比较单侧蛛网膜下腔麻醉下下肢手术患者鞘内给予 0.5%和 0.75%重比重布比卡因的血液动力学效应。

Comparison Of Hemodynamic Effect Caused By Intrathecal Low Dose Administration Of 0.5% Against 0.75% Hyperbaric Bupivacaine In Patients Undergoing Lower Limb Surgery Under Unilateral Spinal Anaesthesia.

机构信息

PAF Hospital Mushaf Sargodha.

Combined Military Hospital Malir Karachi.

出版信息

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):549-552. doi: 10.55519/JAMC-04-12270.

DOI:10.55519/JAMC-04-12270

PMID:38406933

Abstract

BACKGROUND

Spinal anaesthesia has its unique place in modern anaesthetic practice. In past, most of the surgeries, irrespective of the site of surgery, were performed in general anaesthesia but now in the modern anaesthetic field, spinal anaesthesia has markedly replaced general anaesthesia, specifically in obstetrics, lower limbs, and abdominal surgeries.

METHODS

A total of 100 patients fit to undergo lower limb surgery between the ages of 20 to 70 years were included in the study. 50 patients were in 0.5% hyperbaric bupivacaine (Group A) while 50 patients were in the 0.75% hyperbaric bupivacaine group (Group B). Patients with a history of allergies to local anaesthetics, ischemic heart disease and contraindications to spinal anaesthesia were excluded. At the end of the injection, the patient was immediately laid down and tilted to 30 degrees lateral on the operative side for unilateral anaesthesia. Mean arterial pressure at baseline, 15, 30, 45 and 60 minutes was recorded by trainee anaesthesia. A baseline was taken of mean arterial pressure measured 15 minutes before induction of spinal anaesthesia in a lying position.

RESULTS

The mean baseline arterial pressure of patients in group A was 88.72±1.71 mmHg and in group B was 88.94±1.95 mmHg. Mean arterial pressure MAP at 15, 30, 45 and 60 minutes in both groups was as follows; 86.22±2.55 vs 81.78±1.52 mmHg, 83.72±3.36 vs 75.84±1.34 mmHg, 80.02±3.40 vs 70.90±0.97 mmHg and 77.14±4.24 vs 66.06±1.62 mmHg respectively (p-value <0.05).

CONCLUSIONS

This study concluded that the hemodynamic parameters in terms of mean arterial pressure remained more stable by deviating less from the baseline value with the use of a low dose of 0.5% hyperbaric bupivacaine instead of 0.75% hyperbaric bupivacaine in patients undergoing lower limb surgery under unilateral spinal anaesthesia.

摘要

背景

椎管内麻醉在现代麻醉实践中具有独特的地位。过去，大多数手术（无论手术部位如何）均在全身麻醉下进行，但现在在现代麻醉领域，椎管内麻醉已明显取代了全身麻醉，特别是在产科、下肢和腹部手术中。

方法

本研究纳入了 100 名年龄在 20 至 70 岁之间适合行下肢手术的患者。50 名患者接受 0.5%重比重布比卡因（A 组），50 名患者接受 0.75%重比重布比卡因（B 组）。排除对局部麻醉药过敏、缺血性心脏病和椎管内麻醉禁忌的患者。注药结束后，患者立即平卧并向手术侧倾斜 30 度，行单侧麻醉。麻醉师记录基础状态、注药后 15、30、45 和 60 分钟的平均动脉压。在椎管内麻醉诱导前 15 分钟，测量患者卧位时的基础平均动脉压。

结果

A 组患者的基础平均动脉压为 88.72±1.71mmHg，B 组为 88.94±1.95mmHg。两组患者 15、30、45 和 60 分钟的平均动脉压分别为：86.22±2.55 与 81.78±1.52mmHg、83.72±3.36 与 75.84±1.34mmHg、80.02±3.40 与 70.90±0.97mmHg、77.14±4.24 与 66.06±1.62mmHg（p 值均<0.05）。