Tran The Quang, Nguyen Duy Anh,

Bui Thi Bich Ngoc, Nguyen Huu Tu, Nguyen Duc Lam,

Nguyen Nhat Hoan, Pham Minh Hung

Initial evaluation of a new local anesthetic ropivacaine in spinal anesthesia to total abdominal hysterectomies

in Hanoi Obstetric and Gynecology Hospital

IntroductionFibrome uterus - benign disease common in

women. Thorough treatment is complete hysterectomy.

There are many surgical methods but total abdominal hysterectomy mainly (65.2%).

Anesthesia: can be used bupivacaine with fentanyl in spinal anesthesia

IntroductionRopivacaine: a new local anesthetic,

cardiovascular toxicity and nerve than bupivacaine. Inhibition feeling more movement so the patient will soon recover more active

Worldwide, there are many studies on ropivacaine but this is the first drug to enter VN.

Objective1. To assess the effectiveness of the method

of anesthesia spinal anesthesia with ropivacaine fentanyl in collaboration with surgical hysterectomy belly sugar completely.

2. To evaluate the effect of unwanted methods.

Subjects and methods researchSubjects: 30 patients with spinal anesthesia is

UXTC with ropivacaine and fentanyl for hysterectomies completely caesarean

-Time: from March to April 2014 in Hanoi Obstetric and Gynecology Hospital.

- Exclusion criteria: have medical conditions, there are complications in surgery or contraindications of spinal anesthesia.

Research Methodology: descriptive prospective.

Methodology300 ml infusion Ringerlactat before anesthesia Spinal anesthesia at L2 - L3 with 14 mg of

ropivacaine in collaboration with 30μg fentanyl. After anesthesia, the patient is placed supine,

beginning with Assess the level of blocking sensation by means of

blunt needle (Pin - prick) 2 minutes / time until reaching to the surgery block.

Motor block was assessed by Bromage improvement methods.

Results and discussion Table 1. Characteristics of patients and duration of surgery

parameter ± SD Min - Max

Age (years) 47,80 ± 3,26 43 – 54

Height (m) 1,55 ± 0,43 1,5 – 1,63

Weight (kg) 51,48 ± 4,57 44 – 60

Surgery time

(min)

47,05 ± 9,13 35 – 65

Results and discussionTable 2. blockers sensory and motor

parameter X ± SD Min - Max

Time blocking sensation to T10 (min) 3,86 ± 0,92 3 – 6

Time blocking sensation to T6 (min) 7,30 ± 3,02 3 – 12

Time to reach maximum blocking

sensation (min)

12,47 ± 3,74 6 – 18

Time blocking sensation in T6 (min) 65,27 ± 18,93 60 - 85

Time to reach the maximum motor block

(min)

13,26 ± 3,69 6 – 17

Blocking movement time (min) 95,47 ± 30,64 60 - 150

Results and discussion Table 3. Change the circuit, mean arterial blood pressure during surgery

parameter heart rate (beats/min)

X ± SD

Mean BP (mmHg)

X ± SD

Before spinal anesthesia 87,69 ± 8,56 88,85 ± 12,32

After 2 min 88,23 ± 9,18 85,54 ± 13,48

After 4 min 88,92 ± 14,11 82,08 ± 17,44

After 6 min 82,08 ± 11,05 74,25 ± 11,68

After 8 min 84,36 ± 18,91 76,02 ± 10,21

After 10 min 82,90 ± 14,67 72,36 ± 17,16

After 15 min 82,30 ± 11,63 72,80 ± 12,14

After 20 min 78,44 ± 13,13 74,15 ± 9,04

After 25 min 80,63 ± 11,59 73,23 ± 9,97

After 30 min 89,70 ± 10,75 74,89 ± 11,69

After 35 min 87,22 ± 9,68 72,88 ± 12,82

The end of surgery 86,25 ± 7,27 80,25 ± 8,91

Results and discussion Table 4. Changes in respiration in surgery

parameter Breath rate (cycles / min)

