COMPARISON OF BUPIVACAINE–FENTANYL AND BUPIVACAINE-ALFENTANIL USED INTRATHECALLY IN LAPAROSCOPIC APPENDECTOMY SURGERY

Year 2021, Volume: 22 Issue: 5, 414 - 421, 04.08.2021

Mehtap Balcı Fatih Balcı Emre Atay , Erhan Bozkurt , Ayşe Ertekin

https://doi.org/10.18229/kocatepetip.835963

Abstract

OBJECTIVE: Acute appendicitis, which is the most common cause of acute abdominal pain, is an acute inflammation of appendix vermiformis. Spinal anesthesia is one of the most used regional anesthesia technique nowadays, and it is the temporary interruption of nerve conduction by local anesthetic solution injected into the cerebrospinal fluid. In this study we created multimodal analgesia by giving various opioid agent (fentanyl and alfentanil) intrathecally with local anesthetic. The aim of this study is to compare bupivacaine-fentanyl and bupivacaine-alfentanil that are used intrathecally to create motor and sensory block.
MATERIAL AND METHODS: This study was planned as a clinical study using the random sampling method in a tertiary care hospital. 50 voluntary patients who were diagnosed with appendicitis by laboratory tests and clinical diagnosis methods in the general surgery clinic were included in the study. The patients were randomly assigned into two group, Group I (10 mg hyperbaric bupivacaine (2cc) and 25 mcg fentanyl (0.5 cc)) and Group II (10 mg hyperbaric bupivacaine (2 cc) and 250 mcg alfentanil (0.5 cc)). The patients were randomly assigned into two group, Group I and Group II. Before the operation, each patient was informed about the use of the patient-controlled analgesia system and visual pain scale (VPS) for pain scoring. It was compared the postoperative analgesic needs of patients who underwent multimodal spinal anesthesia with different opiates. Sensorial block levels were measured by pinprick test every 2 minutes in the first 10 minutes and every 5 minutes in later periods. It was recorded mean arterial pressure at the beginning of the surgery at 0th minute and at 5-10-30th minutes during the surgery. In addition, mean arterial pressure and heart rate were recorded at 1-2-6-12-24th hours postoperatively.
RESULTS: Postoperative first analgesic requirement time of Group I was found to be late than Group II. Postoperative 6th, 12th and 24th hours visual pain scales were found to be significantly lower in Group I than Group II. But 2nd and 6th hours heart rates were found higher in Group I than Group II.
CONCLUSIONS: It was shown that the duration of analgesia was longer and postoperative first analgesia requirements time were so late in patients who were given bupivacaine–fentanyl than the patients given bupivacaine–alfentanil

Keywords

alfentanil, analgesia, intrathecally fentanyl, visual pain scale

LAPAROSKOPİK APENDEKTOMİ CERRAHİSİNDE İNTRATEKAL OLARAK KULLANILAN BUPİVAKAİN-FENTANİL VE BUPİVAKAİN-ALFENTANİLİN KARŞILAŞTIRILMASI

Abstract

AMAÇ: Akut karın ağrısının en sık nedeni olan akut apandisit, apendiks vermiformisin akut enflamasyonudur. Spinal anestezi günümüzde en çok kullanılan bölgesel anestezi tekniklerinden biri olup, beyin omurilik sıvısına enjekte edilen lokal anestezik solüsyon ile sinir iletiminin geçici olarak kesilmesidir. Bu çalışmada çeşitli opioid ajanların (fentanil ve alfentanil) intratekal olarak lokal anesteziyle verilmesi sonucu multimodal analjezi oluşturuldu. Bu çalışmanın amacı, motor ve duyusal blok oluşturmak için intratekal olarak kullanılan bupivakain-fentanil ve bupivakain-alfentanili karşılaştırmaktır.
GEREÇ VE YÖNTEM: Bu çalışma bir üçüncü basamak sağlık kuruluşunda rastgele örneklem yöntemi ile klinik bir çalışma olarak planlandı. Çalışmaya genel cerrahi kliniğinde laboratuvar testleri ve klinik tanı yöntemleri ile apandisit tanısı almış 50 gönüllü hasta dahil edildi. Hastalar rastgele Grup I (10 mg hiperbarik bupivakain (2cc) ve 25 mcg fentanil (0.5 cc)) ve Grup II (10 mg hiperbarik bupivakain (2 cc) ve 250 mcg alfentanil (0.5 cc)) olmak üzere ikiye ayrıldı. Operasyon öncesinde her hastaya ağrı skorlaması için hasta kontrollü analjezi sistemi ve Görsel Analog Skala (GAS) kullanımı hakkında bilgi verildi. Farklı opiyatlarla multimodal spinal anestezi uygulanan hastaların postoperatif analjezik ihtiyaçları karşılaştırıldı. Duyusal blok seviyeleri ilk 10 dakikada 2 dakikada bir, sonraki dönemlerde 5 dakikada bir iğne testi ile ölçüldü. Ameliyat başlangıcında 0. dakikada ve ameliyat sırasında 5-10-30. dakikalarda ortalama arter basıncı kaydedildi. Ayrıca postoperatif 1-2-6-12-24. saatlerde ortalama arter basıncı ve kalp hızı kaydedildi.
BULGULAR: Grup I'in postoperatif ilk analjezik gereksinim zamanı, Grup II'ye göre gecikti. Postoperatif 6., 12. ve 24. saat GAS ölçekleri Grup I'de Grup II'ye göre anlamlı olarak düşük bulundu. Ancak 2. ve 6. saat kalp hızları Grup I'de Grup II'den daha yüksek bulundu.
SONUÇ: Bupivakain-fentanil verilen hastalarda, bupivakain-alfentanil verilen hastalara göre analjezi süresinin daha uzun olduğu ve ameliyat sonrası ilk analjezi gereksinim süresinin çok geç kaldığı gösterilmiştir.

Keywords

alfentanil, analjezi, görsel analog skala, intratekal fentanil

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