Abstract: [Abstract] Objective To explore the feasibility of application of dexmedetomidine combination of low concentration of levobupivacaine and sufentanil performed by patient controlled – epidural analgesia (PCEA) in cesarean section. Methods Totally 90 full-term pregnancy parturients of single birth with ASAⅠ~Ⅱ, were randomized into three groups: group of control (group C),dexmedetomidine group 1(group D1 ), and dexmedetomidine group 2(group D2). All puerperas’ anesthesia was performed by combining epidural and spinal block in L3-4. The postoperative analgesia that is performed as below: three groups were performed by PCEA, group C: sufentanil 1.5ug.kg-1+0.1% levobupivacaine, dissolved in sterile saline solution with total volume 150ml, group D1: sufentanil 1.5ug.kg-1+0.1% levobupivacaine+ dexmedetomidine 0.02ug.kg-1.h-1, dissolved in sterile saline solution with total volume 150ml, group D2: sufentanil 1.5ug.kg-1+0.1% levobupivacaine + dexmedetomidine 0.05ug.kg-1.h-1, dissolved in sterile saline solution with total volume 150ml. At the end of operation, the PCEA program of all postoperative analgesia pumps were fast delivered 2ml, and set with background infusion of 2ml/h, a lockout of 15 min and a delivery of a bolus dose of 2ml. The normal information (age, weight and height) of puerperas, the time of operation and anesthesia, the incidence of adverse reactions (pruritus, nausea and emesis) for postoperative analgesia, and the BCS scores were recorded. In addition to, VAS scores and Ramsay scores were also recorded at 4h, 8h, 12h, 24h, 48h time points after operation. And the number of valid PCA was recorded and the consumptions of sufentanil for 48h analgesia were assessed. Results The normal information of puerperas and the time of operation and anesthesia, were all no statistical differences in 3 groups. The Ramsay score of group C was lower at the 4h,8h,12h,24h,48h after operation compared with group D1 and group D2 respectively(P < 0.05, P < 0.001). In assessment of the VAS score,group D1 and group D2
were lower at the 4h,8h,12h,24h,48h after operation compared with group C, respectively (P<0.05,P < 0.001). Compared the incidence of adverse reactions (pruritus, nausea and emesis) for postoperative analgesia in different grouops, group D2 is lower than group C in pruritus. In assessment of BCS score, group D1 was higher than group C(P < 0.01), and group D2 was significantly higher than all of group C and group D1(P<0.01, or P <0.001). In Assessment of consumption of sufentanil for 48h analgesia, the consumption of group C was apparently bigger compared with group D1 and group D2(P < 0.01,P < 0.001); and the consumption of group D1 compared group D2 was also bigger (P < 0.05). Conclusion The protocol of dexmedetomidine 0.05ug•kg-1•h-1 + 0.1% levobupivacaine + sufentanil 1.5ug•kg-1 performed by PECA for postoperative analgesia in post-cesarean section with better analgesic effect, and reduction of the total consumption of sufentanil, which is security and feasibility for clinical application.
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