关键词:

剖宫产术, 麻醉方式, 局麻药物, 快速康复

Abstract:

Objective　To compare the anesthesia effects and satisfaction of different intraspinal anesthesia methods and local anesthesia drugs for women taking selective cesarean section, and to observe their impact on the women's rapid recovery. Methods　This was a prospective, randomized, controlled, and double-blind study. A total of 150 single pregnant women who underwent selective cesarean section in The Third Affiliated Hospital of Guangzhou Medical University from April to October 2022 were selected; their America Association of Anesthesiologists (ASA) grade was Ⅰ-Ⅱ; they were 22-39 years old; they had no complications of other systemic systems; they took subuterine transectomy. They were divided into a ropivacaine group (SR group), an epidural lidocaine group (EL group), and an epidural mepivacaine group (EM group) by the random number table method, with 50 cases in each group. In the SR group, 3 ml of isobaric 0.5% ropivacaine was directly applied in the subarachnoid space into the L3-4 interspace; in the EL and EM groups, 12-15 ml of 2% lidocaine or 2% mepivacaine were applied in the epidural space through L2-3 direct approach, respectively. The indwelling catheters were placed in the epidural spaces of all the three groups. The anesthesia effects (time to most superior level of block obtained, drug dose, maximal cephalad sensory block level, and neonatal blood gas), anesthesia satisfaction (satisfaction of patients, surgeons, and anesthesiologists with anesthesia effects), complications, and related recovery indicators (motor block recoovery, Bromage score, postoperative analgesia, time for first off-bed activity, time for first exhausting, time for first peeing, and hospital stay) were observed and recorded. One way ANOVA and Kruskal-Wallis rank sum test were applied. Results　The EL and EM groups had longer duration of anesthetic drug effect and increased drug dosage. However, the incidences of intraoperative hypotension and nausea and vomiting and postoperative urine retention were 34%(17/50), 24%(12/50), and 14%(7/50) in the SR group, were 14%(7/50), 4%(2/50), and 2%(1/50) in the EL group, and were 16%(8/50), 6%(3/50), and 0 in the EM group, with statistical differences (all P<0.05). The times for first off-bed activity of the ER, EL, and EM groups were (23.52±4.22) h, (18.30±3.80) h, and (19.10±5.93) h, respectively; the the hospital stays were (72.68±12.69) h, (65.28±19.88) h, and (65.67±6.14) h respectively; it indicated that the EL and EM groups had better postoperative recovery indicators (all P<0.05). There were no statistical differences in satisfaction, neonatal blood gas, and administration of narcotics in the postoperative period between the three groups (all P>0.05). Moreover, there were no statistical differences in the anesthesia effect and postoperative recovery indicators between the EL and EM groups (all P>0.05). Conclusion　Compared to ropivacaine combined with lumbar epidural anesthesia, epidural application of lidocaine or mepivacaine can promote the patients' rapid postoperative recovery, and it is consistent with the modern ERAS concept.

Key words:

Cesarean section, Anesthesia method, Local anesthetic, Rapid recovery