The Efficacy of Intrathecal Morphine With Bupivacaine For Postoperative Analgesia After TUR-B

Öz

Objective,: In this randomized study, we evaluated two different doses of intrathecal (IT) morphine with bupivacaine for analgesia after transurethral resection of bladder (TUR-B). Methods: Seventy-five patients were randomly divided into three groups. They were allocated to receive IT morphine (100 µg) with 12.5 mg 0.5% bupivacaine (Group 1), IT morphine (200 µg) with 12.5 mg 0.5% bupivacaine (Group 2), and IT 12.5 mg 0.5% bupivacaine without morphine (Group 3). Postoperative pain was evaluated by VAS during 24 h and each patient was given intravenous paracetamol and Dexketoprophen trometamol if pain severity was moderate. Results: VAS scores were significantly lower in Groups I and II than Group III at 1h, 2h, 4h, 6h, 12h (p< 0.05) (Figure 1). The request for analgesia was significantly higher in Group III than the other two groups (p< 0.05). More patients reported postoperative nausea in Group II than the other two groups (p< 0.05) (Figure 2). Conclusion: IT morphine (100 µg and 200 µg) with 12.5 mg 0.5% provided a significant reduction in postoperative pain scores compared to IT 12.5 mg 0.5% bupivacaine alone. IT morphine 100 µg provided comparable postoperative pain control with significantly lower side effects than IT morphine 200 µg after TUR-B.

Anahtar Kelimeler

• Spinal anesthesia,morphine,postoperative analgesia,transurethral resection of bladder

İntratekal Bupivakain İle Morfinin TUR-M Sonrası Postoperatif Analjeziye Etkisi

Öz

Amaç: Bu randomize çalışmada transüretral mesane rezeksiyonu (TUR-M) sonrası analjezi için bupivakain ile iki farklı intratekal (IT) morfin dozu değerlendirildi. Metodlar: Yetmiş beş hasta rastgele üç gruba ayrıldı. IT morfin (100 ug) ile 12,5 mg % 0,5 bupivakain (1. Grup), IT morfin (200 ug) ile 12,5 mg % 0.5 bupivakain (2. Grup) ve morfinsiz IT 12,5 mg % 0,5 bupivakain (3. Grup) alanlar olarak. Postoperatif ağrı 24 saat boyunca VAS ile değerlendirildi ve ağrı şiddeti orta derecede olan her hastaya intravenöz parasetamol ve Dexketoprophen trometamol verildi. Bulgular: Grup I ve II'de VAS skorları 1 saat, 2 saat, 4 saat, 6 saat, 12 saatte Grup III'e göre anlamlı olarak düşüktü (p< 0.05). Analjezi talebi Grup III'te diğer iki gruba göre anlamlı derecede yüksekti (p< 0.05). Grup II'de postoperatif bulantı, diğer iki gruba göre daha fazla rapor edildi (p< 0.05). Sonuç: IT % 12,5 mg % 0.5 bupivakain ile morfin (100 ug ve 200 ug), yanlız IT % 12,5 mg % 0,5 bupivakain’e kıyasla postoperatif ağrı skorlarında anlamlı bir azalma sağladı. TUR-M sonrasında postoperatif ağrı kontrolünde IT 100 ug morfin, IT 200 ug morfinden önemli ölçüde karşılaştırılabilir daha düşük yan etkiler sağladı.

Anahtar Kelimeler

• Spinal anestezi,morfin,postoperative ağrı,transüretral mesane rezeksiyonu

Kaynakça

1. 1. Peter T Nieh, Fray F Marshall. Surgery of Bladder Cancer Chapter 78 . In A. J. Wein, L. R. Kavoussi, A. C. Novick, A. W. Partin, and C. A. Peters editors. Campbell-Walsh Urology Ninth Edition-International Edition. Saunders Elsevier, Philadelphia PA; 2007. pp 2479-2505. 2. Cooney KA, Strawderman MS, Wojno KJ, Doerr KM, Taylor A, Alcser KH, et al. Age-specific distribution of serum prostate-specific antigen in a community-based study of African-American men. Urology 2001, 57, 91-96. 3. Kirson LE, Goldman JM, Slover RB. Low-dose intrathecal morphine for postoperative pain control in patients undergoing transurethral resection of the prostate. Anesthesiology 1989, 71, 192-195. 4. Mark JB, Steele SM. Cardiovascular effects of spinal anesthesia. Int Anesthesiol Clin 1989, 27, 31-39. 5. Rathmell JP, Lair TR, Nauman B. The role of intrathecal drugs in the treatment of acute pain. Anesthesia & Analgesia 2005, 101, 30–43. 6. Meylan N, Elia N, Lysakowski C, Tramer R. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing mojor surgery: meta-analysis of randomized trials. British journal of Anaesthesia 2009, 102, 156-167. 7. Gehling M, Tryba M. Risks and side-effects of inrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia 2008, 64, 643-651. 8. Daniel MP, Elia N, Marret E, Wenk M, Tramer R. Opioids added to local anesthetic for single-shot intrathecal anesthesia in patients undergoing surgery: a meta-analysis of randomized trials. Pain 2012, 153, 784-793. 9. Cunningham AJ, McKenna JA, Skene DS. Single injection spinal anaesthesia with amethocaine and morphine for transurethral prostatectomy. British journal of Anaesthesia 1983, 55, 423-427. 10. Sakai T, Use T, Shimamoto H, Fukano T, Sumikawa K. Mini-dose (0.05 mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate. Canadian Journal of Anesthesia 2003, 50, 1027-1030. 11. Duman A, Apiliogulları S, Balasar M, Karcioglu M. Comparison of 50 μg and 25 μg doses of intrathecal morphine on postoperative analgesic requirements in patients undergoing transurethral resection of the prostate with intrathecal anesthesia. Journal of Clinical Anesthesia 2010, 22, 329–233. 12. Kararmaz A, Kaya S, Turhanoglu S, Ozyilmaz MA. Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy. Anaesthesia 2003, 58, 526-530. 13. Gustafsson LL, Schildt B, Jacobsen K. Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden. British journal of Anaesthesia 1982, 54, 479-485.