摘要
Abstract
Objective:In current clinical practice,patient-controlled intravenous analgesia remains the primary method for postoperative pain relief in parturients undergoing cesarean section following conversion from vaginal delivery with labor analgesia.However,its analgesic effect is not always optimal.This study aims to investigate the efficacy of a single epidural injection of hydromorphone combined with ropivacaine in relieving postoperative pain in such patients.
Methods:A total of 60 parturients undergoing cesarean section after failed vaginal delivery with epidural labor analgesia in Women's Hospital of Nanjing Medical University,between April and November 2023 were included.Based on the epidural analgesic regimen administered at the time of skin closure,they were randomly divided into 2 groups:A hydromorphone plus ropivacaine group(H group)and a ropivacaine-only group(C group),with 30 patients in each group.Upon entering the operating room,both groups received 3 mL of 2%lidocaine via the epidural catheter for test dosing.After 5 minutes without adverse reactions,15 to 20 mL of 3%chloroprocaine was injected to induce epidural anesthesia.At skin closure,the H group received 10 mL of 0.02 mg/mL hydromorphone hydrochloride combined with 0.1%ropivacaine via the epidural space,while the C group received 10 mL of 0.1%ropivacaine alone.Postoperatively,both groups used intravenous patient-controlled analgesia.Pain levels at 6,12,and 24 hours postoperatively were assessed using the Visual Analogue Scale(VAS).Additionally,operative time,intraoperative use of rescue intravenous analgesia(esketamine 20 to 30 mg),postoperative recovery metrics(time to the first ambulation,and time to the first anal exhaust),drug-related adverse effects(e.g.somnolence,dizziness,vomiting,itching),and 24-hour sleep satisfaction were compared between the 2 groups.
Results:There were no significant differences between the 2 groups in baseline characteristics,operation time,or intraoperative use of esketamine(all P>0.05).The H group had significantly shorter fist ambulation and anal exhaust,and a longer duration of initial ambulation compared to the C group(all P<0.05).Sleep satisfaction at 24 hours postoperatively was significantly higher in the H group(t=3.084,P=0.003).There was no significant difference in the incidence of drug-related adverse events between the 2 groups(χ2=0.082,P=0.774).At all time points,VAS scores were significantly lower in the H group than in the C group(all P<0.05).Within-group comparisons in the H group showed no significant differences in VAS scores between time points(all P>0.05).In the C group,VAS scores at 6 and 24 hours postoperatively were significantly lower than those at 12 hours(both P<0.05).
Conclusion:A single epidural injection of hydromorphone hydrochloride combined with ropivacaine significantly reduces postoperative pain and promotes enhanced recovery in parturients undergoing cesarean section following conversion from vaginal delivery analgesia.This method is clinically valuable and warrants broader application.关键词
盐酸氢吗啡酮/罗哌卡因/经阴道分娩/硬膜外镇痛/剖宫产手术/视觉模拟评分法Key words
hydromorphone hydrochloride/ropivacaine/vaginal delivery/epidural analgesia/cesarean section/Visual Analogue Scale
