The Clinical Reseach Of Different Doses Of Bupivacaine Combined With Fentanyl In Spinal-Epidural Anesthesia For Cesarean Section

Objectives To investigate the clinical practicality and superiority of different doses of bupivacaine combined with fentanyl in spinal - epidural anesthesia in cesarean section by observed the anesthesia effective and hemodynamic respondence on spinal - epidural anesthesia with different doses of bupivacaine combined with fentanyl .Methods one hundred twenty ASAⅠ～Ⅱfull-term pregnancy, singleton pregnancies undergoing cesarean section of primipara, who were 22 to 32 years, height 150 ~ 172cm, weight 53 ~ 85kg,, were randomly allocated into four groups. GroupⅠ: bupivacaine 7.5mg, GroupⅡ: bupivacaine 7.5mg + fentanyl 20μg, GroupⅢ: bupivacaine 10mg, GroupⅣ:bupivacaine 10mg + fentanyl 20μg,. Puncture point selecte L2-3, The speed of infusion anesthesic to cavitas subarachnoidealis in all patients was 0.1ml/s. Observed and recorded the onset time of sensory block, the highest sensory block plane, sensory block duration. Browage classification scheme with the modified motor block assessed the situation. The change of blood pressure and heart rate of 5min,10min,15min,20min,30min,40min were observed after intrathecal local anesthetic administration,the foundation values of SBP﹑DBP﹑HR after patient entering room . Record traction response inhibition. Records of patients with hypotension, bradycardia, respiratory depression, chills, nausea and vomiting and the occurrence of the number of cases. Records of newborns 1min, 5min of the Apgar score.Results The onset time of sensory block of patients in each group have no significant difference (P>0.05), The Maximum level of sensory block in groupⅢ, groupⅣwere higher than in groupⅠ, groupsⅡ.the duration of sensory block groupⅠand groupⅡcompared ,groupⅢand groupⅣcompares, the differences were statistically significant (P <0.05).;motor block, the maximum Bromage patients in each group are concentrated in the 2-3 grade level. Four groups of patients with motor block classification in the 2 ~ 3 the number of cases the difference were not statistically significant (P > 0.05). Under the arachnoidea the cavity for medicine 40min in four group of patient SBP, DBP have the varying degree to drop, after entering the inner rooms the blood pressure foundation value compares, four groups after the waist hemp medication's 10min,15min,20min three time intervals, SBP, DBP drop, the difference has statistics significance (P<0.05). GroupⅠ, GroupⅡand GroupⅢ, groupⅣcomparison difference have statistics significance (P<0.05); Comparison of the inhibition of traction reaction in groupⅠand groupⅡ, groupⅢ, groupⅣdifferences were statistically significant (P <0.05). Four groups of chills, nausea and vomiting incidence was no significant difference (P > 0.05). Four groups of newborns 1min, 5min of the Apgar score difference was not statistically significant (P> 0.05); all patients had no significant respiratory depression, postoperative incidence of headache.Conclusion Combined spinal-epidural anesthesia is the ideal method of anesthesia on cesarean section, for acting faster, high achievement ratio, sacral nervey blocked consummately, sure effect, low dosage of local anesthetic. Combined spinal-epidural anesthesia with bupivacaine 7.5mg is the best dose on cesarean section, which the effective is satisfied, slight hemodynamic respondence, less side effect.