| Objective: This paper discusses the use of sufentanil or morphine in combination with low concentration ropivacaine as epidural analgesics for modified radical mastectomy in the treatment of breast cancer. This paper takes a comparative approach in the analysis of anesthesia and adverse effects.Methods: We selected 60 patients in ASA I-II, who scheduled for elective modified radical mastectomy.The procedure is performed under T3-4 intervertebral space epidural puncture and catheterization, then the patient is given a test dose with 0.5% lidocaine 5ml.Subsequently the patients are randomly divided into 3 groups(group E, S and M) according to differences in the first dose of medication, with each group comprising of 20 patients. Patients in group E(control group) are administered first dose medicine 0.25% ropivacaine 20 ml + 0.9% Na Cl 2ml, group S administered first dose medicine 0.25% ropivacaine 20 ml + sufentanil 20μg(2ml),and group M administered first dose medicine 0.25% ropivacaine 20 ml + morphine 2mg(2ml). We then compare these three groups of patients in terms of the duration for the medicine to takes effect, the highest plane block, hemodynamic stability before and after anesthesia, the adverse effects of respiratory function,the anesthetic effect, duration of sensory blockage and the incidence of adverse reactions after operation.se three groups of patients in terms of their age, gender, height, weight, duration of surg ery,the total volume of fluid and the total dose of local anesthetic infusion(P>0.05). Results:1.General information: there is no statistically significant difference among the-2.Measurement of sensory blockage: differences in duration for the medicine to takes effect among these three groups of patients are statistically significant(P<0.05), with group S patients among the fastest(P<0.05). After administering the first dose, differences in sensory blockage before reaching the highest plane block among these three groups of patients are statistically significant(P<0.05), with group S and group M patients visibly moving upward in comparison to the highest plane block of group E patients(P<0.05). The difference is most apparent in Group M patients(P<0.05). Inter-group comparison in terms of duration of sensory blockage among the three groups of patients are statistically significant(P<0.05), with group M patients exhibiting the most lasting effect after administration of the medicine(P<0.05).3. Comparison of hemodynamic and respiratory function: mean arterial pressure(MAP) and heart rate(HR) decreased after applying anesthesia among all three groups of patients, and measurement of Pa CO2 increased 30 minutes after the operation. These measurements are considered statistically significant in comparison to base levels(P<0.05). There is little change in Sp O2 among the three groups of patients before and after application of anesthesia, Sp O2 are maintained at above normal levels, therefore the difference is not considered statistically significant(P>0.05). Inter-group comparisons between group S and group M patients in terms of overall measurements indicate no significant differences(P>0.05). Comparison between group E and S with group M patients, however, does show some differences that are statistically significant(P<0.05). Administration of ephedrine and/or atropine for group E, group S and group M patients are 36.6%, 34.2%, 38.5% respectively, with no significant differences(P>0.05).4. Comparison of Anesthesia effect: During operation, we compare temporary pain experienced by patients while undergoing skin cut and cleaning armpit lymph nodes. Differences between group E and group S, and between group E and group M are considered statically significant(P<0.05), while differences between group S andgroup M are considered not statically significant(P>0.05). Measurement in terms of temporary pain 2 hours after the operation, group E patients are visibly higher than group S and group M patients(P<0.05). Measurement in terms of temporary pain in 6 hours after operation, there is no significant difference between group S and group M patients(P>0.05). After 7 hours, the measurement among all three groups of patients are considered statistically significant(P<0.05). In terms of comprehensive assessment of sensory blockage among the three groups, group S and group M patients exhibit satisfactory results, with the most satisfactory result reaching 95% and 90%, respectively. There is no significant difference between group S and group M patients(P>0.05). The difference between group E and group S, and between group E and group M, however, is considered statistically significant(P<0.05).5. Comparison of post-operation adverse effects: the overall incidence of adverse reactions in group M patients is higher than that in group E and group S patients. The difference is considered statistically significant(P<0.05). There is no significant difference between group E and group S patients(P>0.05).Conclusion: Results of this study indicate that the use of sufentanil combination with low concentration ropivacaine as epidural analgesics for modified radical mastectomy is highly effective in terms of reduction of time required for the anesthesia to take effect, maintenance of steady hemodynamic and respiratory function, enhance the analgesic effect, lessening of post-operation adverse effect and improvement of anesthesia. We highly recommend the result of this study in clinical application. |
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