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The Comparison of Spinal Ropivacaıne and Levobupivacaine for Transurethral Surgery

Yıl 2019, Cilt: 14 Sayı: 2, 80 - 84, 15.07.2019
https://doi.org/10.17517/ksutfd.571916

Öz

Objective. It was aimed to compare the efficacy of levobupivacaine
and ropivacaine during transurethral resection of the prostate under spinal
anesthesia.

Material and Methods:
In this prospective, randomized, double-blind trial, 40 patients
undergoing elective transurethral resection of the prostate under spinal
anesthesia were randomized into two groups. 
0.75% levobupivacaine 7.5mg (Group I) and 0.75% ropivacaine 7.5mg (Group
II) were used intrathecally.

Results: There
were no differences the time for sensorial block to reach T10, maximum
sensorial block level, the time to reach maximum block level, motor block level
at the end of surgery between the groups. 
The two-segment regression time was 53.75 ± 10.75 minutes in Group I and
73.25 ± 15.50 minutes in Group II (p<0.000), the regression time to reach
T12 was 70.25±17.05 minutes in Group I and 88.00 ± 20.42 in Group II
(p<0.005),  the duration of the motor
block was 60.75±36.93 minutes in Group I and 92.00±26.03 minutes in Group II
(p<0.004). There was not any significant difference between groups with
regard to hemodynamic data and side effects.







Conclusions: This study showed that, low-dose levobupivacaine and
ropivacaine used in transurethral surgery have similar effects and delivers
sufficient and reliable anesthesia. Use of ropivacaine constitutes an advantage
since the motor blockage level is shorter with it.
As a result, it was concluded that
low-dose ropivacaine and levobupivacaine used in transurethral surgery had
similar effects, provided adequate and reliable anesthesia, but ropivacaine was
an advantage because of the short duration of motor block.

Kaynakça

  • 1. Dobson PM, Caldicott LD, Gerrish SP, et al: Changes in hemodynamic variables during transurethral resection of the prostate: Comparison of general and spinal anesthesia. Br J Anesth 1994;72:2672.
  • 2. Gravenstein D: Transurethral resection of the prostate (TURP) syndrome: A review of the patophysiology and management. Anesth Analg 1997;84:438
  • 3. McLure HA, Rubin AP: Review of local anaesthetic agents. Minerva Anesthesiol. 2005; 71: 59-74.
  • 4. McClellan KJ, Faulds D: Ropivacaine: an update of its use in regional anaesthesia. Drugs 2000;60: 1065-1093.
  • 5. Foster RH, Markham A. Levobupivacaine: A Review of its Pharmacology and Use as a Local Anaesthetic. Drugs 2000 Mar; 59 (3): 551-579.
  • 6. Wahedi W, Nolte H, Klein P: Ropivacaine for spinal anesthesia. A dose –finding study. Anaesthesist. 1996 Aug; 45(8):737-44.
  • 7. Sell A, Olkkola K T, Jalonen J, Aantaa R. Minimum effective local anaesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery. Br J of Anaest.2005; 94 (2): 239–42
  • 12. Chung CC, Choi SR, Yeo KW, Park HS: Hyperbaric Spinal Ropivacaine for Cesarean Delivery: A Comparison to Hyperbaric Bupivacaine. Anesth Analg. 2001;93:157–61
  • 9. Cappelleri G, Aldegher G, Danelli G, Marchetti C: Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: A prospective, randomized, double-blind study. Anesth Analg. 2005; 101: 77–82
  • 10. Casati A, Moizo E, Marchetti C, Vinciguerra F, A prospective randomize, double-blind comporison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine or levobupivacaine for inguinal herniorrhaphy.Anaesth Analg 2004; 99: 1387-1392
  • 11. Heef JW, Veering BT, Anton GL. Spinal Anesthesia with Ropivacaine: A Double-Blind Study on the Efficacy and Safety of 0.5% and 0.75% Solutions in Patients Undergoing Minor Lower Limb Surgery. Anesth Analg 1994;78: 1125-30
  • 13. McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafson U. Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml(-1) with bupivacaine 5 mg ml (-1) for major orthopaedic suegery. Br J Anaesth 2002;89:702-6
  • 14. Glasser C, Marhofer P, Zimpfer G, et al: Levopupivacaine versus racemic Bupivacaine for spinal anaesthesia. Anaesth Anal 2002; 94: 194-198
  • 15. Lee YY, Muchhal K, Chan CK: Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intensive Care. 2003; 31(6): 637-641

Transüretral Cerrahide Spinal Anestezide Ropivakain ve Levobupivakainin Karşılaştırılması

Yıl 2019, Cilt: 14 Sayı: 2, 80 - 84, 15.07.2019
https://doi.org/10.17517/ksutfd.571916

Öz

Amaç: Çalışmamızda prostatın
transüretral rezeksiyon (TUR-P) cerrahisinde spinal anestezide kullanılan
levobupivakain ve ropivakainin etkinliklerinin karşılaştırılması amaçlandı.

