小剂量罗哌卡因复合芬太尼脊髓麻醉在老年患者手术中的应用

Evaluation of three doses of intrathecal Ropivacaine with Fentanyl in geriatric patients undergoing lower limb surgery

目的比较三种不同剂量罗哌卡因复合芬太尼在老年患者中脊髓麻醉临床效果,探求合理的用药剂量。方法90例ASAⅠ～Ⅱ级、年龄60～80岁、拟行下肢手术患者随机分为三组:Ⅰ组(0.5%重比重罗哌卡因4mg+20μg芬太尼);Ⅱ组(0.5%重比重罗哌卡因5mg+20μg芬太尼)和Ⅲ组(0.5%重比重罗哌卡因6mg+20μg芬太尼)。L3～4穿刺成功后各组分别加入实验药物。记录感觉阻滞时间、感觉消退时间、运动阻滞程度和镇痛评分。结果随着罗哌卡因剂量从4mg增至6mg,感觉平面上升至最高。4～5mg时感觉阻滞平面明显增加(P<0.05),但从5mg增至6mg则感觉平面阻滞无变化(P>0.05)。达最大感觉阻滞平面时间Ⅱ组和Ⅲ组差异无统计学意义(P>0.05)。同其他两组比较Ⅲ组患者感觉消退至S2时间最长(P>0.05)。Ⅱ组和Ⅲ组镇痛效果明显好于Ⅰ组(P<0.05)。Ⅲ组术中低血压发生率高于Ⅰ、Ⅱ组。结论在老年患者手术中用5mg布比卡因+20μg芬太尼脊髓麻醉可提供可靠和满意的感觉和运动阻滞。6mg布比卡因也可提供满意的麻醉效果,但可引起明显的低血压。

Objective To evaluate and compare the efficacy of three different intrathecal dosages of 0. 5% hyperbaric ropivaeaine added with 20 μg fentanyl in geriatric patients. Methods Ninety patients of eltiler sex, aged more than 60 years and scheduled to undergo lower limb surgery under spinal anaesthesia were allocated to three groups ： Group Ⅰ （ n = 30）, received 4 rng of 0. 5 % hyperbaric ropivacaine ＋ 20 μg fentanyl; Group Ⅱ （n =30） , received 5 mg of 0. 5% hyperbaric ropivaeaine ＋ 20 μg fentanyl and Group Ⅲ （n =30）, received 6 mg of 0. 5% hyperbaric ropivaeaine ＋ 20 μg fentanyl. Level of sensory block, time to two-segment regression and regression to S2 dermatome, degree of motor block and degree of analgesia was observed. Incidence of pruritis, nausea, vomiting and respiratory distress was recorded. Results There was a significant increase in median sensory level when dose of intrathecal ropivacaine was increased from 4 mg to 5 mg （P 〈 0. 05 ）. Time to two-segment regression and regression to S2 dermatome was maximum in group Ⅲ when compared to the other two groups （P 〈 0. 05）. The duration of motor block in all the three groups was comparable （P 〉 0. 05）. Intraoperative analgesia, graded by patients, was significantly better in groups Ⅱ and Ⅲ as compared to group Ⅰ （P 〈 0. 05）. Four patients in group Ⅱ and ten patients in group Ⅲ had clinically evident hypotension, while six each in group Ⅱ ＆Ⅲ had mild pruritis which was selflimiting. Conclusions 5 mg intrathecal ropivacaine with 20 μg fentanyl provides reliable and satisfactory sensory and motor blockade for hip surgery in elderly patients. The 6 mg dose of ropivacaine is associated with significant hypotension.