Effect Of Two Types Isobaric Local Anesthetics With Different Concentrations And Dosages For Combined Spinal-epidural Anesthesia In Cesarean Section

Objective To analyze the safety and effectiveness of local anesthetics in cesarean section.Observed the anesthetic effect and adverse reactions of local anesthetics with low concentration,low dose and isospecific gravity through subarachnoid clearance block in cesarean section,so as to provide theoretical basis for clinical use.Method A total of 120 cases of pregnant women underwent cesarean section in the first affiliated hospital of Guangxi Medical University were included in the study.Aged from 24 to 40 years old,weighted from 50 to 90 Kilograms,graded by American Anesthesia Association(ASA)range from classⅠ to class Ⅱ.Divided patients randomly into 4 groups(n=30),0.5%ropivacaine(13.5 mg),0.4% ropivacaine(10.8 mg),0.5% bupivacaine(13.5 mg)and 0.4% bupivacaine(10.8 mg)were anesthetized with the same volume(2.7ml)of spinal anesthesia solution through the subarachnoid space.Record the highest anesthesia level and time of arrival.The anesthetic effects were assessed and recorded,including modified Bromage rating,muscle tone,and visual analogue scale.The incidence of adverse reactions including hypotension,nausea and vomiting,chills,bradycardia,and neurological complications in the four groups after administration were recorded,as well as the Apger score at 1min and 5min and neurological complications.Result The results showed that there were no statistically significant differences in the scores of improved Bromage,degree of muscle relaxation and visual analogue scale among the four groups,which could well meet the requirements of cesarean section.The Apgar score of 1min and 5min was 8～10socer(normal).There was a statistically significant difference in the incidence of hypotension between the 0.4% ropivacaine group and the 0.5% bupivacaine group(0.4%)(P <0.01).The incidence of chills was statistically different between the 0.5% ropivacaine group and the 0.4% ropivacaine group(P < 0.05).The incidence of chills was statistically different between the 0.5% bupivacaine group and 0.4% ropivacaine group(P <0.05).No neurological complications were found in any of the four groups,and there was no statistically significant difference in the incidence of residual adverse reactions between the groups(P>0.05).Conclusion There was no difference in anesthetic effect between the four groups,and all of them could meet the anesthesia requirements of cesarean section.The changes of heart rate and blood pressure in the bupivacaine group were significantly lower than that in the ropivacaine group.The incidence of hypotension and chills in the ropivacaine group of 0.4% was lower than that in the bupivacaine and ropivacaine groups of 0.5% bupivacaine group and 0.5%ropivacaine group.The anesthetic safety of 0.4% ropivacaine group is higher,which can be recommended as a routine clinical medication regimen for cesarean section anesthesia.