Objective To assess the effect and safety of mono and combination of intravenous flurbiprofen axetil (FP) and epidural tramadol on postoperative pain after cesarean section. Methods Eighty parturients undergoing selected cesarean section with combined epidural spinal anesthesia were randomly allocated into 4 groups (n=20 in each): Group FT treated with intravenous FP 50 mg immediately after the umbilical cord was clamped (T1) and epidural tramadol at the time of suturing peritonaeum (T2);Group FF treated with intravenous FP 50 mg at T1 and T2;Group T treated with epidural tramadol 100 mg at T2, and Group F treated with FP 50 mg at T2. Postoperative pain was assessed by parturients using visual analog scales (VAS) at 2, 4, 8, 12, 24 h after surgery. The cases that patients required rescued analgesia were recorded as well as the times of analgesics administration. The events of nausea and vomiting within 24 hours as well as the time of first breast-feeding were observed. Results All groups were similar in VAS at 2 hours after surgery, but were statistically significant different at 4, 8, 12 and 24 hours. Group FF showed significant lower VAS than the other 3 groups. However, no significant difference of VAS was observed among the other 3 groups. Rescued analgesia was administered once after surgery to 7 cases in Group F, 4 in Group T, and 2 in Group FT. No patient in Group FF required rescued analgesia. There was significant difference in the rate of rescued analgesia post surgery among the 4 groups (P=0.0149). No significance in the incidence of nausea and vomiting was observed in 4 groups. There was no significant difference in the time of first breast-feeding after surgery in the 4 groups (F=0.54,P=0.657). Conclusions Intravenous flurbiprofen axetil administration immediately after the umbilical cord is clamped and at the time of closing peritonaeum in cesarean section could relieve postoperative pain and reduce postoperative rescue analgesic requirement without increasing the incidence of nausea and vomiting.

Objective To assess the safety and effect of intraoperative cell salvage (ICS) during cesarean section.Methods This was a case-control study in which 60 gravidas who received ICS (ICS group) and 60 gravidas who received allogenic transfusion (control group) during caesarean section in Obstetrics and Gynecology Hospital of Fudan University during January 2014 to December 2016 were enrolled.Subjects in the two groups were matched in age,gestational age,gestational complications (placenta increta,placenta previa,scarred uterine,leiomyomas and anemia) and hemorrhagic volume during cesarean section.Several indicators including complications of transfusion,postoperative recovery,expense of transfusion,as well as the complete blood count and body temperature before and after operation were compared between the two groups.T,rank-sum or Chi-square test was used for statistical analysis.Results (1) No significant difference in age,gestational age,twin gestation,complications,preoperative body temperature,or the volume of hemorrhage or transfusion was observed between the two groups (all P＞0.05).(2) The autotransfusion volume was 385 (161-583) ml in the ICS group.Fifteen cases (20.0％) in the ICS group also received additional transfusions of leukocyte-reduced red blood cell (RBC) suspension,fresh frozen plasma and cryoprecipitate and two cases (3.3％) received additional transfusions of leukocyte reduced RBC suspension and fresh frozen plasma.The two groups showed no significant difference in the cost of transfusion or per-capita transfusion volume of fresh frozen plasma or cryoprecipitate.However,the transfusion volume of leukocyte-reduced RBC suspension was lower in the ICS group as compared with that in the control group [M(P25-P75),1.9 (1.5-4.5) vs 4.1 (2.8-6.2) U,Z=-2.800,P=0.005].(3) There was no significant difference in complete blood count or coagulation function between the two groups before the operation.White blood cell (WBC) counts in the two groups were elevated following operation.Postoperative WBC count in the control group was higher than that in the ICS group,while the levels of RBC and hemoglobin were lower than those in the ICS group following operation (all P＜0.05).(4) No amniotic fluid embolism was reported in the two groups.Only one case of rash was reported in the ICS group,which was fewer than the transfusion reactions occurred in the control group [1.7％ (1/60) vs 13.3％ (8/60),x2=5.886,P=0.016].(5) The two groups showed no significant difference in preoperative temperature,the highest temperature within three days after operation or incision healing.Compared with the patients in the control group,those in the ICS group had shorter hospital stay [(4.7± 1.1) vs (6.3 ±1.8) d,t=3.341,P＜0.05].Conclusion ICS is a safe and effective measure for gravidas at higher risk of hemorrhage during cesarean section.

Objective To evaluate the efficacy of different doses of dexmedetomidine for prevention of shivering after combined spinal-epidural anesthesia in the patients undergoing caesarean section.Methods A total of 120 patients,of ASA physical status Ⅱ or Ⅱ,aged 20-40 yr,with body mass index≤ 35 kg/m2,scheduled for elective caesarean section under combined spinal-epidural anesthesia,were randomly divided into 4 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine 0.1,0.3 and 0.5 μg/kg groups (D1,D2 and D3 groups).Combined spinal-epidural anesthesia was performed at L3,4 interspace with isobaric 0.5％ bupivacaine 2 ml.In D1,D2 and D3 groups,dexmedetomidine 0.1,0.3 and 0.5 μg/kg (in 50 ml of normal saline) were infused intravenously,respectively.In group C,normal saline 50 ml was infused at a rate of 5 ml/min.The development of shivering,bradycardia,hypotension,nausea and vomiting was recorded during the period from the end of dexmedetomidine infusion to PACU discharge time.Results Compared with group C,the incidence and degree of shivering and incidence of nausea and vomiting were significantly decreased in D2 and D3 groups,and no significant change was found in the parameters mentioned above in group D1.Compared with group D2,the incidence and degree of shivering and incidence of nausea and vomiting were significantly decreased in D3 group.Conclusion Dexmedetomidine 0.3 and 0.5 μg/kg can prevent shivering after combined spinal-epidural anesthesia in the patients undergoing caesarean section,and 0.5 μg/kg provides better efficacy.