Comparison on the effects between combined epidural-spinal anesthesia and different doses ropivacaine for lower limbs operation / 解放军医学杂志

ABSTRACT

Objective To compare the effects of combined epidural-spinal anesthesia and different doses ropivacaine anesthesia for the lower limb operations. Methods One hundred and thirty-six patients for elected operations and 83 emergency operation patients receiving lower limbs operations were enrolled for the comparative study. Patients receiving spinal analgesia were divided into 3 groups with 0.1%, 0.15% and 0.2% ropivacaine, respectively. The dosage was increased from 3mg to 7mg with 1mg increase stepwise for each group, and a total of 15 groups and 219 cases were studied with this regime. For the patients undergoing epidural block anesthesia, 0.2% ropivacaine was used. Patients were placed in lateral recumbent position with the affected limb on the top. Puncture was done at the level of L2-3 interspace with a fine trocar, keeping the anesthetic level at T9-10. The anesthetic effect, BP, HR, SpO2 and Bromage score were then recorded. Results The effective rate was 95% in 6mg and 7mg group, 50%-55% in 5mg group, and 30% in 4mg group. The dosage of 3mg failed to achieve anesthesia. There was no failure in 7mg groups. During the operations the BP, HR and SpO2 were stable. No nausea and vomiting occurred, except 1 patient complaining of headache and 2 patients with urine retention. The intraoperation Bromage score of the affected limbs were 2-3, and for the unaffected limbs it was 0-1. Conclusions It is suggested that 0.1-0.2% ropivacaine in a dosage of 6-7mg for spinal anesthesia combined with 0.2% ropivacaine for epidual block can be used in the limb operation. It overcomes many side effects of traditional lumbar anesthesia. This method may be of great advantage to patients with complete analgesia, less anesthetic agent used, earlier ambulation, stable circulation and respiration, and fewer side-effects.