The Effects And Safty Of Combide Spinal-epidural Anesthesia With Ropivacaine For Holmium Laser Lithotripsy Under Nephroscope

Objective:To explore the efficacy and hemodynamic changes of combidespinal-epidural anesthesia with ropivacaine for Holmium laser lithotripsy undernephroscope.Methods: Seventy-two patients(ASA Ⅰ～Ⅱ)schedualed for electiveHolmium laser lithotripsy under nephroscope were divided into groupRopivacaine(Group R)or group Bupivacaine(Group B)at random,epiduralanesthesia was performed at T11～12and placed catheter then spinal anesthesia was performed at L2～3by injecting0.75%isobaric ropivacaine2ml（15mg）inGroup R or0.5%isobaric bupivacaine2ml （10mg） in Group B into thesubarachnoid selecting3:2as the equivalent dose ratio after entering theoperating room under life supervision，then tested and recorded sensory blocklevel,scored motor block,observed hemodynamic changes and adverse reactions.As needed, additional local anesthetic was injected into the epidural space.Results: Onset time of sensory block in Group R was （53.10±10.22）s,no significant difference from Group B (p>0.05). The time of sensory block toT10in Group R was（188.23±91.59）s，significantly longer than Group B (p <0.05).The time of highest level of sensory block in Group R was (16.17±2.77)min, no significant difference from Group B (p>0.05). The sensory blockadelevel at5min or10min,or the highest level of Group R was T8(T6～11), T6(T4～9)or T5(T3～7) respectively, no significant difference from Group B (p>0.05). Theonset time of limb movement block in Group R was (168.71±47.34) s,significantly slower than Group B (p <0.05), motion block scores at5min or10min was1.39±0.50or2.10±0.72respectively, significantly less than Group B(p <0.05). There was no significant difference of operating time in Group R andGroup B,which was (99.18+38.12) min and (94.50+38.96) min respectively,(p>0.05). Anesthetic effect was satisfy,13cases (36.1%) in Group R or10(27.8%) cases in Group B received additional0.75%ropivacaine or0.5%bupivacaine by epidural respectively due to the operation time more than90min.SBP of two groups at10min or15min after anesthesia was decreased, thedifference was statistically significant compared with anesthesia before(p <0.05), but the decline rate <15%,no significant difference between two groups(p>0.05),2cases (5.6%) or3cases (8.3%) occurred hypotension in Group R orGroup B respectively, there was no significant difference (p>0.05); SBP was significantly reduced after prone position in two groups(p <0.01),6cases(16.7%) in Group R and7cases (19.4%) in Group B occurred hypotension,there was no significant difference (p>0.05), blood pressure recovered afterintravenous injection of ephedrine5~10mg, severe hypotension was notoccurred,4cases (11.1%) in Group R and5cases (13.9%) in Group B appearedbradycardia,7cases (19.4%) in Group R and9cases (25.0%) in Group Bappeared tachycardia, there was no significant difference (p>0.05).Conclusion: Combide spinal-epidural anesthesia with0.75%isobaricRopivacaine for Holmium laser lithotripsy under nephroscope is safe andfeasible.