A Study On The Optimal Dose Of Hypobaric Bupivacaine Combined Spinal Epidural Anesthesia For Hip Surgery In Senile Patients

Objective: To apply different doses of hypobaric bupivacaine,combined spinal epidural anesthesia for hip surgery in senile patients,the changes of hemodynamic changes during the operation,Sensory and motor block,and adverse reactions were observed and compared,which was explored the best dose of hypobaric bupivacaine.To provide a safer and more effective for the anesthesia of the senile patients with hip surgery.Methods: Select 60 cases of senile patients undergoing hip surgery,Affiliated Hospital of Yan'an University from December 2016 to December 2017,aged >=80years,weight 40-75 kg,ASAI-III.This study use the principle of prospective,random and double blindness,divided into three groups of A,B and C by the randomization digital table method,20 cases in each group.Each group of lumbar anesthesia liquid was 0.25% bupivacaine 3ml by used 0.75% bupivacaine 1ml+ Sterile Water for Injection 2ml.Group A: 0.25% hypobaric bupivacaine 1.4ml(bupivacaine 3.5mg);Group B: 0.25% hypobaric bupivacaine1.8ml(bupivacaine 4.5mg);Group C:0.25% hypobaric bupivacaine2.2ml(bupivacaine 5.5mg).To record the values of the systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and blood oxygen saturation(Sp O2)in three groups of A,B and C.To record the effect of anesthesia: the onset time of sensory block?the duration of sensory block?the onset time of motor block?the duration of motor block?the unilateral block incidence of the operative side at 15 minutes.To record nausea and vomiting,shiver,postoperative headache and other adverse reactions within 48 hours after administration;and the occurred frequency of hypotension,bradycardia,and the additional extradural in the operation.Results: 1.General information: There is no significant difference in sex,age,weight,operation time and anesthesia time between the three groups of A,B and C(P>0.05).2.In group C,SBP,DBP,HR,compared with A and B group,the changes of 10 min and 15 min were obvious after administration,and the difference was statistically significant(P<0.05).There was no significant difference in Sp O2 between the three groups of A,B and C at different time points(P>0.05).3.There was no significant difference in the onset time of sensory block and motor block between the three groups of A,B and C(P>0.05).The duration of sensory and motor block in group C was more than that of group A and B,and the difference was statistically significant(P<0.05).4.There was no significant difference the unilateral block incidence of the operative side at 15 minutes in the three groups(P>0.05).5.The nausea and vomiting,shiver,postoperative headache and so on in the three groups,the difference was not statistically significant(P>0.05).;A group of the additional extradural in the operation were compared with B and C group,the difference was statistically significant(P<0.05);the frequency of hypotension and used dopamine in group C higher than A and B,the difference was statistically significant(P<0.05).Conclusion: 0.25% hypobaric bupivacaine1.8ml(bupivacaine 4.5mg),used in hip sugery for senile patients with subarachnoid anesthesia produces a satisfactory anesthetic effect,favors the intraoperative hemodynamic stability,forms unilateral subarachnoid block,reduces the incidence of complications,improves patient'satisfaction.Therefore,this dose of hypobaric bupivacaine spinal anesthesia for hip surgery in senile patients is safe and effective.