The Analgesic Effect of Different Concentrations of Epidural Ropivacaine Alone or Combined With Sufentanil in Patients After Cesarean Section

Abstract

Background: Patients experience moderate-high intensity postoperative pain after cesarean section (CS). The aim of this study was to investigate the optimal concentrations of ropivacaine and sufentanil for use in controlling pain after CS.Methods: One hundred and seventy-four women undergoing elective CS were randomly allocated to four groups. Epidural analgesia was administered with 0.1% ropivacaine in the R1 group, 0.15% ropivacaine in the R2 group, a combination of 0.1% ropivacaine and 0.5 μg/ml of sufentanil in the R1S group, and a combination of 0.15% ropivacaine and 0.5 μg/ml of sufentanil in the R2S group (at a basal rate of 4 ml/h, bolus dose of 4 ml/20 min as needed). Pain scores (numerical rating scale [NRS]: 0–10 cm) at rest (NRS-R), during movement (NRS-M), and when massaging the uterus (NRS-U) were documented at 6 and 24 h. We also recorded patient satisfaction scores, time to first flatus, motor deficits, and adverse drug reactions.Results: NRS (NRS-R, NRS-M, NRS-U) scores in the R2S group (2 [1–3], 4 [3–5], 6 [5–6], respectively) were lower than in the R1 group (3 [3–4], 5 [4–6], 7 [6–8], respectively) (p < 0.001, p < 0.05, p < 0.01, respectively) at 6 h; and patient satisfaction (9 [8–10]) was improved compared to the R1 group (8 [6–8]) (p < 0.01). The time to first flatus (18.7 ± 11.8 h) was reduced relative to the R1 group (25.9 ± 12.0 h) (p < 0.05). The time to first ambulation was not delayed (p > 0.05). However, the incidence of pruritus (4 [9.3%]) was increased compared to the R2 group (0 [0]) (p < 0.05) at 6 h, and the incidence of numbness (23 [53.5%], 23 [53.5%]) was increased compared to the R1 group (10 [23.3%], 10 [23.3%]) (all p < 0.01) at both 6 and 24 h.Conclusions: Although we observed a higher incidence of pruritus and numbness, co-administration of 0.15% ropivacaine and 0.5 μg/ml of sufentanil administered epidurally optimized pain relief after CS, with treated subjects exhibiting lower NRS scores, shorter time to first flatus, and higher patient-satisfaction scores.

Adjuvant Sufentanil Decreased the EC50 of Epidural Ropivacaine for Labor Analgesia in Healthy Term Pregnancy

“…Epidural co-administration of 0.15% ropivacaine and 0.5 µg/mL sufentanil for pain control after cesarean section exhibited lower numerical rating scale (NRS) scores and higher patient-satisfaction scores. 21 In this study, the sufentanil and ropivacaine combination resulted in a higher degree of parturient self-motor control and pain relief, but not absolute satisfaction. Notably, the Apgar scores at 5 and 10 mins were 10 for almost all neonates.…”

Perioperative Management of Sectio Caesarea Surgery in Patient With Heart Valve Disorders

“…Care should be taken to monitor fluid administration to prevent fluid overload (17) . In this case, we administered post-caesarean analgesia in the form of Levobupivacaine to reduce post-cesarean pain, which can cause impaired milk production in patients and reduced quality of neonatal care (18) .…”

Efficacy and safety of different doses of epidural morphine coadministered with low-concentration ropivacaine after cesarean section: A retrospective cohort study

“…Unfortunately, epidural opioid (e.g., morphine) analgesia could be associated with complications, including postoperative nausea and vomiting (PONV), pruritus, respiratory depression, etc., which hinder early recovery after CS ( Guasch et al, 2020 ). Multiple studies have demonstrated that analgesia is more effective and some annoying side effects are minimized when opioids are administered in combination with local anesthetics ( Yang et al, 2019 ; Miao et al, 2021 ; Otao et al, 2021 ). Notably, this multimodal approach has been shown to provide superior analgesia to that of intramuscular or intravenous administration of opioids without significant side effects ( Stocki et al, 2014 ; Yang et al, 2019 ).…”