Spinal Anestezi İle Artroskopik Diz Cerrahisi Geçiren Olgularda Intraartiküler Morfin Ve Ketaminin Postoperatif Aneljeziye Etkisi

Year 2006, Volume: 23 Issue: 4, 113 - 119, 30.12.2009

A. Canpolat S.a. Karacalar B. Sarıhasan A. Tür

Abstract

The Effect of Intraarticular Morphine and Ketamine on Postoperative Analgesia in Patients Undergoing Arthroscopic Knee Surgery Under Spinal Anesthesia

Arthroscopic surgery of the knee is a common out patient procedure. Anesthesia for this kind of surgery should provide sufficient surgical conditions, good postoperative analgesia and early discharge from hospital and minimum side effects. The aim of this study was to eva luate the effects of intraarticular morphine and ketamine on postoperative analgesia and find out the side effects of them in the patients undergoing arthroscopy under spinal a n e sthesia.
ASA I-II, 90 patients scheduled for arthroscopic surgery were included in this study. All patients operated under spinal anaesthesia. Spinal anesthesia was performed at L4-5 inte rsp ac e with 10 mg 0.5% hyperbaric bupivacain. Patients were randomly allocated to receive intraarticular 0.1 mg kg-1 morphine diluted with saline into 30 ml (group M, n=30) or intraarticular 0.5mg kg-1 ketamine diluted with saline into 30 ml (group K, n=30) or intraarticular 30 ml saline (group SF, n=30) at the and of the surgery. Visual analogue score at 4, 8, 12, 24 hr after surgery, ,duration of motor block, duration of first mobilization, the first pain feeling time, the VAS score during first mobilization, the number of patient r e q u e ring rescue analgesic and adverse effects were recorded.

VAS scores at 4, 8, 12, 24 hours and during first mobilization were lower in group M and K than in group SF. First analgesic rescue times were longer in group M (139.5±25.0) and group K'nin (145.5± 40.0) than group SF (124.2±16.2). The number of patients requiring analgesic in 24 hours was higher in group SF than group M and K. No side effect was seen in group M and SF but hallucination was observed in one patient in group K. Conclusion: Intraarticular morphine and ketamine provided better postoperative analgesia than saline group in outpatients requiring arthroscopic knee surgery under spinal anesthesia, However unwanted side effects might seen in ketamine group. That's why we belive that intraarticular morphine administration for postoperative analgesia is suitable in patient undergoing arthroscopic knee surgery.



Artroskopik diz cerrahisi genellikle günübirlik girişim olarak planlanır. Bu girişimlerde uygulanacak anestezi, yeterli cerrahi koşullar ile birlikte postoperatif analjeziyi ve erken mobi-lizasyonu da sağlamalıdır. Bu çalışmanın amacı, spinal anestezi ile artroskopik cerrahi uygulanan olgularda, girişim sonunda intraartiküler verilen morfin, ketamin ve serum fizyolojiğin postoperatif analjezi ve yan etkiler yönünden karşılaştırılmasıdır.
Çalışmaya, yaşları 18-44 arasında, ASA I-II, artroskopik cerrahi planlanan 90 hasta dahil edildi. Tüm olgulara L3-4 seviyesinden 10 mg 0.5% hiperbarik bupivakain ile spinal anestezi yapıldı. Olgular randomize olarak her grupta 30 olgu olacak şekilde 3 gruba ayrıldı. Operasyonun sonunda, birinci gruba (Grup M) intraartiküler 0,1 mg/kg morfin (toplam 30 ml serum fizyolojik içinde), ikinci gruba (Grup K) intraartiküler 0,5 mg/kg ketamin (toplam 30 ml serum fizyolojik içinde) ve serum fizyolojik grubuna (Grup SF) intraartiküler 30 ml serum fizyolojik verildi.Tüm hastalarda postoperatif 4, 8, 12 ve 24.saatlerdeki VAS değerleri, motor blok süreleri, ilk mobilizasyon zamanları, ilk analjezik gereksinim zamanları (İAGZ), ilk mo-bilizasyon sırasındaki VAS değerleri, postoperatif analjezik ihtiyacı olan hasta sayıları ve yan etkiler kaydedildi.
Grup M ve K nın 4, 8, 12 ve 24. saatlerdeki ve ilk mobilizasyon sırasındaki VAS değerleri Grup SF' ye göre anlamlı derecede düşüktü. Grup M (139.5±25.0) ve K'nın (145.5± 40.0) ilk analjezik gereksinim zamanları Grup SF'ye (124.2±16.2) göre anlamlı derecede uzundu. Grup SF'de ilk 24 saatte ek analjezik ihtiyacı olan hasta sayısı Grup M ve K'ya göre anlamlı derecede fazla bulundu (p<0.001). Grup M ve SF'de herhangi bir yan etki gözlenmezken, Grup K'da 1 hastada intra artiküler enjeksiyona bağlı halüsinasyon gözlendi (p>0.05). Spinal anestezi ile artroskopik diz operasyonu yapılan günübirlik olgularda, intraartiküler verilen morfin ve ketaminin kontrol grubu ile karşılaştırıldığında etkin postoperatif analjezi sağladığı, ancak ketamin grubunda istenmeyen sistemik yan etkiler gözlenebileceği için, ar-troskopik girişim yapılacak olgularda postoperatif analjezi amacı ile intraartiküler morfin verilmesinin uygun olduğu kanısına varıldı.

Keywords

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