comfort of Group C at 10、20、30min,1、2、4、6 and 8h after administration was better than that in Group A（p<0.05）;The comfort in 10、20、30min,1、2、4、6、8、12、24 and 36h after administration in Group C was better than that in Group B（p<0.05）.（7）The pressing numbers of PCIA during 48h:In the pressing number of PCIA during 48h had no significant difference between group A and group B（p>0.05）.The pressing number of PCIA in group C was significantly less than that in group A and B（p<0.05）.（8）Adverse reaction:there was 1 case of nausea and vomiting in group A,there were 2 cases of drowsiness and 1cases of nausea and vomiting in group B.No hypotension,respiratory inhibition,skin itching,headache,urine storage,headache,nerve injury,chills and other adverse reactions were observed in the 3 groups.Conclusion:（1）Intravenous or epidural loading dose of butorphanol combined with PCIA may effectively relieve the uterine contractile pain and the traction reaction and increase maternal comfort.（2）Epidural loading dose of butorphanol combined with PCIA is better than intravenous loading dose of butorphanol combined with PCIA in relieving the uterine contractile pain and increasing maternal comfort.