Effects of postoperative epidural analgesia on prolactin level and neonatal neurobehavioral scores after caesarean section

Abstract

Objective To investigate the effect of postoperative epidural analgesia on prolactin level and neonatal neurological and adaptive capacity scores(NACS) after caesarean section.Methods Sixty healthy primipara after caesarean section under combined spinal epidural anesthesia were randomly divided into three groups(n=20).Received epidural analgesia with complex of butorphanol (0.006％) and 1evobupivacaine(0.15％) in group B,those with morphine(0.004％) and levobupivacaine(0.15％) in group M.Group C was given conventional postoperative analgesia with meperidine injection.The visual analog scales (VAS) and the adverse effects were observed at 4,8,12,24 and 48 h after operation.Detect the prolactin (PRL) level in serum before operation,after operation 24 h and 48 h separately by electrochemiluminescence immunoassay.Keep note of the first lactation time.NACS was recorded at 24,48 and 72 h.Results The VAS was significantly lower in group B [4 h:( 1.1±0.7),8 h:(1.2±1.2),12 h:( 1.7±1.1),24 h:(1.4±1.5),48 h:(1.0±0.9)] and group M [4 h:(1.1±0.9),8 h:(1.3±1.9),12 h:(1.6±1.2),24h:(1.3±1.3),48 h:(1.0±0.7)] than that in group C [4 h:(2.2±1.3),8 h:(4.3±1.7),12 h:(4.7±1.5),24 h:(3.6±1.3),48 h:(2.4±1.1)] at all time points (P＜0.05).The adverse effects of pruritus,nausea and vomiting were significantly more in group M (25％,30％,respectively)than that in group B (5％,0％,respectively)(P＜0.05).The first lactation time of the group B (26±8) h and M (26±9) h were distinctively earlier than that of the group C (35±10) h (P＜0.05).The PRL concentration in serum of the group B [(357±62),(387±63) μg/L,respectively] and group M [(367±64),(392±61) μg/L,respectively] at 24,48 h after operation were higher than that of the group C [(299±93),(327±74) μg/L,respectively](P＜0.05).There was no significant difference NACS among the 3 groups.Conclusions Combined with butorphanol levobupivacaine,epidural analgesia in parturient after cesarean section can provide effective analgesia,with less pruritus,nausea and vomiting,and promoting lactation without untoward reaction on NACS. Key words: Butorphanol ; Caesarean section; Epidural analgesia; Prolactin; Neonatal