Application Of Spinal Anesthesia By Different Doses Of Sufentanil Combined With Ropivacaine In Elderly Patients Undergoing Lower Limb Surgery

Objective : To observe the anesthetic effect of Spinal Anesthesia by different doses sufentanil combined with ropivacaine in elderly patients undergoing lower limb surgery,to evaluate its application value and safety,and find out the best combination of drugs for anesthesia in elderly patients undergoing lower limb surgery.Methods: After obtaining Ethical Committee’s approval and patient’s consent.Eighty elderly patients whose age range 65-75 years,ASA grade I-III and without contraindication of intraspinal anesthesia were randomly divided into four groups,A,B,C and D.Group A:sufentanil 5 μg + 0.75% ropivacaine 7.5 mg;Group B: sufentanil 7.5 μg + 0.75% ropivacaine7.5 mg;Group C: sufentanil 10 μg + 0.75% ropivacaine 7.5 mg,Group D: 0.75% ropivacaine7.5 mg;All four groups were added 10% glucose injection to the total amount of 2ml.All patients underwent Combined Spinal-Epidural Anesthesia.the affected limb was in the lateral position.The L3-4 space was used as puncture point.After successful epidural puncture,lumbar anesthesia needle was introduced.After the cerebrospinal fluid flowing out,2 ml drugs were injected into the subarachnoid space at a speed of 0.2 ml/s,and the epidural catheter was placed at the head side for 3-4 cm on demand.Supine position was restored immediately after completion.The changes of hemodynamics : mean arterial pressure(MAP)and heart rate(HR),before and 1,5,10,15,30 and 60 minutes after anesthesia,maximum level of sensory block and arrival time,onset time of sensory block,degree of motor block,duration of motor block,duration of analgesia,sedation and adverse reactions were observed and recorded.Results: In the 15 and 30 minutes after anesthesia,MAP in group C was decreased,significantly different from that in group A,B and D(P < 0.05);In the 5,10,15,30,60 minutes after anesthesia,the MAP in group C was lower than that before anesthesia,and the difference was statistically significant(P < 0.05),In the 15 and 30 minutes after anesthesia,HR in group C decreased which was significantly different from that in group A,B,D and before anesthesia(P < 0.05);There were no significant differences among the highest level of sensory block,degree of motor block and duration of motor block among groups(P > 0.05);The onset time of sensory block in group D was longer than that in group A,B and C(P <0.05);The duration of analgesia in group D was the shortest,which was significantly different from that in group A,B and C(P < 0.05).The duration of analgesia in group A was shorter than that in group B and C(P < 0.05),There was no significant difference in the duration of analgesia between groups B and C(P > 0.05);In the 15 and 30 minutes after anesthesia,Ramsay sedation score in group D was lower than that in group A,B and C(P < 0.05),but there was no significant difference among groups A,B and C(P > 0.05);the incidence of skin itching in group C was higher than that in group A,B and D,and the difference was statistically significant(P < 0.05).Conclusion:7.5 ug sufentanil combined with 7.5 mg ropivacaine for lumbar anesthesia has definite effect.It can prolong the analgesic time,have less influence on motor nerve block,stable hemodynamics and less adverse reactions.It is conducive to the recovery of patients after operation,and can be safely used in lower limb surgery of elderly patients.