Anesthetic and Hemodynamic Effects of Continuous Spinal and Epidural Anesthesia

Yıl 2007, Cilt: 12 Sayı: 3, 201 - 205, 01.06.2007

Koray Erbüyün Gülay Ok İdil Tekin

Öz

Objectives: It was aimed to compare the effects of epidural and continuous spinal anesthesia. Material and Methods: In 35 patients who were to be operated from lower extremities, epidural anesthesia was performed in groupI (n=18) and continuous spinal anesthesia in groupII (n=17). 15 mL(300 mg) of 2%prilocaine as initial dose and 5 mL (100 mg) as additional dose was administered in the group I; in the group II the initial dose was 2.5 mL(50 mg), and additional dose 1mL (20 mg). Hemodynamic parameters, sensorial and motor block levels were recorded every 5 minutes. Intraoperative complications were watched for. Results: Heart rate(HR) and blood pressure(BP) was found to be lower than basal values after the 10.min in group I., HR and BP after 45.min in the group II. Time for sensorial blockade commencement was found to be longer in group I compared to group II.. Duration of sensorial blockade was not found to be different between groups. Motor blockade did not happen in the group I; motor blockade occured in all cases of group II. Conclusion: It is concluded that continuous spinal compared to epidural anesthesia, improved patient comfort by providing better hemodynamic stability and motor blockade with less local anesthetic dose, by affecting faster and causing fewer intraoperative complications, but more technical problems might be encountered. ©2007, Firat University, Medical Faculty

Anahtar Kelimeler

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Sürekli Spinal ve Epidural Anestezi Yöntemlerinin Anestezik ve Hemodinamik Etkilerinin Karşılaştırılması

Öz

Giriş: Epidural ve sürekli spinal anestezi uygulamasının etkilerinin karşılaştırılması amaçlandı. Gereç ve Yöntem: Alt ekstremite operasyonu yapılacak 35 olguda, I. gruba (n=18) epidural, II. gruba (n=17) sürekli spinal anestezi uygulandı. % 2'lik prilokainden; I. gruba, başlangıç dozu 15 mL (300 mg), ek doz 5 mL (100 mg); II. gruba, başlangıç dozu 2.5 mL (50 mg), ek doz 1mL (20 mg) verildi. Hemodinamik parametreler, duyusal ve motor blok seviyeleri beş dakikada bir kaydedildi. Peroperatif komplikasyonlar izlendi. Bulgular: Kalp atım hızı ve kan basıncı, I. grupta 10., II. grupta 45. dakikadan sonra bazal değere göre düşük bulundu. Duyusal blok başlangıç süresi, I. grupta, II. gruba göre uzun bulundu. Duyusal blok etki süresi gruplar arasında farklı bulunmadı. I. grupta motor blok oluşmadı, II. gruptaki olguların tamamında motor blok gerçekleşti. Sonuç: Epidural anesteziye göre sürekli spinal anestezinin, düşük lokal anestezik dozuyla daha iyi hemodinamik stabilite ve motor blok sağlayarak, daha hızlı etkileyerek ve daha az peroperatif komplikasyona neden olarak hasta konforunu artırdığı ancak daha fazla teknik sorunla karşılaşılabileceği sonucuna varıldı. ©2007, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

