| BackgroundCesarean section is one of the common surgical procedures.At present,the rate of cesarean section is increasing worldwide.Data show that in 2015,the cesarean section rate in more than 53 countries was over 27.3%,of which the cesarean section rate in the United States reached 32.2%.Since the full opening of the two-child policy in 2016,China has ushered in a new round of fertility peak.There were a total of 160 million newborns in China from 2008 to 2018,and the cesarean section rate reached 36.7%in 2018.Acute pain after cesarean section is one of the important causes of postpartum complications.Providing good postoperative analgesia is helpful to reduce postoperative stress reaction and reduce the incidence of postpartum complications.Therefore,the improvement of analgesia quality after cesarean section has good social and economic benefits.At.present,multi-mode analgesia including regional nerve block has achieved good results after cesarean section,while quadratus lumbar b lock can provide somatic and visceral analgesia,which can reduce postoperative pain scores,reducing the use of opioids has a unique value.However,there is uncertainty in the e ffective duration of analgesia,and the effect of q uadrat us lumbar block on postpartum prolactin has not been studied.In clinical practice,single epidural morphine injection during combined spinal-epidural anesthesia can effectively relieve somatic and visceral pain and promote prolactin secretion.But single epidural morphine analgesia may increase side effects such as nausea,vomiting and itching.Single quadratus lumbar block or single epidural morphine injection can achieve good analgesic effect after cesarean section.At present,the effect of these two methods combined with patient-controlled intravenous analgesia on postoperative analgesia after cesarean section and the comparison of prolactin secretion have not been reported.Therefore,we designed a prospective randomized controlled trial to compare the effects of these two analgesic methods on postoperative analgesia and prolactin after cesarean section.ObjectiveBy comparing the effects of single quadratus lumbar block and single epidural morphine injection combined with patient-controlled intravenous analgesia on postoperative analgesia and postpartum prolactin after cesarean section,to explore a more optimized multi-mode analgesia method for postoperative analgesia after cesarean section.MethodsThis trial is a prospective,randomized,double-blind study.A total of 90 pregnant women who underwent cesarean section in our hospital from May 2020 to October 2020 were selected,AS A grade Ⅰ-Ⅱ,singleton pregnancy and pregnancy time more than 37 weeks.According to the principle of random number method,the patients were randomly divided into three groups(n=30):quadratus lumbar block+PCIA group(group QLB),epidural morphine+PCIA group(group MF),simple PC IA group(group C).Combined spinal-epidural anesthesia was used in all anesthesia methods.L2-3 or L3-4 was selected for puncture,and the anesthesia level was controlled at T6.After the fetus was taken out,tropisetron mesylate 4.48mg was given intravenously to prevent nausea and vomiting,and flurbiprofen axetil 0.7mg/kg was given intravenously for analgesia during peritoneal suture.During skin suture,group QLB and group C were given normal saline 2ml through epidural catheter,while group MF was given morphine 2ml of lmg/ml concentration through epidural catheter.Then the group QLB received bilateral quadratus lumbar block under the guidance of ultrasound.Half of the total amount of ropivacaine was 1.5 mg/kg and the concentration of ropivacaine was 0.25%.There was no sham block control in group MF and group C.All the parturients in the three groups were given patient-controlled intravenous analgesia after operation,and the VAS score of maintenance exercise was≤4.The PCA times,pain score,BCS comfort score,Ramsay sedation score,adverse reactions and PRL concentration of postoperative analgesia pump were recorded in the three groups.The time of exhaust,indwelling catheter and hospital stay were recorded.Results1.Comparison of general conditions:one parturient in gro up QLB was excluded because of uterine weakness and excessive blood loss during operation,and finally included 89 parturients,including 29 parturients in group QLB,30 in group MF and 30 in group C.There was no significant difference in general condition and laboratory test results among the three groups(P>0.05).2.Comparison of PCA times and pain score:compared with group C,both group QLB and group MF could reduce the effective and actual PCA times of intravenous analgesia pump within 48 hours after operation(P<0.05).The resting and exercise VAS scores at 12 hours after operation in QLB group were lower than those in group C,and at 24 hours after operation,the resting and exercise VAS scores in QLB group were lower than those in MF group(P<0.05).The resting VAS score and exercise VAS score at 6 hours and 12 hours after operation in group MF were lower than those in group C(P<0.05).The verbal rating scale of QLB group and MF group at 6 h,12 h,24 h after operation were lower than those in group C(P<0.05).3.BCS comfort score:the comfort score of group QLB at 6 h,12 h and 24 h after operation was higher than that of group C(P<0.05).The comfort score of group MF at 6 h and 12 h after operation was higher than that of group C(P<0.05).4.There was no significant difference in Ramsay sedation score,uterine floor height,exhaust time,indwelling catheter time and hospitalization time among the three groups at each time after operation(P>0.05).5.There was no significant difference in prolactin concentration among the three groups at 24 hour and 48 hour after operation(P>0.05).6.Adverse reactions:there was no significant difference in the incidence of postoperative analgesia and nausea and vomiting among the three groups.The incidence of pruritus in group MF was the highest,which was significantly higher than that in group QLB and group C(P<0.05).ConclusionsThe use of single quadratus lumbar block or epidural morphine injection in postoperative analgesia after cesarean section can effectively reduce the PCA dosage of sufentanil 48 hours after operation.Quadratus lumbar block within 24 hours after operation can provide good analgesic effect and higher comfort,but does not affect early prolactin secretion,and the incidence of adverse reactions of pruritus is lower. |
