The Effect Of Different Puncture Spots Combined Spinal-Epidral Anesthesia To Blockage Plane And Hemodynamics

Objective: To research the safety and the suitable puncture position of various surgerys combined spinal-epidral anesthesia (CSEA) by compared with the influence of blockage plane and hemodynamics when to choose the L2～3 and L3～4 puncture spots and isobaric bupivacaine of the different doses on the lower limb surgerys.Methods: Eighty patients scheduled for the lower limb surgerys to apply combined spinal-epidral anesthesia (CSEA) are randomly selected who is 18~64 years and ASA physical stadusⅠ～Ⅱ, and divided into four groups:the L2～3 interspace and 7.5mg of isobaric bupivacaine( groupⅠ) ,the L2～3 interspace and 10mg of isobaric bupivacaine(groupⅡ),the L3～4 interspace and 7.5mg of isobaric bupivacaine(groupⅢ) and the L3～4 interspace and 10mg of isobaric bupivacaine(groupⅣ). Each group involves 20 patients. The speed of infusion anesthesic to cavitas subarachnoidealis in all patients was 0.2ml/s. The time of sensory block occur , the time of sensory block reaching to the maxlmum plane and the maxlmum plane of sensory block are Observed and recorded, the numbers of motor block reaching to maxlmum and evaluating motor block by modified bromage scale, the change of blood pressure and heart rate of 5min, 10min, 15min, 20min, 30min, 40min and 60min is observed after intrathecal local anesthetic administration, the foundation values of SBP,DBP,HR after patients entering room, the values and the occurring time of the lowest BP and HR during surgering, the incidence and numbers of hypotension, bradycardia, respiratory depression, shivering, nausea and vomit, postdural puncture headache(PDPH), et al, they are recoded.Results: It doesn't exist significant differences among four groups of the time of sensory block occurred and sensory block reaching to maxlmum plane (P>0.05). There is significant differences between groupⅠand groupⅡ, groupⅢand groupⅣof the maxlmum plane of sensory block(P<0.05). That is groupⅡ>groupⅠand groupⅣ>groupⅢ. There is significant differences between groupⅠand groupⅢ, groupⅡand groupⅣof the maxlmum plane of sensory block(P<0.05). That is groupⅠ>groupⅢand groupⅡ>groupⅣ. Bromage scale of four groups concentrated on 2～3 levels. No among groupⅠand groupⅢ, groupⅡand groupⅣin 2 and 3 level of motor block. SBP, DBP, HR of all patients decreased with different degrees In 60 minutes after SA, but no significant differences betweet Minimum value and foundation value among groupⅠand groupⅢ. So do groupⅡand groupⅣ. The incidence of hypotension groupⅡafter SA is high than groupⅠ, groupⅢand groupⅣ. That is 5%,10%,5% and 5% by turns among four groups. No significant differences among four groups of shivering were observed (P>0.05). All patients have no obvious respiratory depression, nausea , and vomit and postdural puncture headache(PDPH).Conclusion: CSEA at different puncture spots with Isobaric bupivacaine usually has good performance to the lower limb surgerys because of good stability of hemodynamics,the minor incidence rate of untoward effect. The effect of different clearances for puncturing at L2～3 and L3～4 is not the same, choosing L2～3 always obtains at least 2 segment spinals higher planum than L3～4.