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The Dose-response Relationship of Three Local Anesthetics After Intrathecal Injection for Elderly Patients

Author: ZhengBin
Tutor: ZuoShouZhang
School: Guangzhou Medical College
Course: Anesthesiology
Keywords: Levobupivacaine Ropivacaine Dose effect straight relationship Anesthesia , spinal Motor block
CLC: R614
Type: Master's thesis
Year: 2010
Downloads: 22
Quote: 0
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Abstract

With the improvement of people's living standards and the level of health care advances, the trend to extend the life expectancy of the people, China has entered the aging society, the proportion of the elderly population is increasing, more and more elderly surgical patients, elderly patients anesthesia more and more attention of an anesthesiologist, and is particularly important to how to ensure the safety and effectiveness of anesthesia. Bupivacaine is the body and dextral body was mixed with an equal amount of racemic size, and the central nervous system and cardiac toxicity from dextral body. Levobupivacaine and ropivacaine are a new type of local anesthetics on the heart and central nervous system toxicity than bupivacaine, at home and abroad, there are a large number of studies have confirmed its spinal anesthesia (epidural including the safety and efficacy of the block, subarachnoid block), it is foreseeable that in the spinal anesthesia and analgesia in central a broad straight with prospects. As we all know, bedridden caused one of the important factors of deep quiet Wing thrombosis and other complications, the early recovery of motor function shorten patient time in bed to reduce deep quiet Wing thrombosis and other complications. Good sensory block after subarachnoid block, usually caused by sensory and motor block, how to choose a suitable local anesthetic, and the appropriate dose of local anesthetic, so subarachnoid block both the direct effect, can maximum to avoid excessive degree of motor block patients as soon as possible to restore lower limb motor function, is the main point of departure for this study. Therefore, this study compared the effectiveness of sensory and motor block of bupivacaine, levobupivacaine and ropivacaine three local anesthetics subarachnoid block, which compare the feeling of the three local anesthetics a motion separation trends, provide clinical straight reference. Part I: three different local anesthetic intrathecal injection the destination sequential transurethral resection of the median effective dose for elderly patients elderly patients intrathecal injection of 0.5% levobupivacaine, ropivacaine and cloth than ropivacaine for transurethral resection of the sensory block performance. 90 cases of elderly patients in spinal anesthesia epidural anesthesia for transurethral prostate transurethral surgery, AsA Ⅰ ~ Ⅲ grade, age 69 to 82 years old, height 156 ~ 171cm, body mass index lt; 30kg / m ^{2 , were randomly divided into 3 groups (n = 30), the Levobupivacaine group (L): Subarachnoid injection of 0.5% levobupivacaine; ropivacaine group (R group ): subarachnoid injection of 0.5% ropivacaine; bupivacaine group (B): subarachnoid injection of 0.5% bupivacaine. Sequential methods for test, each group of patients local anesthetic doses are 10mg, dose changes gradient of 1mg. The block \\If the previous example, the next example low-level dose; \The sequential method to calculate the two drugs motor block median effective dose (ED ₅₀) and 95% confidence intervals (95% CI), and using the the probit regression Xin method verify. Results levobupivacaine block ED ₅₀ 7.114 mg (95% CI: 6.869 to 7359 mg) ropivacaine block ED ₅₀ 9.194mg (95% CI: 8.889 ~ 9.499 mg), Bupivacaine ED ₅₀ 5.773 mg (95% CI: 5.487 ~ 6.059 mg). The relative block performance ratio: levobupivacaine / bupivacaine because 0.81 ropivacaine / bupivacaine because 0.63 the ropivacaine / L-bupivacaine because 0.77. Conclusion bupivacaine, levobupivacaine and ropivacaine three local anesthetics subarachnoid anesthesia for elderly patients undergoing transurethral surgery block performance from strong to weak order: bupivacaine because of gt; gt; levobupivacaine ropivacaine. Part II: elderly patients intrathecal injection of levobupivacaine, ropivacaine and bupivacaine motor block effect comparison purposes sequential elderly patients by intrathecal injection of 0.5% levobupivacaine , ropivacaine and bupivacaine movement, block performance. Contemplated in elderly patients with 90 cases of spinal anesthesia, epidural anesthesia for transurethral resection AsA Ⅰ ~~ Ⅲ grade, age 66 to 81 years old, Height 157 ~ 173cm, body mass index lt; 30kg / m. , Randomly divided into 3 groups (n = 30), the Levobupivacaine group (L): 0.5% levobupivacaine subarachnoid injection; subarachnoid ropivacaine group (R): injection of 0.5% ropivacaine; bupivacaine group (B): subarachnoid injection of 0.5% bupivacaine. Using the sequential method to test each group of patients local anesthetic dose are 5mg, dose variation gradient 1mg. Motor block \If the previous example, the next example low-level dose; \The sequential method to calculate the two drugs motor block median effective dose (ED ₅₀) and 95% confidence intervals (95% CI), and using the the probit regression Xin method verify. Results the levobupivacaine movement block ED ₅₀ to 5.483 mg (95% CI: 5.236 ~ 5.741 mg); motor block with ropivacaine ED ₅₀ 7.516 mg (95% CI :7-211 ~ 7.834 mg); the bupivacaine sports block ED ₅₀ 4.277 mg (95 % CI: 4.074 ~ 4.498 mg). Relative performance ratio of motor block: levobupivacaine / bupivacaine because 0.78 ropivacaine / bupivacaine because 0.57, ropivacaine / L-bupivacaine because 0.73. Conclusions Elderly patients with subarachnoid three local anesthetic injection motor block performance from strong to weak order: bupivacaine gt; levobupivacaine gt; ropivacaine; latter two are feeling a motor block Separation trend is more obvious.}

The Dose-response Relationship of Three Local Anesthetics After Intrathecal Injection for Elderly Patients

Abstract

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