| Objective:In the hip operation of the elderly patients,under the premise of the existing study on the dosage of bupivacaine,the hypobaric bupivacaine with equal dosage and different concentration was selected for the combined spinal and epidural anesthesia,and the general conditions?including SBP,DBP,SpO2,HR?,anesthesia effect?including sensory nerve blockade effect,the effects of nerve block,and unilateral block incidence of the operative side?and adverse reaction conditions?including nausea and vomiting,headache,low blood pressure,etc.?were observed during the perioperative period.to find an optimal concentration of bupivacaine.The best concentration of bupivacaine can not only provide satisfactory anesthesia effect for patients,but also ensure the stability of vital signs and improve the safety of anesthesia.Methods:According to the principle of random,double-blind and prospective,the elderly patients who were to undergo hip surgery in the Affiliated Hospital of Yan'an University from December 2018 to December 2019 were selected and met the requirements of inclusion criteria and exclusion criteria.All patients were randomly divided into three groups: A,B and C.Each group was made up of 0.75% bupivacaine 0.6ml and different volume of sterile water for injection.The concentration of group A was 0.45%,group B was 0.3%,and group C was 0.225%.The SBP,DBP,HR and SpO2 of the three groups were recorded and compared before anesthesia,1min,5min,10 min,15min,30 min,60min and 90 min after anesthesia;The onset time of sensory block and motor block and duration of sensory block and motor block were recorded and compared;The adverse reactions were recorded and compared within 48 hours after anesthesia.Results:1.Comparison of general data: There was no significant difference in age,weight and gender between groups A,B and C?P > 0.05?;2.Comparison of general situation: The systolic blood pressure,diastolic blood pressure and heart rate of group A at 10,15 and 30 minutes after administration were significantly different from those of group B and group C,with statistically significant differences?P<0.05?;Comparison of SPO2 at each time point in the three groups showed no statistically significant difference?P>0.05?;3.Comparison of anesthesia effect: There was no significant difference in the onset time of sensory nerve block among the three groups?P > 0.05?.The duration of sensory nerve block in group C was significantly shorter than that in group A and group B?P < 0.05?.There was significant difference in the onset time and duration of motor nerve block among the three groups?P < 0.05?.The onset time of motor nerve block in group A was faster than that in group B and group C,and the duration of motor nerve block in group A was significantly longer than that in group B and group C.There was no significant difference in 15 minutes unilateral block rate,operation time and anesthesia time among the three groups?P > 0.05?.4.Comparison of other conditions: There was no significant difference in nausea and vomiting,chills,postoperative headache,bradycardia and the number of atropine use among the three groups?P > 0.05?.The number of intraoperative hypotension and dopamine use in group A was higher than that in group B and group C,and the difference was statistically significant?P < 0.05?,Compared with group A and group B,the number of Epidural appending in group C more than in group A and group B,the difference was statistically significant?P < 0.05?.Conclusion:When combined spinal and epidural anesthesia is used in the elderly patients with hip operation,the local anesthesia with 0.3% and 4.5mg hypobaric bupivacaine can produce satisfactory anesthesia effect,stable hemodynamics during operation,high success rate of unilateral block,few adverse reactions,high satisfaction and comfortable of patients.Therefore,it is safe,effective and feasible to use this concentration of bupivacaine for hip surgery in elderly patients. |
PDF Full Text Request