Department of Anesthesiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China; Department of Anesthesiology, The First People's Hospital of Yunnan Province, Kunming, China.
Department of Anesthesiology, The People's Hospital of Zhenxiong County, Zhenxiong, China.
Ann Palliat Med. 2022 Oct;11(10):3213-3223. doi: 10.21037/apm-22-1026.
Pain management following cesarean section remains a challenge, with many puerpera suffering from severe acute postoperative pain. And for a second cesarean section the degree of uterine contraction pain is more severe and frequent than that of a primipara. This study investigated the effect of different doses of nalbuphine combined with sufentanil for postoperative analgesia in patients undergoing a second cesarean section.
We prospectively recruited 168 women with a scarred uterus undergoing elective second cesarean section and they were randomly divided into 4 groups by random number extraction. A single intravenous injection of different doses of nalbuphine was given before the intravenous drip of oxytocin, and visual analogue scale (VAS) scores of uterine contraction pain were recorded 10 minutes before intravenous infusion of oxytocin (T1) and 10 minutes (T2), 30 minutes (T3), and 60 minutes (T4) after intravenous infusion of oxytocin. At 4, 8, 12, 24, and 48 hours after patient-controlled intravenous analgesia (PCIA), pain intensity was reassessed using the VAS score.
One hundred and sixty patients underwent elective second cesarean section in between December 2020 and May 2021 completed the study. The VAS scores of uterine contractions at T1 and T4 were 3 (1.0), while the VAS scores at T2 and T3 were 7 (1.0), 6 (1.0), 5 (1.0), 5 (1.0) and 8 (1.0), 5 (2.0), 3 (1.0), 3 (0.75). The VAS scores at 12 hours after surgery of nalbuphine10mg and sufentanil (NS1), nalbuphine 10 mg and sufentanil 20 mg (NS2) and nalbuphine 30 mg and sufentanil 20 mg (NS3) were lower than sufentanil (S) group (P<0.001). Compared with the S group, total amount of sufentanil and PCIA compression numbers in the NS1, NS2, and NS3 groups at 4-8 and 8-12 hours after surgery decreased (P<0.001), with a more significant decrease in the NS2 and NS3 groups than in the NS1 group (P<0.001). The NS3 group had a significantly higher incidence of dizziness and sleepiness (P=0.02, P=0.001). Compared with the NS2 and NS3 groups, the incidence of respiratory depression in the S group was significantly higher (P=0.001).
A single intravenous injection of nalbuphine 20 mg 10 minutes before the infusion of oxytocin combined with sufentanil 2 µg/kg could be safely used for postoperative analgesia in patients undergoing a second cesarean section and could effectively inhibit uterine contractions induced by oxytocin and reduce adverse reactions.
Clinical Trial Registry ChiCTR2100042382.
剖宫产术后疼痛管理仍然是一个挑战，许多产妇患有严重的急性术后疼痛。对于第二次剖宫产，子宫收缩疼痛的程度比初产妇更严重且更频繁。本研究探讨了不同剂量纳布啡联合舒芬太尼用于行二次剖宫产产妇术后镇痛的效果。
我们前瞻性招募了 168 例瘢痕子宫行择期二次剖宫产的患者，并通过随机数提取将其随机分为 4 组。在静脉滴注缩宫素前给予不同剂量纳布啡单次静脉注射，记录静脉滴注缩宫素前 10 分钟（T1）、静脉滴注缩宫素后 10 分钟（T2）、30 分钟（T3）和 60 分钟（T4）的子宫收缩疼痛视觉模拟评分（VAS）。在患者自控静脉镇痛（PCIA）后 4、8、12、24 和 48 小时，再次使用 VAS 评分评估疼痛强度。
2020 年 12 月至 2021 年 5 月期间，160 例行择期二次剖宫产的患者完成了研究。T1 和 T4 的子宫收缩 VAS 评分为 3（1.0），T2 和 T3 的 VAS 评分为 7（1.0）、6（1.0）、5（1.0）、5（1.0）和 8（1.0）、5（2.0）、3（1.0）、3（0.75）。纳布啡 10mg 和舒芬太尼（NS1）、纳布啡 10mg 和舒芬太尼 20mg（NS2）和纳布啡 30mg 和舒芬太尼 20mg（NS3）组术后 12 小时的 VAS 评分均低于舒芬太尼（S）组（P<0.001）。与 S 组相比，NS1、NS2 和 NS3 组术后 4-8 小时和 8-12 小时舒芬太尼的总用量和 PCIA 按压次数减少（P<0.001），NS2 和 NS3 组的减少幅度明显大于 NS1 组（P<0.001）。NS3 组头晕和嗜睡的发生率明显更高（P=0.02，P=0.001）。与 NS2 和 NS3 组相比，S 组呼吸抑制的发生率明显更高（P=0.001）。
在静脉滴注缩宫素前 10 分钟给予纳布啡 20mg 单次静脉注射，联合舒芬太尼 2μg/kg 可安全用于行二次剖宫产产妇术后镇痛，能有效抑制缩宫素引起的子宫收缩，减少不良反应。
临床试验注册 ChiCTR2100042382。
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