Effects Of Hydromorphone Combined With Ropivacaine On Single Epidural Analgesia In Patients With Electroprostatectomy

BPH(benign prostatic hyperplasia,BPH)is known as the benign prostatic hypertrophy,has become common in the elderly male patients with multiple chronic diseases.The clinical symptoms are mainly the lower urinary tract clinical symptoms of frequent urination,urination urgency,urine waiting,urine dripping and dysuria,and the main symptoms of urodynamics are the obstruction of the bladder outlet.Transurethral resection of the prostate is considered the "gold standard" for the treatment of benign prostatic hyperplasia(BPH)。Bladder spasm is a common complication after electrotomy of the prostate,and its occurrence is often associated with pain.Hydromorphone is a new type of opioid pure u receptor agonist,which is a semi-synthetic morphine derivative.It has many advantages such as quick onset,strong analgesic effect,less adverse reaction and no biological activity of the metabolites。Therefore,compared with sufentanil and fentanyl,hydromorphone hydrochloride has obvious advantages in analgesia for the elderly.However,patients with electroprostatectomy are mostly elderly patients with multiple diseases,so compared with the above drugs,hydromorphone is more suitable for analgesia after electroprostatectomy.Ropivacaine hydrochloride is a new type of amide local anesthetic commonly used in clinical practice at present.Its mechanism of action is basically the same as lidocaine and bupivacaine.It mainly blocks nerve excitation and conduction by inhibiting sodium ion channels of nerve cells.At the same time,it has the characteristic of separating sensation from motion retardation at low concentration。When ropivacaine is combined with opioid,it not only enhances the analgesic effect of local anesthetic but also does not increase the muscle relaxant effect。The purpose of this study is to find a method of analgesia after electrotomy of prostate,reduce the use of postoperative analgesic drugs,reduce or relieve postoperative pain to a certain extent,so as to reduce postoperative complications,and observe the safety of hydromorphone hydrochloride combined with ropivacaine in spinal canal analgesia.Methods: 90 elderly patients aged from 65 to 75 years old,ASA grade I to III,who planned to undergo selective transurethral plasmoelectric resection of prostate in our hospital from June,2016 to June,2019 were included.They were randomly divided into group A and group B with a random number table.Each group had 45 cases They were given combined spinal and epidural anesthesia,and L3-4 was chosen as the space.Preoperative venous access was opened,and patients were given 3ml/Kg sodium acetate ringer in advance before anesthesia.At the beginning,group A and group B were given 0.5% ropivacaine isospecific gravity solution 2ml in the subarachnoid cavity,and then leave an epidural catheter in place,the anesthesia plane was determined by acupuncture 15 minutes later.At the end of the operation,group A received 20 μ g /ml hydromorphone hydrochloride + 0.1% ropivacaine mixture 6ml in epidural space;In the control group B,6 ml of 0.1% ropivacaine mixture was given to the epidural space.The levels of IL-6were measured 30 minutes before operation(T0)and 2h after operation(T1),6h after operation(T2)and24h after operation(T3),The VAS and Sedation Scores(Ramsay scores)were recorded at T1,T2,and T3,as well as the Bromage score.When the postoperative VAS score was greater than or equal to 4,the ward physician gave dizosin treatment and recorded the dosage of analgesic drugs within 24 hours after the operation,as well as the occurrence of adverse events related to anesthesia.Results: There was no difference in age,height,weight or operation duration between the two groups(P>0.05),and there was no significant difference in intraoperative hypotension and bradycardia(P>0.05);The VAS score of group A was significantly lower than that of group B,the difference was statistically significant(P < 0.05);With the extension of time,the pain degree of both groups increased(P<0.05).The Ramsay score and the modified Bromage score were not statistically significant(P > 0.05),the time of the first use of analgesics in group A was longer than that in group B(P < 0.05),and the use of analgesics in group A was less than that in group B(P < 0.05);There was no significant difference in hypotension,pruritus,nausea and vomiting between group A and group B(P > 0.05).The incidence of cystospasm in group A was significantly lower than that in group B(P < 0.05).Compared with the preoperative level,the level of IL-6 in the two groups increased significantly(P < 0.05),and the level of IL-6 in group A was lower than that in group B(P < 0.05).Conclusion: Single epidural analgesia with hydromorphone hydrochloride and ropivacaine can reduce pain after prostatectomy in elderly patients,prolong the duration of analgesia,reduce the use of analgesicdrugs,reduce postoperative complications,and reduce the release of inflammatory mediators.