Abstract: 【Abstract】 Objective To compare the anesthesic effect and hemodynamic changes between the continuous spinal anesthesia(CSA) and combined spinal-epidural anesthesia (CSEA) with ropivacaine in patients for hip joint surgery. Methods Sixty ASA classⅠ-Ⅲ patients aged 65 to 95 years, undergoing hip joint operation including replacements of total hip and artificial thigh bone were randomly divided into CSA group and CSEA group(n=30). Spinal anesthesia was performed at L2-3 interspace. An initial subarachnoid bolus of 0.75% hyperbaric ropivacaine 0.5 ml-1.0 ml was injected in the CSA group, if analgesia did not reach T10, supplemental ropivacaine was injected by titrating incremental doses. In the CSEA group, 0.75% hyperbaric ropivacaine 1 ml-2 ml was injected to the subarachnoid space at L2-3, and then a catheter was inserted into the epidual space for anesthesia maintenanc. The levels and times of sensory and motor block were measured and analysed. cardiac output(CO), mean artery perssure (MAP), systemic vascular resistance(SVR), acceleration index(ACI) and thoracic fluid content(TFC) were recorded with noninvasive hemodynamics monitor. Results The anesthetic dosage of the CSA group (1.1 ml) was smaller than that of the CSEA group (1.7 ml)(P<0.05). The times of sensory block to T10 (5.6 min) or the maximal level (14.7 min) and motor block (5.1 min) were more rapid in the CSEA group than those of the CSA group (9.6, 18.4, 9.8 min)(P<0.05). There were no significantly difference of MAP in the CSA group after anesthesia. There were all significantly differences in 5, 10 min and 20 min after anesthesia between the two groups(P<0.05, P<0.01). The dosage of ephedrine in the CSA group was significantly fewer than that in the CSEA group(P<0.01). Conclusions Compared to CSEA, CSA is a safe technique of spinal anesthesia with small anesthetic dosages,more reliable and hemodynamically stable and more controllability in patients for hip joint operation.
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