Clinical Investigation Of Postoperative Elderly Patient Controlled Epidural Analgesia With Ropivacaine Combined With Opioid

Objective: To investigate the efficacy of postoperative elderly patient-controlled epiduralanalgesia with low concentrations of ropivacaine combined with opioid so as to seek forthe most advantageous analgesic method for clinical application.Methods: The subjects were ninety ASA I-II patients at the age of60to80undergoingelective abdominal surgery during the period from September2010to October2011inYan’an University Affiliated Hospital. The patients were randomly divided into threegroups: group F (n=30) received continuous infusion with0.2%ropivacaine plus0.4mgfentanyl and1mg droperidol, load:0.1mg fentanyl plus1mg droperidol; group M (n=30) received continuous infusion with0.2%ropivacaine plus4mg morphine and1mgdroperidol, load:1mg morphine plus1mg droperidol; group S (n=30) receivedcontinuous infusion with0.2%ropivacaine plus40μg sufentanil and1mg droperidol,load:10μg sufentanil plus1mg droperidol. In each group, the bolus dose of continuousinfusion was100ml and that of load was5ml. After the establishment of intravenousaccess as soon as they came into the operating room, patients were given500ml balancedsalt. All patients taking lateral position on the left, received general anesthesia combinedwith epidural anesthesia on the waist8-9gap waist. Having been draped after theroutine disinfection, patients firstly received local infiltration anesthesia with2%bullishCain and then were probed with the18G epidural puncture needles. When the doctorshad a sense of lost, they gave patients the negative pressure test until succeeding. Thenthe tube was inserted3cm deep on the head orientation of the needle. Then the patients,taking the supine position were given2%lidocaine (the experimental dose was3ml). Make sure there are no strayed into the blood vessels and the subarachnoid space. Thengive an8ml1:1solution (2%lidocaine plus0.75%levobupivacaine). After15minutes, ifthe level had met the surgical requirements, patients received general anesthesia. Theinduction of general anesthesia included2mg midazolam,40mg propofol,0.2mg fentanyl,4mg vecuronium.1minute later, tube was inserted. After intubation, the surgery beganwith propofol infusion and sevoflurane to maintain the depth of anesthesia. Intraoperativeinfusion of1:1solution continued. In the last30minutes of the surgery, the loading dosewas given, followed by analgesia pump. Then all patients were sent to the recovery room.The extubation happened after patients were fully awake. After hemodynamic and respiratorystability, patients were sent back to the ward. During10minutes before the injection and5min after injection, BP, HR, RR and sPO2were monitored and recorded. At4th,6th,8th,12th,24th hours after surgery, BP, HR, RR and sPO2were monitored. Intraoperativebleeding volume was recorded after the surgery. At4th,6th,8th,12th,24th hours aftersurgery, VAS scores, sedation scores, the number of PCA press were recorded. Suchadverse reactions as nausea, vomiting, itching were monitored.Results:1. No significant difference in age, gender, weight, ASA grading, intraoperative bleedingloss, operation time during the surgery among three groups.2. A visual analog scale was adopted to test the extent of pain (VAS score). At the4th,6th,8th,12th,24th hours, compared with group F, group S and group M performedbetter in analgesic effect (P <0.05). There was no significant difference in the analgesiceffect between group S and group M (P>0.05).3. Concerning the number of PCA press of patients in three groups, group S and groupM was significantly less than group F (P <0.05). There was no significant differencebetween group S and group M (P>0.05).4. Ramsay sedation score (RSS) in group S, group M, group F, were all satisfyingwithout significant difference (P>0.05).5. Such postoperative adverse reactions as nausea, vomiting, pruritus in group S and group F was significantly weaker than the group M (P <0.05) which was ofstatistically significant.Conclusion: The method of0.2%ropivacaine combined with sufentanil, with lowincidence of such adverse events as nausea, vomiting, itching, is suitable forpostoperative elderly patient-controlled epidural analgesia. Its analgesic effect issatisfying.