Comparing analgesic and hemodynamic effects of unilateral spinal levobupivacaine, levobupivacaine-fentanyl and levobupivacaine-morphine combinations for arthroscopic procedures

Yıl 2010, , 75 - 80, 01.06.2010

Pakize Kırdemir Dilek Karaaslan Tülay Tuncer Peker Sinem Sarı Özlem Özorak Sadık Özmen

https://doi.org/10.5799/ahinjs.01.2010.02.0016

Öz

Objectives: Aim of the study was to compare the analgesic and hemodynamic effects of levobupivacaine, levobupivacaine-fentanyl, levobupivacaine-morphine for arthroscopic knee surgery under unilateral spinal anesthesia. Methods: A total of 44 ASA I/II patients scheduled for arthroscopy were included in the study. After prehydration patients kept in a lateral position on the nondependent side. Spinal puncture was performed at L3–4/L4–5 intervertebral space. Patients divided into three subgroups: Group L (n=14) received 0.5% levobupivacaine 1 ml+1 ml distilled water; Group LF (n=15), 25 mcg fentanyl (0.5 ml)+0.5 ml distilled water; and Group LM (n=15), 0.01 mg morphine (0.5 ml)+0.5 ml distilled water. Patients remained in that position for 15 minutes. Blood pressure and heart rate were recorded before and 1st, 3rd, 5th, 10th, 15th, 20th and 30th minutes after the block and every 15 minutes during the operation. Motor blockade and sensorial level, side effects, motor block regression time (MBRT), first urination time and first analgesic need (FAN) were recorded. Results: Group LM had the longest MBRT, but difference with other groups did not reach to a significant level (p>0.05). Group LM had significantly longer FAN time compare with other groups (p

Anahtar Kelimeler

Unilateral spinal, hypobaric, levobupivacaine, analgesia, hemodynamic effects

Artroskopik girişimlerde ünilateral spinal levobupivakain, levobupivakain-fentanyl ve levobupivakain-morfin kombinasyonlarının analjezik ve hemodinamik etkilerinin karşılaştırılması

Öz

Amaç: Artroskopik diz cerrahisi uygulanacak hastalara ünilateral spinal anestezide levobupivakain, levobupivakain-fentanyl, levobupivakain-morfinin analjezik ve hemodinamik etkinliğinin karşılaştırılmasını amaçladık. Yöntem: ASA I-II 44 olgu çalışmaya dahil edildi. Tüm olgular prehidrasyon sonrası opere olacak taraf üstte kalacak şekilde lateral dekübit pozisyona getirildi. Spinal iğne ile L3-L4/L4-L5 spinal aralığından girildi. Tüm gruplarda %0.5 levobupivakain 1ml ilaveten Grup L 1 ml distile su, Grup LF 25 mcg fentanyl (0.5 ml)+0.5 ml distile su, Grup LM 0.01 mg morfin (0.5 ml)+0.5 ml distile su toplam 2 ml olacak şekilde verildi. Hastalar 15 dakika bu pozisyonda yatırıldı. Hastaların tansiyon, kalp atım hızı ve oksijen satürasyon değerleri blok öncesi, blok sonrası 1.,3.,5.,10.,15.,20.,30.dakikalarda ve operasyon boyunca 15 dakikada bir kayıt edildi. Motor blok ve duyu seviyesi, yan etkiler, motor blok gerileme zamanı (MBGZ), ilk idrar yapma zamanı ve ilk analjezik gereksinimi (İAG) kayıt edildi. Bulgular: MBGZ Grup LM de en uzun bulundu ancak anlamlı değildi (p>0.05). İAG Grup LM de daha geç bulundu ve aradaki fark Grup L\'ye göre anlamlı idi (p0.05). Grup L de motor blok oluşumu daha azdı (p

