Unilateral Continuous Spinal Anesthesia With Hypobaric Levobupinacaine in Elderly Patients Undergoing Total Hip Replacement / 医学研究杂志

ABSTRACT

Objective To explore the feasibility of using unilateral continuous spinal anesthesia(UCSA)with hypobaric levobupivacaine in elderly patients undergoing hip replacement.Methods Sixty ASAⅠ~Ⅲ patients aged 63~91 were randomized to one of two groupsgroup U unilateral continuous spinal anesthesia(UCSA)(n=30)and group S single spinal epidural anesthesia(SSEA)(n=30).Patients in group U were performed at L2,3 or L3,4 interspace with the patients in the lateral position with the diseased leg upper most.The patients received a continuous spinal catheter,Hypobaric 0.375% levobupinacaine solution 0.5～1.0ml was injected.If analgesia did not reach T10 after 5～10min the same dose was repeated.Patients in group S were performed at L2,3 or L3,4 interspace with the patients in the lateral position with the diseased leg down most.Hyperbaric 0.375% bupivacaine solution 3 ml was injected into subarach noid through spinal needle,which was threaded through epidural needle.Then epidural catheter was placed.The position was adjusted to the analgesia level to reach T10.Parameters of circulation and respiration function were recorded.The level of block and degree of motor blockade were measured and recorded.The intraoperative and postoperative complication associated with spinal or epidural anesthesia were recorded.Results MAP was slightly decreased after initial dose of local anesthetics as compared to the baseline MAP in both groups.The incidences of hypotension was significantly lower in group U than in group S.There was no significant decreasement in SpO2 and no significant change in HR during operation in both groups.There was lower sensory block in group U than in group S.There was no significant difference in degree of motor blockade,dose of innovar,incidences of tremble,nausea and vomiting,headache and neural complication after operation between the two groups.Conclusion Both UCSA and SSEA can produce satisfactory sensory block for hip replacement.But UCSA can produce stabler hemodynamics and is anesthesia method of choice in elderly patients undergoing hip replacement.