Total kalça protezi sonrası analjezide ropivakain ve levobupivakain epidural infüzyonlarının karşılaştırılmas
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2007
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info:eu-repo/semantics/openAccess
Özet
Bu çalışmada, total kalça protezi yapılacak, yaşları 40-85 arasında değişen, ASA II-IV grubundan 44 olgu randomize olarak 3 gruba ayrıldı. Operasyon odasında üç yollu EKG, noninvaziv kan basıncı, periferik oksijen satürasyonu monitörizasyonu uygulanan olgulara, lateral dekübitus pozisyonunda, steril koşullarda, L2-3 veya L3-4 aralığından 16 gauge Tuohy iğnesi ile median yaklaşımla, direnç kaybı yöntemi kullanılarak epidural kateter yerleştirildi. Midazolam premedikasyonu sonrası anestezi indüksiyonu için %100 oksijen inhalasyonu ile iv 0.1-0.2 mg/kg etomidat, 0.5 mcg/kg fentanil sitrat ve 0.5 mg/kg rokuronyum uygulandı. Oral endotrakeal entübasyon ve mekanik ventilasyon yapıldı. Anestezi idamesi %50 O2+ %50 N2O ve %1-2 sevofluran ve gerektikçe iv 10 mg rokuronyum ile sağlandı. Operasyon bitiminde, ekstübasyon öncesinde, anestezik gazlar kesildikten sonra, epidural kateterden 5 ml %0.2 ropivakain ya da %0.25 levobupivakain enjekte edildi ve hasta kontrollü analjezi cihazı ile 5ml/saat hızda Grup I'e ropivakain, Grup II'ye levobupivakain sürekli infüzyonu başlatıldı. Grup III kontrol grubu olup gerektikçe nonsteroid antiinflamatuvar ilaç ve opioid verildi. Operasyon bitiminde, ekstübasyon sonrası, 10., 30., 60.dakika ve 2., 4., 6., 8., 12., 18., 24.saatlerde hemodinamik ölçümler ve ağrı skorları kaydedildi. Ek analjezik olarak VAS>4 olduğunda subkutan 2.5 mg morfin uygulandı. Kullanılan toplam morfin dozu ve toplam lokal anestezik dozu, her olgu için not edildi. Postoperatif 60.dakika ve 24.saatlerde yan etkiler ve hasta konforu skorları rapor edildi. Demografik veriler, ASA değerleri ve operasyon süreleri benzerdi. Postoperatif 6.saatte sistolik kan basıncı değerleri ile 30.dakika ve 2.saatte diyastolik kan basıncı değerleri, levobupivakain grubunda daha düşük bulundu (p<0.05). Postoperatif 6. ve 8. saatte dakika solunum sayıları ropivakain grubunda daha düşük tespit edildi (p<0.05). Postoperatif dönemde VAS ve yüz skala sonuçları ile uygulanan ek morfin dozu, kontrol grubunda sonuçlar anlamlı yüksek bulundu (p<0.005). Toplam lokal anestezik dozu, levobupivakain grubunda anlamlı yüksek bulundu (p<0.001). Kalp tepe atımları ve SpO2 değerleri ile bulantı ve kusma insidansları ve hasta konforu skorları açısından fark bulunmadı. Sonuçta; total kalça protezi operasyonlarında postoperatif analjezi amacıyla ropivakain ve levobupivakainin sürekli epidural infüzyonları sırasında, her iki grupta da normal fizyolojik sınırlar içinde olmasına rağmen ropivakain grubunda dakika solunum sayısında azalma ve levobupivakain grubunda ise kan basıncı değerlerinde düşme belirlendi. Her iki ilacın analjezik etkinlik, yan etkiler ve hasta konforu açısından birbirlerine üstünlükleri olmadığı kanısına varıldı. Anahtar kelimeler: Postoperatif analjezi, ropivakain, epidural sürekli infüzyon, levobupivakain
In this study, 44 patients, 40-85 years old, ASA I-IV status, undergoing total hip artroplasty, were randomized in three groups. In the operation theatre, electrocardiogram, non-invasive blood pressure and peripheral oxygen monitorization were used and than in lateral decubitus position an epidural catheter was inserted with using loss resistance technique in L2-3 or L3-4 space with using 16 gauge Tuohy needle in sterile conditions. After intravenous midazolam premedication, the anesthesia induction was performed by using 100% oxygen inhalation and intravenous 0.1-0.2 mg/kg hipnomidate, 0.5 mcg/kg fentanyl citrate and 0.5 mg/kg rocuronium. After endotracheal intubation the maintanence of anesthesia was made by using 50% N2O + 50% O2 and 1-2% sevoflurane and during the operation rocuronium was used for maintanence of neuromusculer blockage if necessary. At the and of the operation, before extubation, 5 ml 0.2% ropivacaine or 5 ml 0.25% levobupivacaine was given using epidural catheter. With using patient controlled analgesia device, 5 ml/hr ropivacaine was given continuosly to Group I and also 5 ml/hr levobupivacaine was started to given continuosly to Group II. Group III was agreed as control group and non-steroidal anti-inflammatory drugs and opioids were given if necessary. At the end of the