Comparison Of Maternal And Neonatal Effects Of Intratechal fentanıl And Sufentanıl As An Adjunt To Bupıvacaıne Used For spınal Anesthesıan In Cesarean Sectıons

Yıl 2015, Cilt: 5 Sayı: 1, 18 - 25, 04.03.2015

Emişe Tortop Elif Sener Yasemin Üstün , Ersin Köksal Cengiz Kaya Fatih Özkan Erhan Çetinoğlu

https://doi.org/10.16899/ctd.09158

Öz

Objective: To compare the effects of fentanil, and sufentanil added to hyperbaric bupivacaine in patients scheduled for cesarean section under spinal anesthesia.

Material and Method: 60 pregnants has divided into 2 groups. Intratechally  hyperbaric 0.5% bupivacaine+ 20 mcg fentanyl has administered for Fentanyl Group (Group F) and hyperbaric 0.5 % bupivacaine +5 mcg sufentanyl has administered for Sufentanyl Group (Group S).

Hemodynamic parametres, maximum sensory block level, time to reach this level, regression  of the sensory block to T10 dermatome, degree of motor block (Bromage score ), and resolution time, perioperative visual analogoue scale (VAS) score, complet (CAD) and efective analgesia duration (EAD), postoperatif analgesic requirement and consumption were recorded.

Umblical arterial blood gas analyse, APGAR scores, surgical anaesthesia and relaxation quality and quality of analgesia were evaluated.

Results : Time to regression of sensory block to T10  and resolution of the motor block were prolonged in the sufentanil group (p<0.05). VAS scores at birth, uterine exteriorization, and at 2., and 6. hours of the block were found to be higher in the fentanil group (p<0.05). At Group S while CAT and EAT were higher, PCA requirement clips and amounts were lower.Surgical anaesthesia and relaxation quality and patient satisfaction were better in Group S. APGAR scores and blood gas analyses results were similar. Itching rate was higher in Group S

Conclusion: we suggest that sufentanil added to intrathecal bupivacaine may be preffered for cesarean section  because of better patient and surgeon satisfaction, prolonged analgesia time, decreased analgesic requirements and minimal adverse effects.

 

Anahtar Kelimeler

anesthesia, spinal, Bupivacaine Hydrochloride, sufentanil citrate, fentanyl, cesarean section

Sezayen Operasyonlarında Spinal Anestezi İçin Bupivakanie Eklenen İntratekal Fenranil ve Sufentanilin Maternal ve Neonatal Etkilerinin Karşılaştırılması

Öz

Amaç: Sezaryen olgularında spinal anestezide hiperbarik bupivakaine ilave edilen fentanil veya sufentanilin maternal ve neonatal etkilerini karşılaştırmak.

Gereç ve yöntem: İki gruba ayrılan 60 gebeden;

Fentanil grubuna (Grup F); Hiperbarik %0,5 bupivakain 10 mg+fentanil 20 µg,

Sufentanil grubuna (Grup S); Hiperbarik %0,5 bupivakain 10 mg+sufentanil 5 µg intratekal uygulandı.

Hemodinamik parametreler, sensoryal blok düzeyi ve bu düzeye ulaşma zamanı, sensoryal bloğun T10 dermatomuna gerileme zamanı, motor blok derecesi ve çözülme zamanı, vizüel analog skoru (VAS), komplet (KAS) ve efektif analjezi süresi (EAS), postoperatif analjezik gereksinimi ve tüketimi kaydedildi.

Umblikal arteriyel kan gazları, APGAR skoru, cerrahi anestezi ve gevşeme kalitesi ve analjezi kalitesi değerlendirildi.

Bulgular: Duyusal bloğun T10 dermatomuna gerileme ve motor bloğun çözülme zamanı Grup S’de uzundu (p<0,05). Doğum, uterus eksteriorizasyonu, bloğun 2. ve 6. saatlerindeki VAS değerleri fentanil grubunda yüksekti (p<0,05). Grup S’de KAS ve EAS uzunken, HKA istek sayısı ve miktarı az bulundu (p<0.05).Cerrahi anestezi ve gevşeme kalitesi, hasta memnuniyeti Grup S’te daha iyiydi (p<0.05). Apgar skorları ve kan gazı açısından fark gözlenmedi. Kaşıntı oranı Grup S’te daha yüksekti (p<0,05).

Sonuç: Hasta ve cerrah memnuniyetinin daha iyi olması, analjezi süresinin uzun ve analjezik tüketiminin daha az olması ve minimal yan etki profili nedeniyle intratekal bupivakaine eklenen sufentanilin sezaryenda tercih edilebileceğini düşünüyoruz.

 

Anahtar Kelimeler

Anestezi, spinal, bupivakain hidroklorid, sufentanil sitrat, fentanil, sezaryen

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