Effect Of Sufentanil Combined With Nalbuphine On Patient-controlled Intravenous Analgesia After Cesarean Section

Research BackgroundAfter cesarean section,moderate-severe acute pain is easy to occur,including incision pain and visceral pain.This is a problem that needs to be faced at home and abroad.This acute pain can cause stress on the organs of the body,leading to tremendous changes in neuroendocrine,immune and hemodynamics,thus affecting the physiological,psychological and behavioral conditions.It will also delay the recovery of patients and affect the patients’ satisfaction with anesthesia and surgery.Even it may develop into persistent chronic pain.Therefore,effective postoperative analgesia is very necessary.In recent years,with the improvement of perioperative anesthetic technology,postoperative pain has also been alleviated to a greater extent.Intravenous injection of opioid drugs can effectively reduce postoperative pain,PCIA can control the level of anesthesia analgesia individualized,so the combination of intravenous opioid injection and PCIA can improve patients’ satisfaction and analgesic effect.In fact,PCIA using opioid drugs is indeed the most commonly used mode of postoperative analgesia in clinical practice.Sufentanil,a simple agonist of opioid receptor,is often used for postoperative analgesia because of its powerful analgesic effect.However,there are a lot of adverse reactions that reduce the patients’ satisfaction.Therefore,it is very important to find a way to use it that does not affect its analgesic effect and can reduce the side effects of the drug.Nalbuphine,an opioid κ receptor agitation-antagonist,is also often used for postoperative analgesia,and its analgesic effect is similar to that of morphine.The κ receptor agonists has a unique effect on visceral pain and less adverse reactions.This study investigates the effect of sufentanil and nalbuphine on PCIA using wireless electronic analgesia pump after cesarean section,and provides reference for clinical medication.ObjectiveThe purpose of this study is to investigate the effect of sufentanil combined with nalbuphine on PCIA management after cesarean section.MethodsApproved by the ethics committee of the Second Affiliated Hospital of Zhengzhou University,this study was performed at the Department of Anesthesiology of the Second Affiliated Hospital of Zhengzhou University.The objects of study included 150 primiparas who underwent cesarean section from January 2016 to March 2017,the screening conditions were as follows: aged 20-35 years,weighing 54-89 kg,ASA physical status or Ⅰ Ⅱ,gestational age 37-42 weeks.150 primiparas were randomly divided into three groups,50 in each group.PCIA was given sufentanil(group S),nalbuphine(group N),sufentanil combined with nalbuphine(group SN),respectively.The VAS scores of pain(rest,coughing)and Ramsay sedation scores were recorded at 1,3,6,9,12,24,36 h after the caesarean section.Adverse reactions were observed,such as nausea and vomiting,respiratory depression.Actual pressing times of PCIA were recorded and the maternal satisfaction was further evaluated.All the data were analyzed by SPSS 23 software.The measurement data of normal distribution and homogeneity of variance were expressed as mean±standard deviation(±s),the comparisons among three groups of data were used by one-way ANOVA,such as: age,weight and operation time;the comparisons among three groups of data were used by multivariable repeated measurement variance analysis,such as: VAS scores and Ramsay sedation scores.The nonnormal measurement data were expressed by median and quartile spacing,rank sum test was used to compare the three groups of data,such as: actual pressing times of PCIA.The enumeration data were analyzed by chi-square test or Fisher exact probability method,such as: incidence of adverse reactions(nausea and vomiting,respiratory depression).Ranked data was tested by rank sum test,such as: maternal satisfaction.P<0.05 indicated that the difference had significant statistical significance.Results(1)There was no significant difference in age,weight and operation time among the three groups(P>0.05).(2)There was no statistical difference in VAS scores of patients at rest among the three groups(P>0.05).(3)When coughing,the VAS scores in patients of group SN were significantly lower than that of group S and group N at 6 h and 9 h after the operation,the difference was statistically significant(P<0.05).(4)No statistical significance was found in Ramsay scores among the three groups(P>0.05).(5)The incidence of nausea and vomiting in group N and group SN was significantly lower than that in group S,and the difference was statistically significant(P<0.05).There was no difference in the incidence of respiratory depression among the three groups(P>0.05).The incidence of total adverse reactions in group N and SN was less than group S,and the difference was statistically significant(P<0.05).(6)The actual pressing times of PCIA in group SN were significantly less than group S and group N,and the difference was statistically significant(P<0.05).(7)The total satisfaction of group SN was significantly higher than that of group S and group N(P<0.05).ConclusionSufentanil combined with nalbuphine can achieve satisfactory clinical treatment effect on PCIA management using wireless electronic analgesic pump after cesarean section.Its advantages include good analgesic and sedative effect,few adverse reactions and high maternal satisfaction.