The Clinical Observation Of Epidural Sufentanil For The Supplementation Of Epidural Block

Objective:To observe the effect of epidural Sufentanil for the supplementation of epidural anesthesia for the biliary tract surgery, compared with Sufentanil administered intravenously.Methods:90 patients,ASAⅠ-Ⅱ,undergoing biliary tact surgery,were divided into C group(n=30),I group(n=30)and E group(n=30).we selected T8-9 interspace as the puncture site of epidural anesthesia and used 1%lidocaine comibined with 0.25%tetracaine,adjusting the anesthesia level to T4-T12.Then,the patients in E group was injected 30 ug Sufentanil into epidural space;the patients in I group was infused Sufentanil 15ug/hr intravenously and injected 3ml normal saline into epidural space;the patients in C group was only injected 3ml normal saline into epidural space. Record the MAP,HR at the time ofpreanesthesia,postanesthesia,entering abdominal cavity and 10min,20min,30min,60min after that;Evaluate the degree of sedation,muscle-relaxing and visceral traction reaction during the operation;Observe SPO2 and the incidence of side-effects;Blood sample was taken for serum cortisol level before anesthesia and at the end of the operation.Results:1,There was no difference in the distribution of age,weight and height, the duration of operation,the initial and total dose of local anesthetics,and the total volume of fluid infused among the three groups(P＞0.05);There was no difference in the total dose of sufentanil between the E group and I group.2,The MAP of the three groups decreased significantly after the epidural anesthesia,compared with the preanesthesia period(P＜0.05);The lowest MAP in C group and I group happened separatively at the time of 20min or 10min after entering abdomen cavity(EAC),which was different significantly to the the preoperative period(P＜0.05);At the time of 20min after EAC,the C group's MAP was lower significantly than the other two groups'(P＜0.05).At the time of 10min and 20min after EAC,the HR of C group and I group was decreased significantly,compared with the preoperative period(P＜0.05),which is lower significantly than the E group (P＜0.05).3,As to the degree of visceral traction reaction,the C group's was stronger significantly than the other two group's(P＜0.01);and I group's was stronger significantly than E group's(P＜0.05).The effect of abdominal muscle relaxation of E group was better than the other two group's(P＜0.05). The Ramsay Sedation Scale of I group and E group was higher significantly than C group(P＜0.01).4,There was significant difference in the serum cortisol level among the three groups at the end of operation(P＜0.05),and the E group's was the lowest.5,The incidence of pruritus of E group was higher significantly than I group and C group(P＜0.01).The incidence of nausea and vomitting of E group was lower significantly than C group(P＜0.05).Conclusions:Our findings suggest that:1,Epidural sufentanil 3oug is an effective and safe adjuvant method for the thoracic epidural block,which is superior to the intravenous adjuvant method.2,There is much difference in the action mechanism between the epidural and intravenous sufentanil,and the intravertebal mechanism of epidural liposoluble opioids is proved existing by this clinical study.