Comparisons of combined spinal-epidural anesthesia in different puncture of gaps in urologic surgery anesthesia / 中国基层医药

ABSTRACT

Objective To explore the narcotic effects of different puncture in combined spinal-epidural block anesthesia for urological Surgery.Methods 108 cases of urologic surgery were selected.The patients were randomly divided into the two groups according to digital meter (each group had 54 cases).Both groups were treated with combined spinal-epidural anesthesia.The anesthesia puncture of group A were in lumbar intervertebral 2-3,the anesthesia puncture of Group b were in lumbar intervertebral 3-4.The respects of the two groups were observed and compared such as blood pressure before and after anesthesia,initial anesthesia plane,the time the drug arrived to the sixth thoracic vertebrae,additional lidocaine dose during the operations anesthesia quality rate and anesthesia side effects.Resuits The blood pressures of the patients of group A were significantly lower than those of group B 5 minutes after anesthesia (t =2.73,2.29,2.29,all P ＜ 0.05),the incidence of adverse reactions of Group B such as nausea,vomiting,low blood pressure,difficulty in breathing (24.1％,14.8％),was significantly lower than incidence of group A (44.4％,and 13.0％,x2 =4.97,5.07,4.86,all P ＜ 0.05) the set of initial plane of anesthesia of group a was significantly higher than that of group B (t =2.91,P ＜ 0.05),the time the drug arriving to the sixth thoracic vertebrae,of group A was significantly shorter than group B (t =2.42,P ＜ 0.05) the amounts of additional lidocaine dose of Group A during the operations were significantly less than group A (t =2.61,P ＜ 0.05).There were no significant differences in the anesthesia quality rate (P ＞ 0.05).Conclusion Selecting L3-4 puncture points in combined spinalepidural anesthesia can significantly reduce incidence of adverse reactions such as nausea,vomiting,low blood pressure and difficulty in breathing compared with selecting L2-3 puncture during urology surgery procedure.It can also reduce pain during operations.Though there are significant differences in initial level of anesthesia,the time the drug arrive to the sixth thoracic vertebrae and additional lidocaine doses,leading no effects on superior rate of anesthesia.Thus the clinical significance is not very big.