科研之友
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摘要
Background. Pain after Caesarean delivery is partly related to Pfannenstiel incision, which can be infiltrated with local anaesthetic solutions. Methods. A double- blind randomized control trial was designed to assess the analgesic efficacy of 7.5ˋmg/mL ropivacaine solution compared to control group, in two groups of one hundred and forty four parturients for each group, who underwent Caesarean section under spinal anaesthesia: group R (ropivacaine group) and group C (control group). All parturients also received spinal sufentanil (2.5ˋ g). Results. Ropivacaine infiltration in the Pfannenstiel incision for Caesarean delivery before wound closure leads to a reduction of 30% in the overall consumption of analgesics (348ˋ550ˋmg for group R versus 504ˋ426ˋmg for group C with ), especially opioids in the first 24 hours, but also significantly increases the time interval until the first request for an analgesic (4ˋh 20ˋmin 2ˋhˋ26 for group R versus 2ˋhˋ42 1ˋhˋ30 for group C). The P values for the two groups were: for paracetamol, for ketoprofen and P for nalbuphine which was the most significant. There is no significant difference in the threshold of VAS in the two series. Conclusion. This technique can contribute towards a programme of early rehabilitation in sectioned mothers, with earlier discharge from the post-labour suite. 1. Introduction The number of Caesarean sections is increasing progressively in European countries with the aim of improving fetal prognosis; about 20% of deliveries are performed under Caesarean section [1, 2]. Caesarean section commonly induces moderate to severe pain lasting 48 hours [3每5]. Opioids are commonly used for relief of postoperative pain after Caesarean section, either by intrathecal administration prior to section or parenteral administration postoperatively. The addition of opioids intrathecally prolongs the effects of the spinal anaesthesia and reduces the dose of local anaesthetic required, thus reducing the hemodynamic effects which are deleterious to the fetus. However, to obtain analgesia of good quality and of long duration then higher doses of opioids have to be used. But the risk of complications such as respiratory depression, urinary retention, pruritus, nausea, and vomiting can preclude patient＊s comfort [6每9]. On the other hand, nonopioid systemic analgesics are not powerful enough to allow effective pain control after Caesarean section [10, 11]. Other techniques of postoperative analgesia, such as epidural morphine or local anaesthetics also have limits because they require prolonged clinical surveillance.
