ABSTRACT
Purpose: High rate of cesarean section (CS) bring challenges to analgesic management after CS. Previous studies state that adjuvant treatment with a low dose of esketamine intraoperatively could reduce postoperative pain and opioid consumption, and even prevent postpartum depression. However, few researches involve in patient-controlled intravenous analgesia (PCIA) with esketamine after CS. In this trial, we explored a new combination of esketamine with tramadol for PCIA after CS with the aim to provide a better analgesic regimen for use in the clinic. Patients and Methods: 170 puerperae undergoing CS were recruited for this trial and randomly assigned into 2 groups (1:1): The control group received a formula of PCIA with butorphanol 0.1mg/kg and tramadol 400mg postoperatively, while the intervention group received a formula of PCIA with esketamine 1mg/kg and tramadol 400mg. The primary outcome was the mean numerical rating scale (NRS) scores at rest, sitting, and uterine contraction at 6 hours postoperatively. The second outcomes included the mean NRS scores at rest, sitting, and uterine contraction at 12, 24, and 48 hours postoperatively. The incidence of adverse events, postoperative sedation, postoperative sleep quality, maternal satisfaction regarding postoperative analgesia and the Edinburgh postnatal depression scale (EPDS) score were also be evaluated. Results: The mean (SD) of the mean NRS scores at rest, sitting, and during uterine contraction at 6 hours postoperatively were 4.8 (0.7) points in the intervention group and 5.3 (0.5) points in the control group. The estimated mean difference between the two groups at 6 hours postoperatively was -0.5 points (95% confidence interval [CI], -0.7 to -0.3; P < 0.001). Compared with the control group, the patients in the intervention group had a significantly lower mean pain intensity at 12 and 24 hours postoperatively (-0.5 points [95% CI, -0.6 to -0.3]; P < 0.001 and -0.2 points [95% CI, -0.4 to 0]; P = 0.019 respectively). Otherwise, differences at 48 hours after surgery between the two groups were nonsignificant (0 points [95% CI, -0.2 to 0.2]; P = 0.802). The incidence of adverse events in the intervention group (11.8%) was significantly lower than in the control group (24.7%) (ratio difference -12.9, [95% CI, -24.3 to -1.5]; P = 0.029). No difference was found in postoperative sleep quality (P = 0.765), analgesic satisfaction (P= 0.818) and EPDS scores (P = 0.154) between the two groups. Conclusion: In this trial, among patients undergoing CS, esketamine combined with tramadol by PCIA improved pain intensity 6 hours postoperatively compared with butorphanol combined with tramadol.
ABSTRACT
Planting soybeans (Glycine max (L.) Merr.) in tea gardens decreased soil pH in theory but increased it in practice. This controversy was addressed in this study by treating the tea garden soil consecutively with different parts of a soybean cover crop: aboveground soybean (ASB) parts, underground soybean (USB) root residues, and the whole soybean (WSB) plants. In comparison with the control, the soil pH increased significantly after the third ASB and WSB treatments, but there was no significant change in the soil pH in the USB treatment. Concordantly, the soil exchangeable acidity decreased significantly and the soil exchangeable bases increased significantly in the ASB and WSB treatments. The exchangeable acidity increased in the USB treatment, but the amount of the increased acidity was less than that of the increased bases in the ASB treatment, resulting in a net increase in the exchangeable bases in the WSB treatment. Soybean planting and covering also increased the microbial richness and abundance significantly, which led to significantly more soil organic matters. Exchangeable K+ and Mg2+, and soil organic matters played significantly positive roles and exchangeable Al3+ played negative roles in improving soil pH. Our data suggest that consecutive plantings of soybean cover crop increase the pH of the acidified tea garden soil.
