Effects Of Oral Analgesics And Sufentanil Patient-controlled Intravenous Analgesia On Acute And Chronic Postoperative Pain After Cesarean Section

Background and ObjectiveCesarean section(CS)is one of the most commonly performed surgical procedures in obstetrics and gynecology.There are a tremendous number of CSs in China every year.Postoperative pain was highest in the immediate postoperative and most patients experienced moderate to severe pain after CS.Suboptimal perioperative pain management is associated with delayed functional recovery,difficulty in breastfeeding,impaired maternal-infant bonding,postpartum depression and even chronic postoperative pain.The ideal postoperative pain management needs to fully consider the interests of both the mothers and the infants.It should not only provide satisfactory analgesia for the mothers,but also minimize the risks or side effects related to the drugs to the newborns,but to achieve this goal is still a challenge.Acute pain is common after CS and fortunately most of it can be resolved with tissue healing.However,for some patients,acute postoperative pain persists beyond the usual time of tissue healing and transitions into a chronic pain state.Previous studies have shown that severe acute postoperative pain is an independent risk factor for chronic pain after CS.Therefore,effective treatment of acute postoperative pain may help reduce the incidence of chronic pain after CS.Multimodal analgesia,which provides better analgesic effects and lower rate of side effects,is currently recommend.There are various kinds of postoperative analgesia methods.Different postoperative analgesia methods may have different effects on acute and chronic pain;even if the effects on acute pain are the same or similar,they may have different effects on chronic pain due to the differences of analgesic drugs.Oral analgesics and patient controlled intravenous analgesia(PCIA)are both widely used for postoperative pain analgesia,but there are few reports comparing the effects of these two methods on postoperative acute and chronic pain.Therefore,this study intends to explore the better pain management for CS by comparing the effects of these two methods on acute pain and the effects on the incidence and severity of chronic pain at 3 and 6 months after surgery.Methods A non-randomized contemporaneous controlled study was performed in two centers.300 healthy primiparas with a medically normal pregnancy scheduled for elective CS under spinal anesthesia were recruited.Half of the women were given oral celecoxib capsules 200 mg bid,paracetamol 1g qid and tramadol extended-release tables 100 mg bid for postoperative pain management for 48 hours(group Oral,n=150),while the other 150 women in another hospital received intravenous patient-controlled analgesia with sufentanil 2?g/kg and tropisetron 10mg(diluted to 100 ml with normal saline,loading dose 2ml,background infusion 2ml/h,bolus 2ml,lock out 15 min,maximum dose 12ml/h)(group PCIA,n=150).Acute and chronic rest pain and movement-evoked pain were evaluated by numeric rating scale(NRS)after surgery.The maximum and average pain NRS score within 24 h after surgery,NRS score at 24 h and 48 h after surgery,the events of requiring rescue analgesia and the side effects such as nausea and vomiting during the first 48 hours following surgery were recorded.The phone interview was made after 3 and 6 months of surgery for identification of patients with chronic post-caesarean section pain.The degree of chronic pain interference on daily function was measured by short form Brief Pain Inventory(BPI).The pain location,characteristic and severity as well as the need for analgesics were recorded.Results 1.Compared with group PCIA,the maximum and average pain NRS score within 24 h after surgery,NRS score at 24 h and 48 h after surgery in group Oral were significantly decreased(P<0.05).2.Compared with group PCIA,the incidence of side effects including nausea/vomiting,pruritus,dizziness in group Oral were significantly decreased(P<0.05).3.The NRS score and the degree of chronic pain interference on daily function at 3 months after CS was lower in group Oral(P<0.05)and become no difference at 6 months(P>0.05).4.There were no significant differences between groups in the incidence of chronic pain at 3 and 6 months after CS(P>0.05).Conclusions Orally taking celecoxib,paracetamol and tramadol can provide satisfactory analgesia effect for parturient after CS under spinal anesthesia,especially for acute pain relief and postoperative chronic pain prevention.