Parecoxib, Dezocine and Epidural Morphine for Perioperative Multimodal Analgesia in Cesarean Section: A Randomized Study

Abstract

Objective: To observe the effect of multimodal analgesia with single venous injection of parecoxib sodium and single epidural injection of morphine combine with dezocine intravenous infusion on the maternal pain, the adverse effects, the maternal activity and lactation and the stress response after cesarean section. Methods: The 90 cases of pregnant were randomly divided into three groups: Morphine and Dezocine (MD) group, Parecoxib sodium and Dezocine (PD) group, Parecoxib sodium, Morphine, and Dezocine (PMD) group. There were 30 cases in each group. The following three analgesic methods and their combinations were used: single epidural injection of morphine 1.5 mg, single intravenous injection of parecoxib 40 mg and intravenous analgesia with dezocine 0.5 mg/kg.  Postoperative pain, adverse effects, maternal activity and breastfeeding, and serum substance P levels were observed. Results: These were statistically significant in the differences of VAS of incision pain at 8 h and 12 h after surgery (P < 0.05), in which the VAS in PMD group were lower than that in PD group and MD group, and in which the VAS in PD group was higher than that in MD group. These were statistically significant in the differences of VAS of uterine contractile pain at 8h and 12 h after surgery (P < 0.05), in which the VAS in PMD group were lower than that in PD group and MD group, and in which the VAS in PD group was lower than that in MD group. The time of starting to get out of bed after surgery was earlier in the PMD group than in the PD and MD groups (P < 0.05). The number of steps taken by mothers within 2 days after surgery was higher in the PMD group than in the PD and MD groups (P < 0.05). The step count within two days post-surgery was higher in the PMD group than in the PD and MD groups (P < 0.05). The serum substance P levels at the end of surgery and 1 day after surgery were lower in the PMD and PD groups than in the MD group (P < 0.05). The differences in the number of breastfeeding times within two days after surgery were statistically significant among the three groups (P < 0.05), with that in the PMD group（16.27±2.71) having been higher than in the PD group（12.63±1.67）and MD group（11.03±1.81), and that in the MD group being higher than in the PD group. Conclusion: The single intravenous sodium parecoxib combined with single epidural morphine and dezocine intravenous analgesia can better reduce the incision pain and uterine contractile pain after cesarean section, promote maternal postoperative off-bed activity and breast-feeding  times to newborn.