Spinal Anestezide, Kullanılan İki Farklı Morfin Dozunun Etkinlik Değerlendirmesi

Abstract

Objectives: Spinal anesthesia is the most commonly used anesthesia technique in cesarean sections and intrathecal opioids are frequently used for pain control. Intrathecal morphine provides effective and long-term pain control in the postoperative period. The aim of our study was to compare the intrathecal two different morphine doses in terms of additional analgesic need, patient satisfaction, and side effects. Materials and Methods: A total of 165 American Society of Anesthesiologists (ASA) I-II patients who will undergo elective cesarean section at Ankara University Faculty of Medicine, Gynecology and Obstetrics Hospital were included in the study. The study was designed as prospective, randomized and double-blind. The pregnant women were randomly alloceted into three groups to receive either 50 or 100 μg intrathecal morphine and the control group. All patients were anesthetized with 10 mg hyperbaric bupivacaine. Pain levels of the patients were determined by visual analogue scale (VAS) at 24 hours postoperatively and additional analgesic needs were determined. Morphine-related side effects such as nausea-vomiting, pruritus and respiratory depression were evaluated. Results: In the postoperative period, VAS scores and additional analgesic needs were found to be significantly lower in the morphine-administered groups compared to the control group. There was no significant difference between Groups II and III in terms of these parameters. Itching and nausea-vomiting were found to be significantly higher in Group III compared to Group II. Conclusion: We found that intrathecal 50 μg morphine dose had the same analgesic efficacy as the 100 μg dose for cesarean section operations. We think that 50 μg intrathecal morphine dose is an effective analgesic dose for pain control after cesarean section, due to the lower incidence of postoperative side effects. Key Words: Caesarean, Intrathecal Morphine, Postoperative Analgesia

Keywords

• Caesarean
• Intrathecal Morphine
• Postoperative Analgesia

Spinal Anestezide, Kullanılan İki Farklı Morfin Dozunun Etkinlik Değerlendirmesi

Abstract

Amaç: Spinal anestezi sezaryen operasyonlarında en sık kullanılan anestezi tekniğidir. Spinal anestezi ile gerçekleştirilen sezaryen operasyonlarından sonra ağrı kontrolü için sıklıkla intratekal opioidler kullanılmaktadır. İntratekal morfin, postoperatif dönemde etkin ve uzun süreli bir ağrı kontrolü sağlamaktadır. Çalışmamızın amacı sezaryen operasyonu geçiren gebelerde iki faklı dozda uygulanan intratekal morfin dozunu etkinlik, ek aneljezik ihtiyaç, hasta memnuniyeti ve yan etkiler açısından karşılaştırmaktır. Gereç ve Yöntem: Ankara Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Hastanesi’nde elektif sezaryen operasyonuna alınacak American Society of Anesthesiologists (ASA) I-II toplam 165 hasta çalışmaya dahil edildi. Çalışma prospektif, randomize ve çift kör olarak tasarlandı. Gebeler intratekal 50 mikrogram (μg) (Grup II), 100 μg (Grup III) morfin uygulanan ve morfin uygulanmayan kontrol grubu (Grup I) olarak randomize edildi. Tüm gruplara 10 mg hyperbaric bupivacaine intratekal olarak uygulandı. Hastaların postoperatif 24 saat görsel analog skalası (VAS) ile ağrı düzeyleri saptandı, ek analjezik ihtiyaçları belirlendi. Morfine bağlı bulantı-kusma, kaşıntı ve solunum depresyonu gibi yan etkiler değerlendirildi. Bulgular: Postoperatif dönemde morfin uygulanan gruplarda VAS skorları ve ek aneljezik ihtiyaçları kontrol grubuna göre anlamlı olarak düşük saptandı. Grup II ve III arasında bu parametreler açısından anlamlı fark saptanmadı. Kaşıntı ve bulantı-kusma Grup III’te Grup II’ye oranla anlamlı olarak yüksek saptandı. Sonuç: Sezaryen operasyonları için intratekal 50 μg morfin dozunun 100 μg dozla aynı analjezik etkinlikte olduğunu saptadık. Postoperatif yan etki sıklığının daha az olması nedeniyle 50 μg intratekal morfin dozunun sezaryen sonrası ağrı kontrolünde etkin analjezik doz olduğunu düşünmekteyiz. Anahtar Kelimeler: Sezaryen, İntratekal Morfin, Postoperatif Analjezi

