Comparison of the effects of different analgesia methods for artificial abortion / 中国基层医药

ABSTRACT

Objective To observe the clinical effect of multimodal analgesia for painless artificial abortion . Methods 150 cases of ASA Ⅰ-Ⅱ pregnancy received painless artificial abortion operation ,no contraindication for all patients,were randomly divided into the five groups ,30 cases in each group,the blank control group (group S)do not use any analgesia measure ,intravenous injection of 0.9% sodium chloride 2mL preoperation;the fentanyl group ( F group )intravenous injection of fentanyl 1μg/kg preoperation ;the parecoxib group ( group P )intravenous injection of parecoxib sodium 40mg preoperation.The patients were given painless artificial abortion after injection the above drugs.Nerve block group ( N group)the implementation of painless induced abortion operation after sleep in patients with the cervical nerve block ,injection of 1%lidocaine 2 mL.Multimodal analgesia group (group M)intra-venous injection of parecoxib sodium 40mg,fentanyl 1μg/kg,then the implementation method the same as N group . The operation time,anesthesia onset time,recovery time,time of accurate orientation and additional dosage of propo-fol;incidence rate of artificial abortion syndrome ,the incidence rate of uterine contraction pain ,10min,30min,1h,6h pain scores after operation; adverse reaction;satisfaction score of analgesic effect postoperative 24h were observed. Results The additional dosage of propofol in the group S ,group F,group P,group N and group M were (78.45 ± 20.36)mg,(15.55 ±12.33)mg,(16.75 ±13.13)mg,(14.55 ±10.25)mg,(9.35 ±8.27)mg.The incidence rates of uterine contraction pain in the group S ,group F,group P,group N and group M were 30%,10%,10%,10%,0. Compared with group M ,the additional dosage of propofol and incidence rate of uterine contraction pain in the other four groups were significantly increased (t=3.05,1.82,1.84,1.78,χ2 =72.1,68.2,68.2,68.2,all P<0.05). Pain scores after operation 10min,30min,1h,6h in the group S were (6.6 ±1.5)points,(5.6 ±1.4)points,(4.6 ± 1.1)points,(3.6 ±1.4)points.Those in group F were (5.1 ±1.5)points,(4.3 ±1.1)points,(3.1 ±0.9)points, (2.8 ±0.8).Pain scores after operation 10min,30min,1h,6h in the group P were (4.6 ±1.5) points,(4.2 ± 0.9)points,(2.9 ±0.8) points,(2.7 ±0.6) points.Those in the group N were (4.5 ±1.5) points,(4.1 ± 0.8)points,(2.9 ±0.8)points,(2.6 ±0.5).Pain scores after operation 10min,30min,1h,6h in the group M were (2.2 ±0.8)points,(1.9 ±0.7)points,(1.5 ±0.5)points,(1.2 ±0.3)points.Compared with the group M,pain scores after operation 10min,30min,1h,6h in the other four groups were significantly elevated ( t=2.03,1.96,1.86, 1.84,1.98,1.82,1.80,1.76,2.05,1.99,1.95,1.86,2.06,1.88,1.82,1.76,all P<0.05).Compared with S group,postoperative 24h satisfaction score of analgesia in the group M was improved significantly ( t =1.98,P<0.05).Compared with group M,the incidence rate of nausea in the other four groups was increased significantly (χ2 =72.2,68.9,68.1,68.1,all P<0.05).Conclusion Multimodal analgesia method can greatly reduce artificial abor-tion postoperative pain ,reduce the adverse reactions ,improve patients'satisfaction score ,ensure the safety of operation .