Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, People's Republic of China.
Department of Anesthesiology, Huadu District People's Hospital, Guangzhou, Guangdong Province, People's Republic of China.
Drug Des Devel Ther. 2024 Jun 18;18:2381-2392. doi: 10.2147/DDDT.S460924. eCollection 2024.
We aimed to evaluate the effect of intravenous esketamine combined with dexmedetomidine as supplemental analgesia in reducing intraoperative visceral pain during elective cesarean section under combined spinal-epidural anesthesia (CSEA).
A total of 269 parturients scheduled for elective cesarean section under CSEA between May 2023 and August 2023 were assessed. The parturients were randomly allocated to receiving either intravenous infusion of 0.3-mg/kg esketamine combined with 0.5-μg/kg dexmedetomidine (group ED, n=76), 0.5-μg/kg dexmedetomidine (group D, n=76), or normal saline (group C, n=76) after umbilical cord clamping. The primary outcome was intraoperative visceral pain. Secondary outcomes included the visual analog scale (VAS) score for pain evaluation and other intraoperative complications.
The incidence of visceral pain was lower in group ED [9 (12.7%)] than in group D [32 (43.8%)] and group C [36 (48.6%), <0.0001]. The VAS score was also lower in group ED when exploring abdominal cavity [0 (0), <0.0001] and suturing the muscle layer [0 (0), =0.036]. The mean arterial pressure was higher in group D [83 (9) mmHg] and group ED [81 (11) mmHg] than in group C [75 (10) mmHg, <0.0001] after solution infusion. The heart rate after infusion of the solution was lower in group D [80 (12) bpm] than in group C [86 (14) bpm] and group ED [85 (12) bpm, = 0.016]. The incidence of transient neurologic or mental symptoms was higher in group ED compared to group C and group D (76.1% vs 18.9% vs 23.3%, <0.0001).
During cesarean section, 0.3-mg/kg esketamine combined with 0.5-μg/kg dexmedetomidine can alleviate visceral traction pain and provide stable hemodynamics. Parturients receiving this regimen may experience transient neurologic or mental symptoms that can spontaneously resolve at the end of the surgery.
我们旨在评估静脉注射氯胺酮联合右美托咪定作为辅助镇痛在椎管内麻醉下（CSEA）剖宫产术中减轻内脏疼痛的效果。
对 2023 年 5 月至 2023 年 8 月期间接受 CSEA 择期剖宫产术的 269 名产妇进行评估。产妇被随机分配接受静脉输注 0.3mg/kg 氯胺酮联合 0.5μg/kg 右美托咪定（ED 组，n=76）、0.5μg/kg 右美托咪定（D 组，n=76）或生理盐水（C 组，n=76），在脐带夹闭后。主要结局为术中内脏痛。次要结局包括疼痛评估的视觉模拟量表（VAS）评分和其他术中并发症。
ED 组内脏痛发生率[9（12.7%）]低于 D 组[32（43.8%）]和 C 组[36（48.6%）]，<0.0001。ED 组在探查腹腔[0（0），<0.0001]和缝合肌肉层[0（0），=0.036]时 VAS 评分也较低。溶液输注后，D 组[83（9）mmHg]和 ED 组[81（11）mmHg]的平均动脉压均高于 C 组[75（10）mmHg]，<0.0001。溶液输注后，D 组[80（12）bpm]的心率低于 C 组[86（14）bpm]和 ED 组[85（12）bpm]，=0.016。ED 组短暂性神经或精神症状的发生率高于 C 组和 D 组（76.1%比 18.9%比 23.3%），<0.0001。
在剖宫产术中，0.3mg/kg 氯胺酮联合 0.5μg/kg 右美托咪定可减轻内脏牵引痛，并提供稳定的血液动力学。接受该方案的产妇可能会出现短暂的神经或精神症状，这些症状在手术结束时会自行缓解。
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