X ± SD

SpO2

X ± SD

Before spinal anesthesia 18,4 ± 1,8 98,3 ± 1,0

After 2 min 18,2 ± 1,7 98,0 ± 1,5

After 4 min 17,4 ± 1,6 98,8 ± 0,9

After 6 min 17,2 ± 2,2 98,8 ± 0,9

After 8 min 17 ± 1,6 98,6 ± 0,9

After 10 min 16,7 ± 1,4 98,5 ± 1,0

After 15 min 16,7 ± 1,5 98,5 ± 1,1

After 20 min 16,7 ± 1,9 98,3 ± 1,0

After 25 min 17,0 ± 1,7 98,4 ± 1,1

After 30 min 16,9 ± 1,6 98,5 ± 1,1

After 35 min 16,5 ± 1,6 98,6 ± 1,1

The end of surgery 16,3 ± 1,5 98,4 ± 1,1

Results and discussionTable 5. The fluid and ephedrine used in surgery

parameter X ± SD Min - max

Fluid (ml) 810 ± 256 690 – 1050

ephedrin (mg) 6,7 ± 4,26 – 18

Results and discussionTable 6. Quality of anesthesia

degree n %

excellent 19 76,67 %

normal 7 23,33 %

bad 0 0

Results and discussion Table 7. Evaluation of the surgeon about relax abdominal muscle

Degree n %

excellent 21 70 %

normal 9 30 %

bad 0 0

Results and discussion Table 8. The side effects

parameter n %

hypotention 6 20

bradycardia 3 10

vomiting 4 13,33

frisson 3 10

Discussion1. Safety of ropivacaine in spinal anesthesia

Ropivacaine less toxicity on the nervous and cardiovascular Levobupivacain and bupivacaine on empirical

Ropivacaine causes less prolonged QRS complex than bupivacaine, the rate of cardiac arrest emergency success of ropivacaine and bupivacaine higher than that.

On human volunteers, intravenous infusion ropivacaine: symptoms of neurological toxicity and cardiovascular less than bupivacaine.

Discussion1. Safety of ropivacaine in spinal anesthesia

In spinal anesthesia, experimental studies in rats and dogs: the drug does not cause neurotoxicity.

On humans, ropivacaine has been studied using safe: - Mc Namee: total hip replacement surgery - Malinovsky JW: Laparoscopic surgery for prostate - Vankleef JW and JB Whiteside: surgical abdomen

and lower extremities - Surjeet Sirgh: cesarean section. In this study, no serious complications encountered,

less common side effects of ropivacaine.

2. The effect of anesthesia2.1. Blocking sensation

Timeout blocking sensation to T10, blocking timeout maximum feeling of ropivacaine compared with bupivacaine longer under Surgeet Singh

The percentage rate of hypotension and nausea, vomiting higher bupivacaine group ropivacaine group.

Level up blockers feel no difference compared with bupivacaine.

Time blocking sensation in T6 is 65.27 ± 18.93 minutes (60-85), lower than spinal anesthesia with bupivacaine (118 ± 32.5 minutes) by JB Whiteside

Therefore, appropriate ropivacaine spinal anesthesia for surgery and medium short, on the day of surgery.

2.2. Block motor

Waiting time to reach the maximum motor block of ropivacaine was 3.69 ± 13.26 minutes.

Time running short blockades (95.47 ± 30.64 min), lower than bupivacaine (165.3 ± 26.2 minutes) as Surgeet Singh (p <0.05).

This is the main advantage of ropivacaine, suitable for GTTS for minor gynecological surgery: shaping perineum, Bartholin gland tumors ...

2.2. Block motorAccording to Whiteside, GTTS with

ropivacaine group had time shorter motor block and be able to urinate sooner than the bupivacaine group.

Therefore, it is possible to withdraw early and limited catheterization urinary infections.

3. Side effects

3.1.Hypotention and bradycardia Proportion of hypotension in our study is lower

than Surgeet Singh (26.09%) may be due to the lower doses used ropivacaine (14 mg versus 17.5 mg and 24 mg).

The ratio is 10% slower circuits, equivalent to Sururgeet Singh (8.7%). All cases have responded well to atropine 0.5 mg.

3. The side effects

3.2. Vomiting and nausea Proportion of nausea and vomiting in this study

was 13.33%, equivalent to a number of studies on spinal anesthesia with bupivacaine.

Treatment with 10 mg of intravenous Primperan, all patients respond well.

3. The side effects

3.3. Frisson Percentage chills nor our differences with the

study of bupivacaine (10%). Not having serious complications: respiratory

failure, nerve damage and other side effects such as urinary retention, pruritus ...

Conclusion

Spinal anesthesia with ropivacaine 14 mg doses at the same ratio with 30 mcg fentanyl coordinate effectively insensitive enough to complete hysterectomies caesarean, recovery time early mobilization.

Having experienced some side effects are: hypotension, bradycardia, nausea, vomiting, chills.

May apply for gynecological surgery is not prolonged, surgery of the day.