Clinical Application Of Spinal Anesthesia With Low-dose Ropivacaine-fentanyl In Anorectal Surgery

ObjectiveTo explore the feasibility of low-dose ropivacaine combined with fentanyl in anorectal surgery of spinal anesthesia. Comparing hemodynamics,sensory block,motor block in ropivacaine group and two different dose ropivacaine combined with fentanyl in anorectal surgery of spinal anesthesia. Observe effect of nesthesia,adverse reaction in three different groups. To draw the evidence of suitable dose of ropivacaine combined with fentanyl in anorectal surgery of spinal anesthesia.MethodsGrouping 60 patients of anorectal diseases, graded by American Anesthesia Association (ASA) in class I or classⅡ, into three groups randomly and averagely. Ropivacaine group (RP group) received 0.5% ropivacaine as control group. RF1 group received 0.5% ropivacaine and fentanyl. RF2 group received 0.3% ropivacaine and fentanyl. RP group administrated 0.5% ropivacaine 7.5 mg. RF1 group administrated 0.5% ropivacaine 7.5mg and fentanyl 10μg. RF2 group administrated 0.3% ropivacaine 6mg and fentanyl 10μg. Transfusing lactated ringer's solution, continuously monitoring blood pressure(BP),EGG,HR and SpO2 Patients were placed in right lateral position, side of head raisided by 15°,and pricking were manipulated through interspace of lumbar 3-4, transfixion pin incline facing sacroiliac, injection time between 10s. Recording the time of sensory block'onset and recovery,the highest block plane. Recording the time of motor block'onset and recovery,upgraded Bromage score of extent of motor block and score of operation completed time.Recording change of hemodynamics, such as:heart rate and blood pressure, before drug injection and 15min later after drug injection. Recording the lowest heart rate and blood pressure in operation. Recording appearance of adverse reaction:hypotension,nausea,vomiting,urine retention,Itch of skin,headache and time of operation.ResultsEffect of anesthesia in three groups were satisfaction. There were no significant difference in three groups in Sensory bloc,block motor'onset,highest block plane (P>0.05). RF2 group'Sensory recovery were earlier than RP group and RF1 group(P<0.05).Motor block were weaker in RF2 group than in RP group and RF1 group.There were no significant difference between RP group and RF1 group in motor block (P>0.05). RF2 group'time of motor block were shorter than the other two groups(P<0.05), there were no significant difference between RP group and RF1 group (P>0.05). Index of hemodynamics were stable in three groups(P<0.05),in different operation progression.All patients can fitting to move in RF2 group, and lower limb can exercise freedomly. Only one patient had headache,there were no hypotension nausea,vomiting.ConclusionThat low-dose of ropivacaine combined with fentanyl 10μg for spinal anesthesia in anorectal surgery can satisfied with surgery in stable hemodynamics,Sensory block,motor block. Furthermore motor block were weaker than the other two groups. Recovery of motor need less time. Lower limb of all patients can exercise freedomly after operation. They only felt lower limb heavy of different extent. Incidence rate of adverse reaction was low, such as:hypotension,nausea,omiting,urine retention,Itch of skin,headache.Therefore low-dose of ropivacaine combined with fentanyl 10μg was very fitting to the anorectal surgery, which needed little time.