Sürekli spinal anestezi, epidural anestezi, hemodinami, prilokain

Kaynakça

• Kashanipour A, Strasser K, Klimscha W, Taslimi R, Aloy A, Semsroth M. Continuous spinal anesthesia versus continuous epidural anesthesia in surgery of the lower extremities. A prospective randomized study. Reg Anesth 1991; 14:83-87.
• Hurley R. Continuous spinal anesthesia. Int Anesth Clin 1989; 27: 46-50.
• Lambert DH. Continuous spinal anesthesia. Anesth Clin North America 1992; 10:87-102 .
• Bromage PR. Mechanism of Action, Epidural Analgesia. Philadelphia, WB Saunders; 1978. p. 119-159.
• Favarel-Garrigues JF, Sztark F, Petitjean ME, Thicoipe M, Lassie P, Dabadie P. Hemodynamic effects of spinal anesthesia in eldery: Single dose versus titration tbrough a catheter. Anesth Analg 1996; 82: 312-316.
• Demirel CB, Katı İ, Tuncer YC, Hüseyinoğlu ÜA, Silay E. Yaşlı hastalarda tek doz spinal anestezi ile sürekli spinal anestezi yöntemlerinin karşılaştırılması. Türk Anest Rean Cem Mecmuası 2001; 29:563- 569. ve hemodinamik etkilerinin
• Reisli R, Horasanlı E, Demirbilek S, Dikmen B, Yiğitbaşı B, Göğüş N. Tek doz ve sürekli spinal anestezinin hemodinamik ve anestezik etkilerinin karşılaştırılması. Türk Anest Rean Cem Mecmuası 1999; 27:21-26.
• Klimscha W, Weinstable C, Ilias W, Mayer N, Kashanipour A, Schneider B, Hammerle A. Continuous spinal anesthesia with a microcatheter and hemodynamic eff'ects of centroneuraxis blocks in elderly patients. Anesth Analg 1993; 77: 275-280. the
• Sutter PA, Gamulin Z, Forster A. Comparison of continuous spinal and continuous epidural anaesthesia for lower limb surgery in elderly patients. Anaesthesia 1989; 44: 47-50.
• Van Gessel EF, Forster A, Schweizer A, Gamulin Z. Comparison of hypobaric, hyperbaric and isobaric solutions of bupivacaine during continuous spinal anesthesia. Anesth Analg 1991; 72:779- 784.
• Mollmann M. Continuous spinal anaesthesia.Anaesthesist 1997; 46:616-621.
• Petros AJ, Smith D, Barnard M, Ronzoni G, Carlı F. Continuous spinal anesthesia: Dose requirements and characteristics of the block. Regional Anesthesia 1993; 18:52-54.
• Ata S, Shulmen MS. Causes for diffıculty with placement of continuous subarachnoid catheters. Anesthesiology 1991; 75:A1092.
• Van Gessel EF, Alain F. Continuous spinal anesthesia: Where do spinal catheters go? Anesth Analg 1993; 76:1004-1007.
• Hurley RJ, Lambert DH. Continuous spinal anesthesia with microcatheter tecnique: Preliminary experience. Anesth Analg 1990; 70:97-102.
• Van Gessel E, Foster A, Gamulin Z. A prospective study of the feasibility of continuous in university hospital. Anesth Analg 1995; 80: 884-885.
• Standl T, Eckert S, Schulte am Esch J. Microcatheter continuous spinal anaesthesia in the post-operative period: a prospective study of its effectiveness and complications. Eur J Anaesthesiol 1995; 12:273-279.
• Muralidhar V, Kaul HL, Mallick P. Over-the-needle versus microcatheter-through-needle technique for continuous. Reg Anesth Pain Med 1999; 24: 417-421.
• Horlocker TT, Mcgregor DG, Matsushige DK, Scliroeder DR, Besse JA. A retrospective review of 4767 consecutive spinal anesthetics: Central Nervous system complications. Anesth Analg 1997; 84:578-584.
• Denny N, Masters R, Pearson D, Read J, Shhota M, Selander D. Postdural puncture headache after continuous spinal anesthesia. Anesth Analg 1987; 66: 791-794.
• Mahisekar UL, Winnie AP, Vasireddy AR, Masters RW. Continuous spinal anesthesia and post dural puncture headache: a retrospective study. Reg Anesth 1991; 16:107-111.
• Mollmann M, Cord S, Holst D, Landwehr U. Continuous spinal anaesthesia or continuous epidural anaesthesia for post-operative pain control after hip replacement?: Eur J Anaesthesiol 1999; 16:454-461.
• Pappa X, Pouliou K, Nastou H, Davinou K, Kyriakido A. The potential for contamination of continuous spinal catheters. Acta Anaesthesiol Belgica 1994; 45:107-112.
• Chan VWS, Chung F, Gomez M, Seyone C, Baylon G. Anesthetic and hemodynamic effects of single bolus versus incremental titration of hyperbaric spinal lidocaine trough microcatheter. Anesth Analg 1994; 74:117-123.
• Rigler ML, Drasner K, Bohner D. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg 1991; 72; 275-281.
• Pleym H, Spigset O. Peripheral neurologic deficits in relation to subarachnoid or epidural administration of local anesthetics for surgery. Acta Anaesthesiol Scand 1997; 41: 453-460.
• Ostgaard G, Hallaraker O, Ulveseth OK, Flaatten H. A randomised study of lidocaine and prilocaine for spinal anesthesia. Acta Anaesthesiol Scand 2000;44: 436-440.
• Kabul Tarihi: 18.04.2007