Influence of Epidural and Intravenous Patient-controlled Analgesia on Low Back Pain after Caesarean Section_West China Medical Journal

Authors：

 YUYi-bing , LIHai-bing ,  LIUZhi-qiang

Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040, P. R. China;

Corresponding?author：

LIUZhi-qiang, Email: jinqiliu@sohu.com

Keywords：

Caesarean section; Patient-controlled analgesia; Epidural; Intravenous; Low back pain

DOI：

10.7507/1002-0179.20140021

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare postoperative patient-controlled epidural analgesia (PCEA) and intravenous patient-controlled analgesia (PCIA) on maternal low back pain after caesarean section. Methods Sixty cases of American Society of Anesthesiology gradeⅠ-Ⅱ single-birth full-term elective caesarean delivery primiparae chosen between July to September 2012 were divided into 3 groups randomly, 20 in each group. Group A accepted sufentanil 1 μg/mL and ropivacaine 1 mg/mL PCEA; group B had sufentanil 1.5 μg/mL PCEA; group C was given sufentanil 1.5 μg/mL and ondansetron 0.16 mg/mL PCIA. Background dose was 2 mL/h, patient-controlled analgesia dose was 2 mL, and locking time was 20 min. Visual analogue pain score was used to assess the effect of postoperative analgesia, and we recorded analgesia pump usage, adverse reactions, and at the same time investigated the onset of maternal low back pain. Results No obvious postoperative pain was found, and the analgesic effect was good in all the three groups, and the differences were not statistically significant (P>0.05). All three groups of women had a certain proportion of low back pain, and the differences were not statistically significant (P>0.05). After operation, group A had 5 cases of leg numbness, group B had 1, and group C had none. Leg numbness occurred significantly more in group A than in group B and C (P<0.05). Group B had one case of nausea and vomiting, while none occurred in group A and C (P>0.05). Conclusion With the same effect of postoperative analgesia, compared with PCIA, PCEA does not increase postoperative low back pain incidence after caesarean section.

Citation： YUYi-bing, LIHai-bing, LIUZhi-qiang. Influence of Epidural and Intravenous Patient-controlled Analgesia on Low Back Pain after Caesarean Section. West China Medical Journal, 2014, 29(1): 77-79. doi: 10.7507/1002-0179.20140021 Copy

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4.	李兆軍. 硬膜外穿刺后的腰背痛[J]. 臨床麻醉學雜志, 2001, 17(11):642-647.
5.	Usubiaga JE. Neurological complication following epidural anesthesia[J]. Int Anesthesical Clin, 1975, 13(2):45-46.
6.	LaBan MM, Rapp NS, von Oeyen P, et al. The lumbar herniated disk of pregnancy:a report of six cases identified by magnetic resonance imaging[J]. Arch Phys Med Rehabil, 1995, 76(5):476-479.
7.	陳龍. Ⅱ型腰穿針穿刺對剖宮產術后腰背痛的影響[J]. 中國醫藥導報, 2011, 8(18):174-175.
8.	劉廣召, 劉海濤, 孫振海. 不同入路腰部硬膜外穿刺對術后腰痛發生的影響[J]. 中華麻醉學雜志, 2006, 26(7):669-670.
9.	蘇東玲, 傅志海, 吳雅松, 等. 羅哌卡因復合舒芬太尼用于剖宮產術后硬膜外鎮痛的半數有效濃度[J]. 實用臨床醫學, 2012, 13(3):34-36.
10.	Palm S, Gertzen W, Ledowski T, et al. Minimum local analgesic dose of plain ropivacaine vs. ropivacaine combined with sufentanil during epidural analgesia for labour[J]. Anaesthesia, 2001, 56(7):526-529.
11.	賈真, 蘇中宏, 馬欣, 等. 羅比卡因復合舒芬太尼行硬膜外分娩鎮痛的最低有效濃度探討[J]. 臨床麻醉學雜志, 2006, 22(6):183-186.
12.	李海冰, 劉志強, 陳秀斌, 等. 椎管內不同誘導方式下舒芬太尼復合羅哌卡因應用于分娩鎮痛的臨床觀察[J]. 上海交通大學學報·醫學版, 2012, 32(4):499-502.
13.	徐世琴, 沈曉鳳, 趙青松, 等. 硬膜外混合不同濃度舒芬太尼分娩鎮痛時羅哌卡因的半數有效濃度[J]. 臨床麻醉學雜志, 2007, 27(1):14-16.
14.	張偉, 李世忠, 楊拔賢. 羅哌卡因神經束內或周圍給藥對大鼠坐骨神經損傷的影響[J]. 中華麻醉學雜志, 2010, 30(10):1198-1201.
15.	徐世元. 左旋布比卡因和羅哌卡因對周圍神經的毒性作用[J]. 國際麻醉學與復蘇雜志, 2008, 29(12):571-573.
16.	李海冰, 劉志強, 陶怡怡, 等. 患者自控硬膜外分娩鎮痛對母嬰影響的臨床觀察[J]. 中國疼痛醫學雜志, 2012, 18(8):480-482, 488.
17.	Sia AT, Lim Y, Ocampo C. A comparison of a basal infusion with automated mandatory boluses in parturient-controlled epidural analgesia during labor[J]. Anesth Analg, 2007, 104(3):673-678.

