Spinal Anestezi ile Transüretral Rezeksiyon Yapılan Hastalarda Bupivakain ve Ropivakaine Bağlı Geçici Nörolojik Semptom İnsidansının Karşılaştırılması

Yıl 2009, Cilt: 42 Sayı: 2, 61 - 68, 01.08.2009

Gülbahar Gülnerman Selma Keleş Menşure Kaya Neslihan Kuru Nihal Kadıoğulları

Öz

İn the present study ıve compared transient neurological symptoms, and recovery characteristics of patients undergoing transurethral resection in lithotomy position with spinal anesthesia using bupivacaine or ropivacaine. Ninety ASA 1-3 patients were enrolled in to the study. Spinal anesthesia was performed with modified pencil-point needle in sitting position in ali patients. Group 1; received 3 mL of 0.5% hyperbaric bupivacaine 15 mg, group 2; 3 mL of 0.5% hyperbaric ropivacaine 15 mg and group 3; 3 mL of isobaric ropivacaine 15 mg. Hemodynamic parameters, level of sensorial and motor block were recorded. At 24, 48 and 72 hand one week later, patients were interviewed about pain in surgical area, lumbar pain and transient neurological symptoms. The regression time of sensorial block to L1 dermatome was longer in hyperbaric bupivacaine group. The complete resolution of motor was shortest in hyperbaric ropivacaine group and iongest in hyperbaric bupivacaine group. There was no dif-ference among the group regarding surgical and lumbar pain, and transient neurological symptom. One patient both in hyper-baric bupivacaine and hyperbaric ropivacaine group had transient neurological symptom. The lumbar pain was moderate in both patients and symptoms resoived completely in ten days. İn conclusion, similar sensorial and motor block levels were obtained with bupivacaine and ropivacaine. The duration of sensorial and motor block were shorter in both ropivacaine groups. The inci-dence of transient neurological symptoms were similar in three groups. Ropivacaine can be an alternative to bupivacaine in short duration surgical procedures with its similar effects and transient neurological symptoms incidence.

Anahtar Kelimeler

Spinal anesthesia, postoperative complications, transient neurologic symptoms, lithotomy position, ropivacaine, bupivacaine.

The Comparison of the Incidence of Transierıt Neurological Symptoms Associated By Bupivacain and Ropivacain in Patients Undergoing Transurethral Resection with Spinal Anesthseia

Öz

Bu çalışmada spinal anestezi ile litotomi pozisyonunda transüretral rezeksiyon uygulanan hastalarda, bupivakain ve ropivakaine bağlı geçici nörolojik semptom insidansı ve derlenme özellikleri karşılaştırıldı. ASA 1 -3 grubundan 90 hasta çalışmaya alındı. Spinal anestezi tüm hastalarda oturur pozisyonda, modifiye "pencil-point" iğne kullanılarak uygulandı. Birinci gruba 3 mL 15 mg %0.5 hiperbarik bupivakain, ikinci gruba 3 mL 15 mg %0.5 hiperbarik ropivakain, üçüncü gruba ise 3 mL 15 mg izobarik ropi-vakain enjekte edildi. Hemodinamik parametreler ile sensöriyel ve motor blok düzeyleri kaydedildi. Hastalarla 24, 48 ve 72. saatlerde ve bir hafta sonunda görüşülerek operasyon bölgesinde ağrı, bel ağrısı ve geçici nörolojik semptomlar sorgulandı. Sensöriyel bloğun L1 dermatomuna gerileme süresi hiperbarik bupivakain grubunda, ropivakain gruplarına göre anlamlı olarak uzun bulundu. Motor bloğun derlenme süresi hiperbarik ropivakain grubunda en kısa, hiperbarik bupivakain grubunda ise en uzundu. Gruplar arasında operasyon bölgesindeki ağrı ve bel ağrısı ile geçici nörolojik semptom insidansı yönünden anlamlı farklılık bulunmadı. Hiperbarik bupivakain ve hiperbarik ropivakain gruplarında birer hastada geçici nörolojik semptom bulguları görüldü. Her iki hastada bel ağrısı orta şiddetliydi ve semptomlar 10. günde tamamen düzeldi. Sonuç olarak, transüretral rezeksiyon operasyonlarında, bupivakain ve ropivakain ile benzer sensöriyel ve motor blok düzeyi elde edildi. Ancak sensöriyel ve motor blok süresi ropivakain gruplarında bupivakaine göre daha kısaydı. Geçici nörolojik semptom insidansı her üç grupta benzerdi. Benzer etki profili ve geçici nörolojik semptom insidansı ile ropivakain, kısa süreli cerrahi girişimlerde bupivakaine alternatif olabilecek bir anestezik ajandır.

Anahtar Kelimeler

Kelimeler: Spinal anestezi, postoperatif komplikasyon, geçici nörolojik semptom, litotomi pozisyonu, ropivakain, bupivakain.

Kaynakça

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