Gereç ve Yöntemler:
Prospektif, randomize çift kör olarak ASA I-III risk grubunda 40 hasta
çalışmaya dahil edildi. I. Grupta (n=20) intratekal aralığa % 0.75’lik levobupivakain
7.5mg, ikinci grupta % 0.75 ‘lik ropivakain 7,5 mg verilerek spinal anestezi
uygulandı.

Bulgular: Gruplar arasında
duyusal bloğun T10’a ulaşma süreleri, maksimum blok seviyesi, maksimum bloğa
ulaşma süreleri, operasyon sonu motor blok seviyesi bakımından istatistiksel
olarak anlamlı fark yoktu. İki segment regresyon süresi, grup I’de 73,25 ±
15,50 dk, Grup II’de 53,75 ± 10,75 dk, T12’ye regresyon süresi grup I’de 88,00
± 20,42 dk, grup II’de 70,25±17,05 dk, motor blok süresi ise grup I’de 92,00±26,03
dk, grup II’de 60,75±36,93 dk. bulundu. Hemodinamik
veriler ve yan etkiler bakımından istatistiksel olarak anlamlı fark saptanmadı.







Sonuç: Çalışmamızda; düşük doz levobupivakain veya ropivakain ile
yapılan spinal anestezide TUR için yeterli duyusal ve motor blok sağlandı.
Ropivakain grubunda motor blok süresi anlamlı olarak kısa bulundu. Sonuç olarak
transüretral cerrahide kullanılan düşük doz ropivakain ve levobupivakain’in
birbirine benzer etkilerinin olduğu, yeterli seviyede ve güvenilir anestezi sağladığı,
ancak motor blok süresinin kısa olması nedeniyle ropivakain kullanılmasının bir
avantaj olduğu kanısına varıldı. 

Kaynakça

  • 1. Dobson PM, Caldicott LD, Gerrish SP, et al: Changes in hemodynamic variables during transurethral resection of the prostate: Comparison of general and spinal anesthesia. Br J Anesth 1994;72:2672.
  • 2. Gravenstein D: Transurethral resection of the prostate (TURP) syndrome: A review of the patophysiology and management. Anesth Analg 1997;84:438
  • 3. McLure HA, Rubin AP: Review of local anaesthetic agents. Minerva Anesthesiol. 2005; 71: 59-74.
  • 4. McClellan KJ, Faulds D: Ropivacaine: an update of its use in regional anaesthesia. Drugs 2000;60: 1065-1093.
  • 5. Foster RH, Markham A. Levobupivacaine: A Review of its Pharmacology and Use as a Local Anaesthetic. Drugs 2000 Mar; 59 (3): 551-579.
  • 6. Wahedi W, Nolte H, Klein P: Ropivacaine for spinal anesthesia. A dose –finding study. Anaesthesist. 1996 Aug; 45(8):737-44.
  • 7. Sell A, Olkkola K T, Jalonen J, Aantaa R. Minimum effective local anaesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery. Br J of Anaest.2005; 94 (2): 239–42
  • 12. Chung CC, Choi SR, Yeo KW, Park HS: Hyperbaric Spinal Ropivacaine for Cesarean Delivery: A Comparison to Hyperbaric Bupivacaine. Anesth Analg. 2001;93:157–61
  • 9. Cappelleri G, Aldegher G, Danelli G, Marchetti C: Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: A prospective, randomized, double-blind study. Anesth Analg. 2005; 101: 77–82
  • 10. Casati A, Moizo E, Marchetti C, Vinciguerra F, A prospective randomize, double-blind comporison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine or levobupivacaine for inguinal herniorrhaphy.Anaesth Analg 2004; 99: 1387-1392
  • 11. Heef JW, Veering BT, Anton GL. Spinal Anesthesia with Ropivacaine: A Double-Blind Study on the Efficacy and Safety of 0.5% and 0.75% Solutions in Patients Undergoing Minor Lower Limb Surgery. Anesth Analg 1994;78: 1125-30
  • 13. McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafson U. Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml(-1) with bupivacaine 5 mg ml (-1) for major orthopaedic suegery. Br J Anaesth 2002;89:702-6
  • 14. Glasser C, Marhofer P, Zimpfer G, et al: Levopupivacaine versus racemic Bupivacaine for spinal anaesthesia. Anaesth Anal 2002; 94: 194-198
  • 15. Lee YY, Muchhal K, Chan CK: Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intensive Care. 2003; 31(6): 637-641
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Bora Bilal 0000-0003-3884-8042

Özgür Yağan 0000-0003-1596-1421

Mahinur Demet Albayrak Bu kişi benim 0000-0002-2657-872X

Belgin Akan Tunçtürk 0000-0003-1589-3553

Nermin Göğüş Bu kişi benim 0000-0002-1706-7039

Yayımlanma Tarihi 15 Temmuz 2019
Gönderilme Tarihi 30 Mayıs 2019
Kabul Tarihi 12 Haziran 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 14 Sayı: 2

Kaynak Göster

AMA Bilal B, Yağan Ö, Albayrak MD, Akan Tunçtürk B, Göğüş N. The Comparison of Spinal Ropivacaıne and Levobupivacaine for Transurethral Surgery. KSÜ Tıp Fak Der. Temmuz 2019;14(2):80-84. doi:10.17517/ksutfd.571916