Effects of Sufentanil on Epidural Anesthesia in Elderly Patients

Background and objective:Transurethral Prostatectomy（TURP） for the treatment of benign prostatic hyperplasia（BPH） has advantages:wide indications,short surgical time,less blood loss,postoperative recovery,etc.Patients with benign prostatic hyperplasia are almost all the elderly,about 1/3 of the patients have chronic disease,such as hypertension,coronary heart disease,decreased ventilatory function,diabetes,renal dysfunction and so on.Therefore,how to ensure that these high-risk patient were safety and steady in perioperative is worthy of our concern.Sufentanil are fentanyl derivatives and central morphine analgesic.It has the high fat-soluble,osmoses the nerve cell membrane and blood-brain barrier easily,takes effect quickly.Sufentanil given epidurally can be absorbed by epidural fat and vascular,and then takes effect in circulation system.It also acts on spinal cord directly through osmosis.Ropivacaine is a new long-acting amide local anesthetics,at the time of high concentration,it has low toxicity on heart and central nervous system,at the time of low concentration,it has sensory and motor nerve block better separation and so on.Inadequacies are slower onset.At present,if it is safe and effective that the high lipophilic opioid drugs were given epidural lack of substantial clinical data.This experiment was to adopt different doses of sufentanil intravenous or epidural administration for TURP patient and to observe the epidural anesthesia effects,and further explore the role of opioid mechanisms and their corresponding the appropriate dose. Materials and Methods1.Case selection and groupingUndergoing TURP 100 patients,ASAⅠ～Ⅱclass,age 65-80 years old,weight 50～80 kg.All the patients had no obvious preoperative heart,lung liver,kidney disease,history of spinal trauma,puncture site infection,uncontrolled hypertension, mental disorders,a history of diseases of the nervous system.The patients were randomly divided into five groups（n=20）:sufentanil 7.5ug epidural group（E₁ group）,sufentanil 15ug epidural group（E₂ group）,sufentanil 7.5ug intravenous group（V₁ group）,sufentanil 15ug intravenous group（V₂ Group）,the control group（C group）.All the patients did not use preoperative medicine. Preoperative eating Strict 12h,ban drinking 4h.Burglary after routine monitoring of blood pressure,electrocardiogram,pulse oxygen saturation（SpO₂）.The establishment of intravenous access,30min infusion of lactated Ringer’s solution with 500ml.2.AnesthesiaAll patients were lying in the left-lateral position,at L_3-4 epidural space puncture, given 2%lidocaine 3ml,head to the tube 3.5cm.5min observation if no epidural anesthesia in patients with abnormal performance,E₁ group additional 0.75% ropivacaine 10ml and sufentanil 7.Sug（2ml）.E₂ group additional 0.75%ropivacaine 10ml and sufentanil 15ug（2ml）l.Group V₁ additional 0.75%ropivacaine 10ml and saline 2ml,while intravenous injection of sufentanil 7.5ug（2ml）.V₂ Group additional 0.75%ropivacaine 10ml and saline 2ml,while intravenous injection of sufentanil 15ug（2ml）.C group additional 0.75%ropivacaine 10ml and saline 2ml,After injection when the systolic blood pressure below 90 mmHg intravenous ephedrine（5-10mg） and to accelerate the speed rehydration.Heart rate less than 55 times / min intravenous atropine 0.3mg.3.ObserverGeneralized case After epidural injection once every 3min record blood pressure（BP）,heart rate（HR）,pulse oxygen saturation（SpO₂）.And recorded in each group the incidence of hypotension and bradycardia. Assessment of sensory block Sensory block was assessed using a blunt point needle to test for loss of pain to pin-prick in the left anterior axillary line.Assessments were made every lmin during first 9min after the epidural injection,subsequently every 3min until fixation of sensory dermatomal level and after that every 30min until total recovery from analgesia.Observed and recorded the onset time,time until maximal cephalad spread,the maximal cehpalad spread level and time until total recovery from analgesia.Assessment of motor block Motor block was evaluated every 3min after the epidural injection by using a modified Bromage scale.Observed and recorded the onset time,maintenance time,and maximum degree of motor block.The effect of anesthesia and sedation was assessed.Hemodynamic monitoring during anesthesiaSBP,DBP and HR were monitored continuously and values recorded before injection and at time points 5,10,20,30,45,60,90,120 min after injection.The adverse reactions,the quantity of bleeding and fluid infusion were recorded during anesthesia.4.Statistics analysisStatistical package（SPSS 11.0） was used for processing data,the numerical data variables expressed as mean±standard deviation or median.The use of KS,Levene carried out separately test of normality and homogeneity of variance test.Consistent with the normal distribution and homogeneity used by single factor analysis of variance（ANOVA） and repeated measures ANOVA,comparison of the highest level using rank sum test,compared count data using chi-square test.Theαwas set at 0.05.Results1.General information on the comparativeNo significant difference was noted with regard to age,height,weight and surgery time in five groups.2.Sensory block2.1 Sensory block onset time E₂ group,V₂ group compared with the control group,sensory block onset time was significantly shorter,the difference has statistical significance（P＜0.05）.2.2 The duration of sensory block.Compare to control group,the duration of sensory block of E₁ group,E₂ group and V₂ group was significantly longer.V₂ group compared with the V₁ the duration time of sensory block was significantly longer,the difference was statistically significant（P＜0.05）.E₂ group compared with the E₁ the duration time of sensory block was significantly longer,the difference was statistically significant（P＜0.05）.2.3 Postanesthesia sensory block reached the highest level and time E₂ group compared with the control group on,the highest level was marked shift. Reached the highest level E₂ group was significantly shorter.E₂ group compared with the E₁,highest level was marked shift.The time of reached the highest level was significantly shorter.The difference was statistically significant（P＜0.05）.3.motor blockThere was no significant difference in five groups on onset time and duration time（P＞0.05）4.Anesthetic effectE₂ group,V₂ group compared with the control group significantly enhance the analgesic effect,the difference has statistical significance（P＜0.05）.5.Sedative effectV₁ group,V₂ group compared with the control group significantly enhance the degree of sedation,the difference has statistical significance（P＜0.05）.6.HemodynamicsPatients in each group at 5 minutes,10 minutes,20 minutes,30 minutes after anesthesia,compared with the pre-anesthesia,heart rate increased.Patients in each group at 10 minutes,20 minutes,30 minutes,40 minutes after anesthesia,compared with the pre-anesthesia,SBP decreased significantly,compared with pre-anesthesia, patients in each group 45min after anesthesia DBP decreased significantly.7.Adverse ReactionsThe incidence of a variety adverse reactions of five groups have no significant differenceConclusions1 Epidural sufentanil can enhance the analgesic effect betterly,epidural sufentanil has better anesthetic effect and shows that epidural small-dose of sufentanil’s synergies on local anesthetics is spinal cord-oriented.2 Epidural 15ug sufentanil combined with ropivacaine can improve the effect of sensory block.Intravenous 7.Sug sufentanil in elderly patients is appropriate dose of sedative.3 Epidural small-dose of sufentanil does not increase the degree of motor block,In favor of an earlier movement in patients after surgery.4 Epidural and intravenous small-doses of sufentanil combined with epidural anesthesia in patients have no significant effect on the hemodynamics and a variety of adverse reactions.