Comparison Of The Effects Of Intrathecal Different-dose Ropivacaine And Fentanyl For Eldly Patients During TUR-P Surgery

Objective: To investigate sensory and motor block and the hemodynamic effects of 25μg fentanyl added to ropivacaine in subarachnoid block in the elderly patients for TURP, detect the perfect dose of ropivacaine in subarachnoid block for TURP, assess its value of clinical applications.Methods:By its different anaethesia,40 patients with ASA physical ststus I and II scheduled to undergo TURP-surgery were randomized into the following four groups 10 in each: either one CEA group or three CSEA groups. Patients were placed in the left lateral position and inserted into the epidural space at the L3-L4 interspace by a loss-of-resistance technique. In both group, a epidural catheter was inserted 3 cm into the epidural space. In CSEA groups, patients were randomly allocated to receive spinally mixture after combined spinal-epidural anesthesia puncture was applied Group E(n=10), 0.375%Ropivoaine+l%Lidocaine; GroupS1(n= 10), ropivacine 7.5mg; GroupS2(n=10), ropivacine 7.5mg+ fentanyl 25μg; Group S3(n=10),5mg+ fentanyl 25μg. All spinally mixture were combinded with 0.75%ropivacaine lml or 1%ropivacain 0.5ml and fentanyl(50ug/ml)0.5ml.The final volume of intrathecal injectate was adjusted to 2.5ml with 10% glucose liquor. Patient's breathing frequency, pulse-oxygen saturation and haemodynamic parameters(blood pressure, heart rate, systemic vascular resistance, cardiac output, cardiac index accelerated etc.) were monitored by BS-PM-9000 and Bioz.com during anaethesia. After venous channel established, all the patients were transfused liquid(crystal:colloid=2:1). Record the parameters:basic before anaethesia, after anaethesia 20 min, the lowest, collecting monitoring parameters to prepare for analysis statistically.The highest level of sensory block,the time which patients get it and the duration of sensory block and its fadeaway were all observed and noted. The plane of motor blockade was scored with modified Bromage motor scale.Results:There was not a statistically significant deferences in haemodynamic parameters before and after anaethesia in all four groups.The duration which patients in group E and group S3 get the highest level of sensory block is significantly longer than the other two groups(*P<0.05), and group E's time is the longest in all groups, While the highest level of sensory block in group S3 is the lowest (ΔP<0.05). The time of sensory block in group S2 is significantly longer than the other two CSEA groups (#P<0.05). There were statistically significant differences between groups in the motor block.Group S1,S2 resulted in the highest Bromage sorces at 30 min after analgesia were performed,respectly as 7.2±1.9,7.8±0.3, which are significantly higher than that in Group S3 (#P<0.05).The duration of motor block in Group S3 and E Group are the shortest, in which patients had no motor block and Bromage sorces is 0 at the end of operation.There were different degree of motor block after the injection,yet none of the patients needed supplementation of analgesia during the operation.The degree of motor block was more intense in Group S1,GroupS2 compared with Group E,Group S3.Conclusion:Intrathecal different-dose ropivacaine and small-dose fentanyl is safe for eldly patients during TUR-Surgery。...