Keywords

• Sezaryen
• İntratekal Morfin
• Postoperatif Analjezi

References

1. 1. Sharpe EE, Molitor RJ, Arendt KW, et al. Intrathecal Morphine versus Intrathecal Hydromorphone for Analgesia after Cesarean Delivery: A Randomized Clinical Trial. Anesthesiology. 2020;132:1382-1391.
2. 2. Tamura T, Yokota S, Ando M, et al. A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section. Int J Obstet Anesth. 2019;40:32-38.
3. 3. Yonekura H, Mazda Y, Noguchi S, et al. Trend in neuraxial morphine use and postoperative analgesia after cesarean delivery in Japan from 2005 to 2020. Sci Rep. 2022;12:17234.
4. 4. Carvalho FA, Tenório SB. Comparative study between doses of intrathecal morphine for analgesia after caesarean. Braz J Anesthesiol. 2013;63:492- 499.
5. 5. Axelsson K, Widman GB. A comparison of bupivacaine and tetracaine in spinal anaesthesia with special reference to motor block. Acta Anaesthesiol Scand. 1985;29:79-86.
6. 6. AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON FETUS AND NEWBORN; AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS COMMITTEE ON OBSTETRIC PRACTICE. The Apgar Score. Pediatrics. 2015;136:819-822.
7. 7. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-S252.
8. 8. Şanli M, Gülhaş N, Bilen BT, et al. The effect of addition of ketamineto lidocaine on postoperative pain in rhinoplasties. Turk J Med Sci. 2016;46:789-794.

9. 9. Abouleish E, Rawal N, Fallon K, et al. Combined intrathecal morphine and bupivacaine for cesarean section. Anesth Analg. 1988;67:370-374.
10. 10. Girgin NK, Gurbet A, Turker G, et al. Intrathecal morphine in anesthesia for cesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine. Journal of Clinical Anesthesia.2008;20:180-185.
11. 11. Milner AR, Bogod DG, Harwood RJ. Intrathecal administration of morphine for elective Caesarean section. A comparison between 0.1 mg and 0.2 mg. Anaesthesia. 1996;51:871-873.
12. 12. Uchiyama A, Nakano S, Ueyama H, et al. Low dose intrathecal morphine and pain relief following caesarean section. Int J Obstet Anesth. 1994;3:87-91.
13. 13. Palmer CM, Emerson S, Volgoropolous D, et al. Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology. 1999;90:437-444.
14. 14. Ganem EM, Módolo NS, Ferrari F, et al. Efeitos da associação entre pequenas doses subaracnóideas de morfina e cetoprofeno venoso e oral em pacientes submetidas à cesariana [Effects of low spinal morphine doses associated to intravenous and oral ketoprofen in patients submitted to cesarean sections]. Rev Bras Anestesiol. 2003;53:431-439.
15. 15. Aly M, Ibrahim A, Farrag W, et al. Pruritus after intrathecal morphine for cesarean delivery: incidence, severity and its relation to serum serotonin level. Int J Obstet Anesth. 2018;35:52-56.
16. 16. Mikuni I, Hirai H, Toyama Y, et al. Efficacy of intrathecal morphine with epidural ropivacaine infusion for postcesarean analgesia. J Clin Anesth. 2010;22:268-273.
17. 17. Cardoso MM, Carvalho JC, Amaro AR, et al. Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery. Anesth Analg. 1998;86:538-541.
18. 18. Bauchat JR, Weiniger CF, Sultan P, et al. Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia. Anesth Analg. 2019;129:458-474.
19. 19. Kato R, Shimamoto H, Terui K, et al. Delayed respiratory depression associated with 0.15 mg intrathecal morphine for cesarean section: a review of 1915 cases. J Anesth. 2008;22:112-116.
20. 20. Terajima K, Onodera H, Kobayashi M, et al. Efficacy of intrathecal morphine for analgesia following elective cesarean section: comparison with previous delivery. J Nippon Med Sch. 2003;70:327-333.