Study On The Small Dose Of Levobupivacaine With Fentanyl In Spinal Anesthesia In The Small Gynecological Operation And The Correlation Between PDPH

Objectives Comparative analysis of efficacy levobupivacaine combined with fentanyland lidocaine combined with fentanyl two drugs in gynecological operation in anesthesia.For patients with spinal anesthesia, compare different occipital altitude on the catheterpuncture of postoperative headache and incidence of head and neck sore waist, afterpatient comfort and satisfaction, and find out to cause the pain after the catheter puncturerisk factors.Methods From2012August to2013November in our department were outpatients ofgynecological small operation, in accordance with the operation were divided into groupⅠ(Lidocaine10mg+fentanyl15ug+water for injection of mixed liquid3ml) and groupⅡ(Levobupivacaine3mg+fentanyl15ug+water for injection of mixed liquid3ml).Observation of intraoperative anesthetic effect time, sensory blockade to T8, T6, T4,T10, L2, L4time, whether to change the anesthesia, improved alertness/sedation scores,precise propofol, fentanyl and methamphetamine application volume and operationtime.Record to start the operation time and the highest sensory blockade plane, usingmodified Bromage score standard to evaluate the degree of motor block and motor blockof time and sensory block of time. In August of2012~2013in February, a total of1094in patients undergoing spinal anesthesia, were randomly divided into two groups.Afterexperimental group for spinal anesthesia, giving patients sleep pillow8h.Control groupafter spinal anesthesia, recovery after lying posture not sleeping pillow, let patients keepto supine pillow8h.Observed two groups of patients after surgery1d,2d,3d for theincidence of headache after catheter puncture and assess the severity of the headache.After dural puncture headache pain assessment standards adopted crocker seriousevaluation form evaluation. On the first day after the operation evaluation of patients withhead and neck stiffness and soreness, using visual analog scale. Before the patient isdischarged, the quality of service given anesthesia satisfaction questionnaire. Logisticregression analysis using multivariate risk factor for postoperative cause PDPH occurred.Results Two groups of anesthesia effect time and intraoperative condition differencehas no statistical significance (P﹥0.05), all patients were successfully completedsurgery.In the first sensory block to reach the T8time, lidocaine significantly faster than Levobupivacaine, the difference was statistically significant (P <0.05).Arrived for thefirst time in feeling T8, T6, T4, T10, L2and L4time comparison, levobupivacaine fastertime to reach the lidocaine group, the difference was statistically significant (P<0.05).Sensory block reached S3, basically the same two groups of time, no significantdifference (P>0.05). GroupⅠsensory block recovery time shorter than the groupⅡ, thedifference was statistically significant (P <0.05).No significant differences in motornerve block in patients of the two groups, walkingtime first micturition time, no statisticalsignificance and discharge time difference(P>0.05). The experimental group and controlgroup two groups of patients in postoperative incidence of PDPH, there was nostatistically significant difference, but the experimental group degree of neck andshoulder pain after surgery and anesthesia in patients with satisfaction, significantlybetter than that of control group (P <0.05). In the cause in terms of PDPH, female,age>30years old, and a history of chronic headache,>2or more times a piercing relationwith PDPH occurred significantly (P <0.05).Conclusions The study found that in the selective subarachnoid block, levobupivacaine3mg and fentanyl can completely replace the lidocaine10mg with fentanyl.Suitable foranesthesia and hospitalization in patients with gynecological operation in short time.Whether patients with sleep pillow after spinal anesthesia and postoperative there was nostatistically significant difference between the incidence of PDPH. Give patients afterspinal anesthesia pillow, does not increase the incidence of PDPH, and can reduce thedegree of patients with neck shoulder pain, increase the comfortable degree of patients,improve patients with anesthesia services overall satisfaction.