Laminektomi operasyonu olan ileri yaş hastalarda genel anestezi ile spinal anestezinin postoperatif ağrı ve analjezik tüketimi üzerine etkileri: retrospektif deneyimlerimiz
Abstract
Giriş ve Amaç: Genel anesteziye (GA) göre spinal
anestezide (SA) lumbar laminektomi cerrahisi uygulanan hastalarda daha stabil
perioperatif hemodinamik durumlar, daha düşük maliyetler ve daha düşük
perioperatif komplikasyon oranı bildirilmiştir. Amacımız bu operasyonu geçirmiş
ileri yaş hastalarda SA ve GA'nın ağrı skalası ve tradomol tüketimi üzerindeki
etkilerini gözlemlemektir
Materyel Metod: Retrospektif olarak planlanan
çalışmada, 01.01.2017 ile 31.12.2017 tarihleri arasında tek seviye lumbar laminektomi
cerrahisi geçiren toplam ASA I-II-III fiziksel durumda ileri yaş (>65 yaş)
121 hasta çalışmaya dahil edildi. SA uygulanan hastalar grup S(n= 62), GA uygulanan
hastalar grup G (n=59) ye dahil edildi. Ameliyattan sonraki 24 saat süresince
postoperatif mobilizasyon süreleri, komplikasyonlar, visuel analog skala (VAS)
ve postoperatif Tradomol HCL tüketimi dosya kayıtları incelenerek kaydedildi.
Bulgular ve Tartışma: Ortalama VAS gruplar arasında
benzerdi (p> 0.05). Toplam Tramadol HCL tüketimi, S ve G grupları için
120.96 mg ve 213.55 mg (p <0.05) idi. İlk tramadol HCL, S ve G grupları için
589.51 ve 233.13 dakika (p <0.05) idi. Postoperatif mobilizasyon süreleri ve
yan etkiler gruplar arasında farklılık göstermedi (p> 0.05). Bu çalışmanın
sonuçları, SA'nın tek seviye lumbar laminektomi cerrahisinde genel anesteziye
göre daha güvenli ve daha rahat bir anestezik yöntem olduğunu göstermiştir.
Sonuç: SA ile yaşlı olan hastalarda lumbar
laminektomi cerrahisi güvenlidir, Postoperatif ağrı kontrolü daha iyi olup Tradamol
tüketiminin daha düşüktür. Bu bulguları doğrulamak için ileriye dönük
çalışmalara ihtiyaç vardır.
References
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- 2. Finsterwald M, Muster M, Farshad M, Saporito A, Brada M, Aguirre JA. Spinal versus general anesthesia for lumbar spine surgery in high risk patients: Perioperative hemodynamic stability, complications and costs. J Clin Anesth. 2018 Jan 6;46:3-7. doi: 10.1016/j.jclinane.2018.01.004
- 3. Sieber FE, Barnett SR. Preventing postoperative complications in the elderly. Anesthesiol Clin. 2011 Mar;29(1):83-97. doi: 10.1016/j.anclin.2010.11.011. Epub 2011 Jan 5.
- 4. Yun SH, Park JC, Kim SR, Choi YS. Effects of Dexmedetomidine on Serum Interleukin-6, Hemodynamic Stability, and Postoperative Pain Relief in Elderly Patients under Spinal Anesthesia. Acta Med Okayama. 2016;70(1):37-43.
- 5. Liu LL, Wiener-Kronish JP. Perioperative anesthesia issues in the elderly. Crit Care Clin. 2003 Oct;19(4):641-56
- 6. Mclain RF, Bell GR, Kalfas I, et al. Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia. Spine 2004;29:2542- 2547
- 7. Mclain RF, Kalfas I, Bell GR, et al. Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine 2005;2:17-22.
- 8. Demirel CB, Kalayci M, Ozkocak I, et al. A prospective randomized study comparing perioperative out- come variables after epidural or general anesthesia for lumbar disc surgery. J Neurosurg Anesthesiol 2003;15:185-192.
- 9. Attari MA, Mirhosseini SA, Honarmand A, and Safavi MR. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial. J Res Med Sci 2011;16:524-529.
- 10. Khosravi MB, Azemati S, Sahmeddini MA Gabapentin versus naproxen in the management of failed back surgery syndrome; a randomized controlled trial. Acta Anaesthesiol Belg. 2014;65(1):31-7.
