Objective  To explore the clinical effect of deopioid anesthesia and analgesia based on the concept of enhanced recovery after surgery in the perioperative period of emergency cesarean section after combined spinal-epidural anesthesia.

Method  A total of 300 patients who underwent emergency cesarean section were selected as subjects for a randomized, controlled trial. Patients were divided into a opioid-free group (OF group), a sufentanil group (S group) and a morphine group (M group) with 100 patients in each group. Enhanced recovery after surgery strategies were used in all three groups before cesarean section. Opioid-free anesthesia analgesia was used in the OF group during operation, and intravenous patient-controlled analgesia with flurbiprofen axetil and dexmedetomidine was administered after the operation. S group was given sufentanil for intraoperative analgesia, and patient-controlled analgesia with sufentanil and dexmedetomidine after operation. M group was given sufentanil for intraoperative analgesia and patient-controlled epidural analgesia with morphine and ropivacaine after operation. Patients in the OF and S group received ultrasonography-guided quadratus lumborum block after cesarean section. The time from cesarean section treatment to discharge, time to get out of bed for the first time after cesarean section, ObsQoR-11 score 24 h after cesarean section, dynamic visual simulation score 48 h after cesarean section, perioperative complications and other information were recorded in the three groups.

Results  Compared with M group, the time from cesarean section treatment to discharge was significantly shorter, the time to get out of bed was earlier, ObsQoR-11 score was higher, and the incidence of itching was lower in group OF and S (P<0.05). Compared with M group and S group, the incidence of perioperative nausea, vomiting and abdominal distension was lower in OF group (P<0.05). There were no significant differences in visual simulation score, perioperative shivering, dizziness, headache and urinary retention among the three groups (P>0.05).

Conclusion  Opioid-free anesthesia and analgesia is effective in emergency cesarean section after combined spinal-epidural anesthesia, which can shorten the hospital stay after cesarean section and reduce the perioperative complications.

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