Diz Protez Cerrahisinde Preinsizyonel ve Postinsizyonel Epidural, Bupivakain Verapamil ve Ketamin Postoperatif Analjezik Tüketimine Etkileri

Year 2011, Volume: 64 Issue: 1, 36 - 45, 01.01.2011

Evren Özgencil Feyhan Ökten Melek Tulunay Asuman Uysalel

https://doi.org/10.1501/Tipfak_0000000783

Abstract

Keywords

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Diz Protez Cerrahisinde Preinsizyonel ve Postinsizyonel Epidural, Bupivakain Verapamil ve Ketamin Postoperatif Analjezik Tüketimine Etkileri

Abstract

Hastalar ve Yöntem: Çalışmaya total diz artroplastisi planlanan 164 hasta dahil edilmiş, hastalar
rastgele 8 gruba ayrılmıştır. Grup 1(preB), preinsizyonal bupivakain, postinsizyonal serumfizyolojik
(SF); grup 2 (postB), preinsizyonal SF, postinsizyonal bupivakain; grup 3 (preBK), preinsizyonal
bupivakain+ketamin, postinsizyonal SF; grup 4 (postBK), preinsizyonal SF, postinsizyonal
bupivakain+ketamin; grup 5 (preBKV), preinsizyonal bupivakain+ketamin+verapamil, postinsizyonal
SF; grup 6 (postBKV), preinsizyonal SF, postinsizyonal bupivakain+ketamin+verapamil; grup 7
(preBV), preinsizyonal bupivakain+verapamil, postinsizyonal SF; grup 8 (postBV), preinsizyonal SF,
postinsizyonal bupivakain+verapamil olarak planlanmıştır. Epidural uygulanan ajanların dozları şu
şekildedir: bupivakain, %0.5’lik 50 mg; ketamin 60 mg; verapamil 5 mg ; serum fizyolojik 10 ml.
Hastaların epidural kateterleri yerleştirildikten sonra standart monitorizasyon ile genel anestezi verilmiş,
preinsizyonal uygulama için cerrahi insizyondan 15 dk. önce, postinsizyonal uygulama içinse
cerrahi insizyondan 30 dk. sonra epidural ilaçlar uygulanmıştır. Derlenme, ağrı düzeyi ve analjezik
gereksinimi, yan etkiler, hasta ve hekim memnuniyeti kaydedilmiştir. Bulgular: Bupivakaine kıyasla,
ketamin ve/veya verapamilli kombinasyonların analjezik etkinlikleri daha iyi bulunmuştur. Postoperatif
24 saat kombinasyon gruplarının analjezik tüketimleri benzer iken, ikinci 24 saatte verapamilli
kombinasyonlarınki daha düşüktür. Tüm preemptif gruplarda analjezik tüketimi postinsizyonel
olanlara göre daha düşük, global değerlendirmede ise hasta ve hekim memnuniyeti açısından en
iyi grup preBKV bulunmuştur.
Sonuç: Epidural bupivakaine ketamin ve verapamil eklenmesi ile daha etkin ve uzun analjezi sağ-
lanmakta, preemptif uygulama ile postinsizyonel uygulamaya göre postoperatif analjezik gereksinimi
azalmaktadır.

Keywords

Postoperatif ağrı, diz protez cerrahisi, analjezik tüketimi, bupivakain, ketamin, verapamil, epidural

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