Observation about clinical effects of PCSA on postoperative analgesia after second cesarean section

Objective: To compare the therapeutic effects between patient-controlled subcutaneous analgesia (PCSA) and patient-controlled epidural analgesia (PCEA). Methods: One hundred parturient women who underwent the second cesarean section in our hospital from June 2016 to February 2017 were accepted in this study. And they were equally divided into PCSA group and PCEA group by the random number table method. The postoperative follow-up indexes included the visual analogue scale (VAS) scores of the wound pain and uterine contraction pain at 4 h, 6 h, 24 h and 48 h after operation, the opioid dose within 6 h, 12 h, 24 h and 48 h after operation, the incidence of postoperative complications, the evaluation score of patients' satisfaction degree, the time of lactation and anal exhaust, the frequency of breastfeeding, the amount of vaginal bleeding and the off-bed activity time. Results: There was a statistically significant difference in the VAS scores between PCSA group (P = 0.000) and PCEA group (P = 0.003) at postoperative 4 h, 6 h, 24 h and 48 h. The VAS score at postoperative 6 h, 24 h and 48 h in PCSA group was lower than that in PCEA group (all P < 0.001). The dosage of ropivacaine at postoperative 4 h, 6 h, 24 h and 48 h in PCSA group was obviously lower than that in PCEA group (all P < 0.001). The incidence of nausea (P = 0.027) and pruritus (P = 0.014) in PCSA group was lower than that in PCEA group. And the patients' satisfaction degree of PCSA group was observably higher than that of PCEA group (P = 0.004). Compared with the PCEA group, the time of lactation (P = 0.021), anal exhaust (P = 0.045) and off-bed activity (P = 0.036) in PCSA group was advanced, the frequency of breastfeeding (P = 0.007) in 24 h was increased while the amount of vaginal bleeding (P = 0.001) was decreased. Conclusion: Compared with the PCEA, the PCSA can offer great therapeutic effects on wound pain and uterine contraction pain after the second cesarean section, reduce the incidence of postoperative adverse reactions and shorten the recovery time.