Effect of Combined Spinal-Epidural Anesthesia with Different Concentrations of Ropivacaine in Elderly Patients Undergoing Hip Replacement and Incidence of Postoperative Delirium
Objective To investigate the effect of combined spinal-epidural anesthesia with different concentrations of ropivacaine in elderly patients undergoing hip replacement,and to analyze the incidence of postoperative delirium.Methods A total of 102 elderly patients who underwent unilateral spinal-epidural joint hip replacement in Hebi Coal Industry(Group)Co.,Ltd.General Hospital from January to December 2022 were randomly divided into three groups,observation group A,observation group B and observation group C,with 34 cases in each group,and were given 2.5,5.0,7.5 g·L-1 ropivacaine hydrochloride anesthesia respectively.The operation time and anesthesia effect of each group were compared.Heart rate(HR)and mean arterial pressure(MAP)before anesthesia(T0),after anesthesia for 15 minutes(T1),after anesthesia for 30 minutes(T2)and at the end of operation(T3),delirium analysis system(CAM-CR)scores before surgery,1 hour after surgery,6 hours after surgery,24 hours after surgery and 72 hours after surgery,and the occurrence of adverse reactions.Results There was no statistical significance in the comparison of operation time among the three groups(P＞0.05).The comparison of onset time of sensory block and motor block among the three groups was as follows:observation group A＞observation group B＞observation group C(P＜0.05).The comparison of recovery time of sensory block and motor block among the three groups was as follows:observation group A＜observation group B＜observation group C(P＜0.05).At T1,T2 and T3,the HR and MAP of the two groups were lower than those at T0(P＜0.05),and the comparison of HR and MAP of the three groups:observation group A＞observation group B＞observation group C,the differences were statistically significant(P＜0.05).The CAM-CR score of observation group A and observation group B was increased 1 and 6 h after surgery(P＜0.05),and the CAM-CR score of observation group C was increased 1,6 and 24 h after surgery(P＜0.05).The CAM-CR score of observation group A and observation group B was lower than that of observation group C at 1,6 and 24 h after surgery(P＜0.05),and there was no statistical significance in CAM-CR score among 3 groups at 72 h after surgery(P＞0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P＞0.05).Conclusion The application of 2.5 g·L-1 ropivacaine combined with spinal-epidural anesthesia in elderly hip replacement has the advantages of quick onset of sensory and motor block,more conducive to stabilizing vital signs,less postoperative delirium and high safety.
different concentrationropivacainecombined spinal-epidural anesthesiaelderly hip replacementvital signsmotor block
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