A Comparative Study of the Effects of Ropivacaine versus Bupivacaine Combined Spinal-Epidural Anesthesia on Stress Response and Cognitive Function in Elderly Patients Undergoing Transurethral Resection of the Prostate
ZHUO Peng
LUO Fan
CHEN Liang
ZENG Xianghao
CHEN Jie
Abstract：Objective To compare the effects of ropivacaine and bupivacaine combined spinal-epidural anesthesia on the stress response and cognitive function of elderly patients undergoing transurethral resection of the prostate.Methods A total of 150 elderly patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate at Chengdu Wuhou District People's Hospital from June 2023 to June 2025 were prospectively enrolled.Using the random number table method,patients were divided into the ropivacaine group(combined spinal-epidural anesthesia with ropivacaine,n=76)and the bupivacaine group(combined spinal-epidural anesthesia with bupivacaine,n=74).All patients received standard temperature protection measures during surgery.The onset and maintenance times of sensory and motor block,the incidence of adverse reactions,as well as stress response indicators[adrenaline(EPI),cortisol(COR)],cognitive function[Mini-Mental State Examination(MMSE)]and hemodynamic parameters[heart rate(HR),mean arterial pressure(MAP)]at different time points were compared between the two groups.Results The maintenance times of both sensory and motor block in the ropivacaine group were significantly shorter than those in the bupivacaine group,while the onset time of motor block in the ropivacaine group was significantly longer than that in the bupivacaine group(P<0.05).The intergroup main effect,time main effect,and interaction effect on MMSE scores were statistically significant in both groups(P<0.05).The MMSE scores at 24 hours and 7 days after surgery were significantly lower than those before surgery in both groups(P<0.05),and the scores in the ropivacaine group were significantly higher than those in the bupivacaine group at both time points(P<0.05).Compared with preoperative levels,serum EPI and COR levels at 24 hours after surgery were significantly increased in both groups,and the levels in the ropivacaine group were significantly lower than those in the bupivacaine group(P<0.05).The intergroup main effect,time main effect,and interaction effect on HR and MAP were statistically significant in both groups(P<0.05).HR and MAP at 5 minutes(T1)and 10 minutes(T2)after anesthesia induction were significantly lower than those before anesthesia(T0)in both groups(P<0.05),and HR and MAP at T1 and T2 in the ropivacaine group were significantly higher than those in the bupivacaine group(P<0.05).The incidence of postoperative adverse reactions in the ropivacaine group was 10.53%,which showed no statistically significant difference compared with 17.57%in the bupivacaine group(P>0.05).Conclusion Compared with bupivacaine,ropivacaine used for combined spinal-epidural anesthesia in elderly patients undergoing transurethral resection of the prostate can more effectively alleviate the intraoperative stress response,maintain hemodynamic stability more steadily,shorten the maintenance time of sensory and motor block,and help reduce the risk of early postoperative cognitive impairment,with a comparable safety profile.
Keywords：ropivacainebupivacainetransurethral resection of the prostateagedstress responsecognitive function
Publication Date：2026-03-20
Online Publishing Date：2026-03-26(First online date of this platform, not the publication date of the document)
Pages：6( 485-490 )