- 11. Khan ZH, Rahimi M, Makarem J, Khan RH. Optimal dose of pre-incision/post-incision gabapentin for pain relief following lumbarlaminectomy: a randomized study. Acta Anaesthesiol Scand. 2011 Mar;55(3):306-12. doi: 10.1111/j.1399-6576.2010.02377.x.
- 12. Vrdoljak D, Borovac JA. Medication in the elderly - considerations and therapy prescription guidelines. Acta Med Acad. 2015;44(2):159-68. doi: 10.5644/ama2006-124.142.
- 13. Kuo TC, Hsu JL, Su KS, Huang CH, Lee DN, Cherng NY, Chen WS.Pre- and intra-operative administration of epidural morphine provides good postoperative painrelief after laminectomy. Acta Anaesthesiol Sin. 1996 Jun;34(2):69-74.
- 14. Teddy PJ, Fabinyi GC, Kerr JH, Briggs M. Bupivacaine infiltration after lumbar laminectomy. Local infiltration in the control of early postoperative lumbar laminectomy pain. Anaesthesia. 1981 Apr;36(4):380-3.
Abstract
References
- 1. Agarwal P, Pierce J, Welch WC. Cost analysis of spinal versus general anesthesia for lumbar diskectomy and laminectomy spine surgery. World Neurosurg 2016;89: 266–71.
- 2. Finsterwald M, Muster M, Farshad M, Saporito A, Brada M, Aguirre JA. Spinal versus general anesthesia for lumbar spine surgery in high risk patients: Perioperative hemodynamic stability, complications and costs. J Clin Anesth. 2018 Jan 6;46:3-7. doi: 10.1016/j.jclinane.2018.01.004
- 3. Sieber FE, Barnett SR. Preventing postoperative complications in the elderly. Anesthesiol Clin. 2011 Mar;29(1):83-97. doi: 10.1016/j.anclin.2010.11.011. Epub 2011 Jan 5.
- 4. Yun SH, Park JC, Kim SR, Choi YS. Effects of Dexmedetomidine on Serum Interleukin-6, Hemodynamic Stability, and Postoperative Pain Relief in Elderly Patients under Spinal Anesthesia. Acta Med Okayama. 2016;70(1):37-43.
- 5. Liu LL, Wiener-Kronish JP. Perioperative anesthesia issues in the elderly. Crit Care Clin. 2003 Oct;19(4):641-56
- 6. Mclain RF, Bell GR, Kalfas I, et al. Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia. Spine 2004;29:2542- 2547
- 7. Mclain RF, Kalfas I, Bell GR, et al. Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine 2005;2:17-22.
- 8. Demirel CB, Kalayci M, Ozkocak I, et al. A prospective randomized study comparing perioperative out- come variables after epidural or general anesthesia for lumbar disc surgery. J Neurosurg Anesthesiol 2003;15:185-192.
- 9. Attari MA, Mirhosseini SA, Honarmand A, and Safavi MR. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial. J Res Med Sci 2011;16:524-529.
- 10. Khosravi MB, Azemati S, Sahmeddini MA Gabapentin versus naproxen in the management of failed back surgery syndrome; a randomized controlled trial. Acta Anaesthesiol Belg. 2014;65(1):31-7.
- 11. Khan ZH, Rahimi M, Makarem J, Khan RH. Optimal dose of pre-incision/post-incision gabapentin for pain relief following lumbarlaminectomy: a randomized study. Acta Anaesthesiol Scand. 2011 Mar;55(3):306-12. doi: 10.1111/j.1399-6576.2010.02377.x.
- 12. Vrdoljak D, Borovac JA. Medication in the elderly - considerations and therapy prescription guidelines. Acta Med Acad. 2015;44(2):159-68. doi: 10.5644/ama2006-124.142.
- 13. Kuo TC, Hsu JL, Su KS, Huang CH, Lee DN, Cherng NY, Chen WS.Pre- and intra-operative administration of epidural morphine provides good postoperative painrelief after laminectomy. Acta Anaesthesiol Sin. 1996 Jun;34(2):69-74.
- 14. Teddy PJ, Fabinyi GC, Kerr JH, Briggs M. Bupivacaine infiltration after lumbar laminectomy. Local infiltration in the control of early postoperative lumbar laminectomy pain. Anaesthesia. 1981 Apr;36(4):380-3.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Article |
| Authors | |
| Publication Date | March 3, 2019 |
| Submission Date | May 2, 2018 |
| Published in Issue | Year 2019 Volume: 46 Issue: 1 |