operation, after extubation, at 10th, 30th, 60th minutes and 2th, 4th, 6th, 8th, 12th, 18th and 24th hours, hemodinamic measurements and pain scores were all recorded. Subcutaneously 2.5 mg morphine was used if VAS pain score was greater than 4. Total morphine consumption and total local anesthetic consumption were all recorded. Side effects and patient satisfaction were recorded at 60th minute and 24th hour in the postoperative period. Demografic data, ASA scores and operation times were similar in all groups. The systolic blood pressure in postoperative 6.hour and diastolic blood pressure measurements in postoperative 30.minute and 2.hour were lower in levobupivacaine group (p<0.05). In postoperative 6. and 8.hours breathing time were lower in ropivacaine group (p<0.05). In postoperative period VAS and face scala pain scores, supplementation morphine dose was higher in control group (p<0.005). Total local anesthetic dose was significantly higher in levobupivacaine group (p<0.001). Heart rate, peripheral oxygen saturation, nausea and vomiting frequency and patient satisfaction were all similar. In conclusion; decreases of breathing rate in ropivacaine group and decreases of blood pressure levels in levobupivacaine group were detected. These decreases were in physiologyc limits normally. There were no differences in analgesic efficiency, side effects and patient satisfaction between the two groups. Key words: Postoperative analgesia, ropivacaine, epidural continuous infusion, levobupivacaine
In this study, 44 patients, 40-85 years old, ASA I-IV status, undergoing total hip artroplasty, were randomized in three groups. In the operation theatre, electrocardiogram, non-invasive blood pressure and peripheral oxygen monitorization were used and than in lateral decubitus position an epidural catheter was inserted with using loss resistance technique in L2-3 or L3-4 space with using 16 gauge Tuohy needle in sterile conditions. After intravenous midazolam premedication, the anesthesia induction was performed by using 100% oxygen inhalation and intravenous 0.1-0.2 mg/kg hipnomidate, 0.5 mcg/kg fentanyl citrate and 0.5 mg/kg rocuronium. After endotracheal intubation the maintanence of anesthesia was made by using 50% N2O + 50% O2 and 1-2% sevoflurane and during the operation rocuronium was used for maintanence of neuromusculer blockage if necessary. At the and of the operation, before extubation, 5 ml 0.2% ropivacaine or 5 ml 0.25% levobupivacaine was given using epidural catheter. With using patient controlled analgesia device, 5 ml/hr ropivacaine was given continuosly to Group I and also 5 ml/hr levobupivacaine was started to given continuosly to Group II. Group III was agreed as control group and non-steroidal anti-inflammatory drugs and opioids were given if necessary. At the end of the operation, after extubation, at 10th, 30th, 60th minutes and 2th, 4th, 6th, 8th, 12th, 18th and 24th hours, hemodinamic measurements and pain scores were all recorded. Subcutaneously 2.5 mg morphine was used if VAS pain score was greater than 4. Total morphine consumption and total local anesthetic consumption were all recorded. Side effects and patient satisfaction were recorded at 60th minute and 24th hour in the postoperative period. Demografic data, ASA scores and operation times were similar in all groups. The systolic blood pressure in postoperative 6.hour and diastolic blood pressure measurements in postoperative 30.minute and 2.hour were lower in levobupivacaine group (p<0.05). In postoperative 6. and 8.hours breathing time were lower in ropivacaine group (p<0.05). In postoperative period VAS and face scala pain scores, supplementation morphine dose was higher in control group (p<0.005). Total local anesthetic dose was significantly higher in levobupivacaine group (p<0.001). Heart rate, peripheral oxygen saturation, nausea and vomiting frequency and patient satisfaction were all similar. In conclusion; decreases of breathing rate in ropivacaine group and decreases of blood pressure levels in levobupivacaine group were detected. These decreases were in physiologyc limits normally. There were no differences in analgesic efficiency, side effects and patient satisfaction between the two groups. Key words: Postoperative analgesia, ropivacaine, epidural continuous infusion, levobupivacaine
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