1. Miller RD. 米勒麻醉學[M]. 6版. 曾因明, 鄧小明, 譯. 北京:北京大學醫學出版社, 2006:2115-2119.
2. Morgan GE Jr, Mikhail MS, Murray MJ. 摩根臨床麻醉學[M]. 4版. 岳云, 吳新民, 羅愛倫, 譯. 北京:人民衛生出版社, 2007:730-739.
3. Lee BB, Ngan Kee WD, Ng FF, et al. Epidural infusions of ropivacaineand bupivaeaine for labor analgesia:a randomized, double-blind study of obstetric outcome[J]. Anesth Analg, 2004, 98(4):1145-1152.
4. 李兆軍. 硬膜外穿刺后的腰背痛[J]. 臨床麻醉學雜志, 2001, 17(11):642-647.
5. Usubiaga JE. Neurological complication following epidural anesthesia[J]. Int Anesthesical Clin, 1975, 13(2):45-46.
6. LaBan MM, Rapp NS, von Oeyen P, et al. The lumbar herniated disk of pregnancy:a report of six cases identified by magnetic resonance imaging[J]. Arch Phys Med Rehabil, 1995, 76(5):476-479.
7. 陳龍. Ⅱ型腰穿針穿刺對剖宮產術后腰背痛的影響[J]. 中國醫藥導報, 2011, 8(18):174-175.
8. 劉廣召, 劉海濤, 孫振海. 不同入路腰部硬膜外穿刺對術后腰痛發生的影響[J]. 中華麻醉學雜志, 2006, 26(7):669-670.
9. 蘇東玲, 傅志海, 吳雅松, 等. 羅哌卡因復合舒芬太尼用于剖宮產術后硬膜外鎮痛的半數有效濃度[J]. 實用臨床醫學, 2012, 13(3):34-36.
10. Palm S, Gertzen W, Ledowski T, et al. Minimum local analgesic dose of plain ropivacaine vs. ropivacaine combined with sufentanil during epidural analgesia for labour[J]. Anaesthesia, 2001, 56(7):526-529.
11. 賈真, 蘇中宏, 馬欣, 等. 羅比卡因復合舒芬太尼行硬膜外分娩鎮痛的最低有效濃度探討[J]. 臨床麻醉學雜志, 2006, 22(6):183-186.
12. 李海冰, 劉志強, 陳秀斌, 等. 椎管內不同誘導方式下舒芬太尼復合羅哌卡因應用于分娩鎮痛的臨床觀察[J]. 上海交通大學學報·醫學版, 2012, 32(4):499-502.
13. 徐世琴, 沈曉鳳, 趙青松, 等. 硬膜外混合不同濃度舒芬太尼分娩鎮痛時羅哌卡因的半數有效濃度[J]. 臨床麻醉學雜志, 2007, 27(1):14-16.
14. 張偉, 李世忠, 楊拔賢. 羅哌卡因神經束內或周圍給藥對大鼠坐骨神經損傷的影響[J]. 中華麻醉學雜志, 2010, 30(10):1198-1201.
15. 徐世元. 左旋布比卡因和羅哌卡因對周圍神經的毒性作用[J]. 國際麻醉學與復蘇雜志, 2008, 29(12):571-573.
16. 李海冰, 劉志強, 陶怡怡, 等. 患者自控硬膜外分娩鎮痛對母嬰影響的臨床觀察[J]. 中國疼痛醫學雜志, 2012, 18(8):480-482, 488.
17. Sia AT, Lim Y, Ocampo C. A comparison of a basal infusion with automated mandatory boluses in parturient-controlled epidural analgesia during labor[J]. Anesth Analg, 2007, 104(3):673-678.

West China Medical Journal

Influence of Epidural and Intravenous Patient-controlled Analgesia on Low Back Pain after Caesarean Section

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