THE COMPARISON OF HYPERBARIC BUPIVACAINE AND ROPIVACAINE USAGE IN SPINAL ANESTHESIA AT HIP AND LOWER EXTREMITY SURGERY

Yıl 2013, Cilt: 3 Sayı: 1, 36 - 41, 01.03.2013

Aynur Şahin Mevlüt Çömlekçi

Öz

Introduction: Hyperbaric forms of ropivacaine and bupivacaine were frequently prefered to perform in spinal anesthesia for orthopedic surgery. It was reported that hyperbaric form of ropivacaine which obtained by adding glucose to the isobaric form, was adequate to provide an effective spinal anesthesia. In the present study; we aimed to compare the effects of hyperbaric ropivacaine and bupivacaine in spinal anesthesia. Material and Methods: After the Ethics Committee approval, 60 patients whose planned hip and lower extremity operation, ages between 20 and 78, ASA I and II, were included into study. Patients were seperated into two randomized groups; Group A and Group B, after informed consents were obtained. Hyperbaric bupivacaine 12.5 mgs to Group A and hyperbaric ropivacaine 12.5 mgs to Group B were administered by entering intrathecal space with 25 Gauge Quincke-Babcock type spinal needle. Heart rates, systolic, diastolic and mean arterial blood pressures, perpiherical oxygen saturation values of the patients were measured at every five minutes. The time of sensory block to reach T10 level, top dermatome level and lasting time; starting time of motor block, time to reach top dermatome level and lasting times were recorded. Complications in peroperative and postoperative period were recorded. Results: The time of sensory block to reach T10 dermatome in Group B was found shorter. Times of sensory and motor block to reach top dermatomal level in Group A were higher than Group B. The sensory and motor block lasting times were found higher in Group B. Since, hypotension in 6, bradycardia in 2 and vomiting in 2 patients were occured in Group A, hypotension in 4, bradycardia in 3 and vomiting in 2 patients were seen in Group B. Conclusion: Ropivacaine and bupivacaine usage in hip and lower extremity surgery may provide hemodynamic stability, therefore we suggest that ropivacaine and bupivacaine are safe to use in spinal anesthesia for this kind of processes.

Anahtar Kelimeler

Ropivacaine, bupivacaine, anesthesia, spinal, complications.

KALÇA VE ALT EKSTREMİTE CERRAHİSİNDE SPİNAL ANESTEZİ TEKNİĞİ İLE HİPERBARİK BUPİVAKAİN VE ROPİVAKAİN KULLANIMLARININ KARŞILAŞTIRILMASI

Öz

Giriş: Ortopedik cerrahide bupivakain ve ropivakainin sıklıkla hiperbarik formları tercih edilmektedir. Ropivakainin izobarik formuna glukoz eklenerek elde edilen hiperbarik formun etkili bir spinal anestezi sağladığı bildirilmiştir. Bu çalışmada; spinal anestezi tekniği ile hiperbarik bupivakain ve ropivakainin kullanımlarının karşılaştırılması amaçlanmıştır. Materyal ve Metod: Etik Kurul onayı alındıktan sonra, kalça ve alt ekstremite ameliyatı olacak, yaşları 20 ile 78 arasında, ASA I veya II olan, toplam 60 hasta çalışmaya dahil edildi. Hastaların onamları alınarak, Grup A ve Grup B olarak randomize eşit iki gruba ayrıldı. 25 Gauge Quincke-Babcock tipi spinal iğne ile intratekal mesafeye girilerek, Grup A'ya, hiperbarik bupivakain 12.5 mg ve Grup B'ye, hiperbarik ropivakain 12.5 mg uygulandı. Hastaların kalp atım hızları, sistolik, diyastolik, ortalama arteriyel basınçları, periferik oksijen saturasyonu değerleri ameliyatın bitimine kadar her 5 dakikada bir ölçüldü. Hastalarda duyusal bloğun T10 düzeyine ulaşma süresi, maksimal üst dermatom seviyesi, maksimal düzeye ulaşma ve sonlanma zamanı, motor bloğun başlama, maksimal düzeye ulaşma ve geri dönüş zamanları kaydedildi. Peroperatif ve postoperatif görülen komplikasyonlar kaydedildi. Bulgular: Duyusal bloğun T10 dermatomuna ulaşması için geçen süre Grup B'de daha kısa idi. Grup A'da duyusal bloğun maksimal üst dermatomal seviyeye ulaşma zamanı ve maksimal motor bloğa ulaşma zamanı daha uzun bulundu. Duyusal bloğun sonlanma zamanı ve motor bloğun geri dönüş süresi Grup B'de daha uzun bulundu. Grup A'daki hastaların 6'sında hipotansiyon, 2'sinde bradikardi, 2'sinde kusma görülürken; Grup B'dekilerin 4'ünde hipotansiyon, 3'ünde bradikardi ve 2'sinde kusma görüldü. Sonuç: Ortopedik kalça ve alt ekstremite cerrahisinde, ropivakain ve bupivakain kullanılmasının, hemodinamik stabilite sağladığı ve bu nedenle, güvenle kullanılabileceğini düşünmekteyiz.

Anahtar Kelimeler

Ropivakain, bupivakain, anestezi, spinal, komplikasyonlar.

Kaynakça

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