| Good analgesia and muscle relaxation conditions should be provided in mixed hemorrhoidectomy,preserving motor function,and effectively controlling severe postoperative pain,which facilitates accelerating postoperative recovery.Ropivacaine is one of the best local anesthetics for mixed hemorrhoidectomy.At present,the minimum dose and the optimal dose of ropivacaine in mixed hemorrhoidectomy are rarely reported.In terms of postoperative analgesia,intrathecal morphine is the gold standard.The optimal dose of intrathecal morphine is not yet known in mixed hemorrhoidectomy.To balance the analgesic effect and side effects,and to improve postoperative pain in patients undergoing mixed hemorrhoidectomy,this study was divided into two parts,determining the effective doses of ropivacaine with spinal anesthesia in mixed hemorrhoidectomy and comparing the effect of 95%effective dose of intrathecal ropivacaine combined with different doses of morphine on postoperative analgesia in mixed hemorrhoidectomy,respectively.Part Ⅰ:Effective Doses of Intrathecal Ropivacaine in Mixed HemorrhoidectomyObjective:To calculate ED50 and ED95 of ropivacaine in mixed hemorrhoidectomy,providing reference for clinical medication.Methods:Patients undergoing elective mixed hemorrhoidectomy were included,who were 18 to 65 years old,150 to 180 cm,ASA Ⅰ or Ⅱ.According to the sequential up-and-down design of the study,the initial dose of ropivacaine was 7 mg,and the dose interval was 0.5 mg.The next dose of ropivacaine was based on the effect of anesthesia in the last patient.At least 6 consecutive turning points from ineffective to effective were ensured.The ED50 and ED95 of ropivacaine and their 95%confidence intervals(CI)were analyzed and calculated by probit regression analysis.Results:A total of 22 patients were included.The ED50 of ropivacaine was 6.057 mg and the 95%CIwas 5.491-6.680 mg.The ED95 of ropivacaine was 7.958 mg,and the 95%CI was 5.482-11.552 mg.Sensory level was T11(T10,T12),the onset time of sensory block was 27.9±12.7 s,the duration of sensory block was 345.4±157.9 min.The motion block rate was 32%(Bromage Ⅰ/Ⅱ/Ⅲ,23%/9%/0%),and the recovery time of motion block was 104.4±41.2 min.The effect of muscle relaxation was relatively satisfactory or above in all patients.Intraoperative vital signs remained stable,postoperative nausea and/or vomiting occurred in 32%of patients.Conclusions:The ED50 of intrathecal ropivacaine was 6.057(5.491-6.680 mg)mg and the ED95 was 7.958(5.482-11.552 mg)mg in mixed hemorrhoidectomy.Part Ⅱ:Effect of Different Doses of Intrathecal Morphine on Postoperative Analgesia in Mixed HemorrhoidectomyObjective:To compare the analgesic effect of different doses of intrathecal morphine(ITM)in mixed hemorrhoidectomy,providing reference for clinical medication.Methods:Seventy-six patients,who were 18-65 years old,150-180 cm,ASA Ⅰ or Ⅱ,undergoing elective mixed hemorrhoidectomy with spinal anesthesia were included.Then they were randomized to one of four groups(n=19).Four groups were given 8 mg ropivacaine,and the experimental groups were given 100μg morphine(group M100),150 μg morphine(group M150)and 200μg morphine(group M200)combined with ropivacaine,respectively.The control group(group C)was not given ITM.Every patient received postoperative analgesia which was standardized and multimodal after surgery.The first postoperative rescue analgesia time,numerical rating scale(NRS)within 48 h after surgery,24 h and 48 h intravenous morphine equivalent(IME)were recorded.The sensory level,the efficacy of anesthesia,and the motion block rate were recorded.The incidence of postoperative side effects such as nausea and/or vomiting,pruritus,respiratory depression and catheterization,and the time of first urination were recorded.The heart rate,mean arterial pressure and fingertip pulse oxygen saturation at the 5 minutes before anesthesia(T0),the 5 minutes after anesthesia(T1),the 15 minutes after anesthesia(T2),the 30 minutes after anesthesia(T3),and the end of surgery(T4)were recorded.Results:Compared with group C,the first postoperative rescue analgesia time was significantly prolonged(P<0.05),24 h IME was significantly decreased(P<0.01),2 h,4 h,8 h,12 h and 24 h NRS scores after surgery were significantly decreased(P<0.05)in groups M100,M150 and M200.Compared with group C,48 h IME was significantly decreased(P<0.01)and 36 h NRS score after surgery was significantly decreased(P<0.05)in group M200.Compared with group M100,8 h NRS score after surgery in group M200 was significantly decreased(P<0.05).Compared with group C,the incidence of pruritus was significantly increased in groups M150 and M200(P<0.05),and the incidence of urinary catheterisation was significantly increased in group M200(P<0.05).There were no significant differences among the four groups in the effect of anesthesia,sensory level,the motion block rate,the incidence of nausea and vomiting,respiratory depression,and the time to first urination.Compared with T0,heart rate and mean arterial pressure among the four groups were significantly decreased from T1 to T4(P<0.05).There were no significant differences in heart rate,mean arterial pressure and fingertip pulse oxygen saturation from T0 to T4 among the four groups.Conclusions:Considering the analgesia effect and side effects,ITM 100μg is the desirable relative dose in mixed hemorrhoidectomy with spinal anesthesia. |
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