The Clinic Research To Combined Spinal-Epidural Anesthesia On Transurethral Resectio Of Prostates In The Elderly

Objectives To investigate the safety and the best dose of bupivacaine combined spinal-epidural anesthesia(CSEA)on transurethral resection of prostate(TURP)in the elderly by observed the effective and hemodynamic respondence on combined spinal-epidural anesthesia with different dose of bupivacaine.Methods Sixty ASA physical stadusâ… -â…¢patients(aged≥65 years) who undergone transurethral resection of prostate to apply combined spinal-epidural anesthesia were divided into three groups randomly.Every group involved 20 patients.CSEA of all patients was performed at the L_2-3interspace with spinal-epidural needle.Epidural catheter place 4.0cm faced capitulum after local anesthetic was injected into subarachnoid space,groupâ… received 5mg(1ml)of bupivacaine 0.5%for spinal anesthesia;groupâ…¡received 7.5mg(1.5ml)of bupivacaine 0.5%for spinal anesthesia;groupâ…¢received 10mg(2ml)of bupivacaine 0.5%for spinal anesthesia.If analgesia didn't reach T₁₀within 20mins,supplemental lidocaine 2%was injected into epidural space. Observing and recording:the time of sensory block occur;the time of sensory block reaching maxlmum plane;the maximum plane of sensory block;the time of motor block occur;the time of motor block reaching maxlmum and evaluating motor block by modified bromage scale;the change of blood pressure and heart rate of the 5min,10min,15min,20min,30min and 40min after intrathecal local anesthetic administration;the incidence of hypotension, bradycardia,respiratory depression,shivering,nausea and vomit,postdural puncture headache(PDPH),et al.Results No significant differences among three groups of the time of sensory block occured and sensory block reaching maxlmum plane were observed(p＞0.05).There is significant differences between groupâ…¢and groupâ… of the maxlmum plane of sensory block(p＜0.05),but no significant differences between groupâ…¡and groupâ… ,groupâ…¡and groupâ…¢(p＞0.05). There is significant differences between groupâ…¡and groupâ… ,groupâ…¢and groupâ… of the time of motor block occured(p＜0.05),but no significant differences between groupâ…¡and groupâ…¢(p＞0.05).There is significant differences among three groups of the time of motor block reaching maxlmum(p＜0.05).Bromage scale of three groups concentrated on 2～3 levels.Effective evaluating:well 80%,good 20%in groupâ… ;well 95%,good 5%in groupâ…¡;well 100%in groupâ…¢.Three groups of SBP,DBP,and HR all decreased with different degrees after anesthesia,but no significant differences compaired groupâ… and groupâ…¡with their baseline(p＞0.05).There is significant differences of SBP at 15min,20min,30min after anesthesia in groupâ…¢(p＜0.05),but no significant differences of DBP and HR in groupâ…¢over it's base(p＞0.05).However,no significant differences among three groups of hemodynamic respondence were observed(p＞0.05).The incidence of hypotension is groupⅢ＞groupⅡ＞groupâ… ,but no significant differences among three groups(p＞0.05).The incidence of bradycardia is groupⅢ＞groupⅡ＞groupâ… ,but There is significant differences between groupâ… and group â…¢(p＜0.05)and no significant differences between groupâ… ,groupâ…¢and groupâ…¡(p＞0.05).No significant differences between three groups of shivering were observed(p＞0.05).No happened significant respiratory depression,nausea and vomit,PDPH,et al.Conclusion Combined spinal-epidural anesthesia is the ideal method of anesthesia on TURP in the elderly,for acting faster,high achievement ratio, sacral nervey blocked consummately,sure effect,low dosage of local anesthetic. Combined spinal-epidural anesthesia with 0.5%bupivacaine 1.5ml(7.5mg)is the best dose on TURP in the elderly patients,which the effective is satisfied, slight hemodynamic respondence,less side effect.