Application Of Ropivacaine Compound Fentanyl In Elderly Patients With Transurethral Resection Of Prostate

Objective:To observe the anesthetic effect of ropivacain compound small dose fentanyl used for combined spinal-epidural anesthesia (CSEA) in elderly patients with transurethral resection of prostate (TURP).Method:90cases (ASA â…¡-â…¢),70-90years old. undergoing elective transurethral resection of prostate. The random and double-blind method was used, patients were divided into three groups (n=30):group RF received0.75%ropivacaine hydrochloride1.0ml+fentanyl0.2ml (10ug)+cerebrospinal fluid1.8ml; group R received0.75%ropivacaine hydrochloride2.0ml+cerebrospinal fluid1.0ml; group B received0.5%bupivacaine hydrochloride2.0ml+cerebrospinal fluid1.0ml,(subarachnoid total capacity of each group was3.0ml). Combined spinal-epidural anesthesia kit which produced by Tuoren Medical Device Co. LTD. was applied at L2-L3interspace. It was confirmed that the epidural needle reached the epidural space, penpoint lumbar spinal needle (Size25G) was inserted slowly. Subarachnoid puncture was not successful until transparency cerebrospinal fluid flowed among the needle, and3ml of drug was injected into subarachnoid space at the rate of0.15ml a second, then place the epidural catheter in the direction of the head. When anesthetic effect was not satisfied during operation,0.375%ropivacaine hydrochloride mixed with1%lidocaine hydrochloride (1:1) were given through epidural catheter to maintain anesthesia.10min before and5min,10min,20min and30min after the injection of drugs into subarachnoid cavity (T0, T1, T2, T3and T4, respectively), the folloring datas were collected:the degree of sensory and motor block and adverse reactions, and hemodynamic changes include:blood oxygen saturation (SpO2), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR).Result:The onset time of sensory block in group RF was shorter than group R and group B (P<0.05), the onset time of motor block in group RF was shorter than group R and group B (P<0.05); the time of duration of sensory block in group B was longer than group RF and group R (P<0.05). Hemodynamic changes:5min after anesthesia:SBP decreased in each group, decline degree of SBP was maximum in group B and minimum in group RF, the differences among three groups were significantly different (P<0.05):10min after anesthesia:SBP stopped falling in group RF, but continued to decrease in group R and group B, decline degree of SBP in group B was more than group R (P<0.05). In group B, there were5cases used the vasopressor agent and SBP at10min after anesthesia was lowest than other time points (P<0.05). DBP had no significantly changed in three groups at each time point (P>0.05);5min after anesthesia. HR had different increased (group B>group R> group RF) and there was significantly different among three groups (P<0.05). There was1case used atropine in group B.10min after anesthesia, HR continued to increased in group B, but stopped decreasing in group R and group RF, there was significantly different among three groups (P<0.05). In group B, HR at10min after anesthesia was lowest than other time points (P<0.05).Conclusion:Ropivacaine compound small dose fentanyl used for CSEA in elderly patients with TURP is a secure and effective anaesthesia method, because of its sensory nerve block completely, quicker recovery of motor function, intraoperative hemodynamic stability, and less intraoperative and postoperative adverse reactions.