Effect of ropivacaine hydrochloride combined with sufentanil for intraspinal patient controlled analgesia in delivery analgesia and its influence on stress reaction and pregnancy outcome / 中国医师杂志

ABSTRACT

Objective:To investigate the effect of ropivacaine hydrochloride combined with sufentanil for intraspinal patient-controlled analgesia (PCA) in labor analgesia, and its influence on stress response and pregnancy outcome.Methods:The general data of 97 parturients who underwent intraspinal PCA delivery analgesia in Chengdu Seventh People′s Hospital from April 2019 to March 2021 were retrospectively analyzed. They were divided into the observation group (51 cases) and the control group (46 cases) according to different analgesia methods. The observation group parturients were given ropivacaine hydrochloride combined with sufentanil intraspinal PCA, and the control group parturients were given ropivacaine hydrochloride intraspinal PCA. The numerical scoring system (NRS) was used to evaluate the pain degree of the parturient before, 15 minutes after, 30 minutes after, 45 minutes after analgesia and when the uterine orifice was fully opened. The onset time of analgesia, the time of perfection of analgesia, the amount of ropivacaine hydrochloride, sufentanil and the total amount of analgesic drugs were counted. The levels of serum cortisol (COR), adrenocorticotropic hormone (ACTH) and Norepinephrine (NA) were detected by enzyme-linked immunosorbent assay (ELISA). The time of the first stage of labor, the active stage, the second stage of labor, and the third stage of labor, the amount of vaginal bleeding (during labor and within 2 hours after delivery), the proportion of oxytocin application, normal labor, forceps delivery, lateral perineum resection, and caesarean section, the occurrence of adverse reactions (itching, fever, nausea and vomiting, urinary retention, and fetal bradycardia), and the Apgar score of newborns (1 min and 5 min after birth) were counted.Results:There was no statistically significant difference in the onset time and improvement time of analgesia between the two groups of postpartum women, as well as the NRS scores before and after analgesia at 15, 30, and 45 minutes, as well as when the cervix was fully opened (all P>0.05). The dosage of Ropivacaine hydrochloride and the total amount of analgesics in the observation group were significantly less than those in the control group (all P<0.05). After analgesia, the serum levels of COR, ACTH, and NA in both groups decreased significantly compared to before analgesia (all P<0.05); After analgesia, there was no statistically significant difference in serum COR, ACTH, and NA levels between the two groups (all P>0.05). The second stage of labor in the observation group was shorter than that in the control group, the vaginal bleeding volume and the proportion of caesarean section were lower than those in the control group, the proportion of normal delivery and the Apgar score 1 min after birth of the fetus were higher than those in the control group, and the difference was statistically significant (all P<0.05). There was no statistically significant difference in the analgesic effect and total incidence of adverse reactions between the two groups of postpartum women (all P>0.05). Conclusions:Ropivacaine hydrochloride combined with sufentanil intraspinal PCA can effectively alleviate labor pain, reduce the amount of analgesics, and improve maternal and fetal pregnancy outcomes.