Anahtar Kelimeler

Ünilateral spinal, hipobarik, levobupivakain, analjezi, hemodianmik etkiler

Kaynakça

• Appelleri G, Aldegheri G, Danelli G et al. Spinal anesthe
• Appelleri G, Aldegheri G, Danelli G et al. Spinal anesthe
• Appelleri G, Aldegheri G, Danelli G et al. Spinal anesthe
• sia with hyperbaric levobupivacaine and ropivacaine for
• outpatient knee arthroscopy: A prospective, randomized,
• double-blind study. Anesth Analg 2005;101:77–82.
• Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg 1985; 64:715–30.
• Cousins MJ, Veering BT. Neural Blockade. In clinical anaes- thesia and management of pain. Lipincott-Raven Publish- ers, Philedelphia-Newyork 1998; 243–320.
• Pederson H, Finster M. Selection and use of local anesthetic: Clinical Obstetrics and Gynocology 1987; 30:505–13.
• Gustafsson LL, Hallin ZW. Spinal opioid analgesia. Drugs 1988; 35:597–603.
• Kirson LE, Goldman JM, Slover RE. Low dose intrathecal morphine for postoperative pain control in patients under- going transuretral resection of the prostate. Anesthesiology 1989;71: 192–5.
• DahI JB, Rosenborg J, Dirkes WE. Prevention of postopera- tive pain by balanced analgesia. Br J Anaesth 1990;64:518– 20.
• Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. In- trathecal fentanyl with small-dose dilute bupivacaine: Bet- ter anesthesia without prolonging recovery. Anesth Analg 1997;85:560–5.
• Abbound TK, Dror A, Mosaad P et al. Mini-dose intrathecal morphine for relief of postcesarean section pain: Safety, ef- ficacy and ventilatory response to carbon dioxide. Anesth Analg 1988;67:137–40.
• Fanelli G, Borghi B, Casati A, Bertini L, Montebugnoli M, Torri G. Unilateral bupivacaine spinal anaesthesia for out- patient knee arthroscopy. Italian Study Group on Unilateral Spinal Anaesthesia. Can J Anaesth 2000; 47: 746-51.
• Casati A, Fanelli G, Cappelleri G et al. Low dose hyperbaric bupivacaine for unilateral anaesthesia. Can J Anaesth 1998; 45: 850-4.
• Durmuş M, Türköz A, Toğal T et al. Bupivakaine fentanil ilave edilmesi tek taraflı spinal bloğu etkilermi? Türk Anest ve Rean Cem 2001; 29; 2:65–8.
• Kuusniemi KS, Pihlajamaki KK, Pitkanen MT. A low dose of plain or hyperbaric bupivacaine for unilateral spinal an- esthesia. Reg Anesth Pain Med 2000; 25: 605–10.
• Covino BG, Scolt DB, Lambert DH. Pharmacological con- siderations, baricity of anaesthetic solutions. In: Covino BG eds. Handbook of spinal anaesthesia and analgesia. Fribourg 1, Switzerland: Medialobe SA Qublishor,1994,89–93.
• McLeod GA. Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose. Br J Anaesth, 2004; 92: 547-51.
• Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupiva- caine in volunteers. Anesth Analg 2002;94:188–193
• Glaser C, Marhofer P, Zimpfer G, et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg 2002; 94.194–8.
• Casati A. Bupivacaine, levobupivacaine and Ropivacaine: Are they clinically different? Best Prasctice&Reserch Clin. Anaest.2005; 6: 247–68.
• Esmaoglu A. Bilateral vs. unilateral spinal anesthesia for outpatient knee artroscopies. Knee Surg Sports Traumatol Artrosc 2004;12:155–8.
• Casati A, Moizo E, Marchetti C, Vinciguerra F. A prospec- tive, randomized, double-blind comparison of unilateral spinal anesthesia wıth hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorraphy. Anesth Analg 2004;99:1387–92.
• Sell A, Olkkola KT, Jalonen J. Minimum effective local an- aesthetic dose of izobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement sur- gery. Br J Anaesth 2005; 94:239–42.
• Breebaart MB, Vercauteren MP, Hoffmann VL, Adriaensen HA. Urinary bladder scanning after day-case arthroscopy under spinal anesthesia: comparison between lidocaine, ropıvacaine and levobupivakaine, Br J Anaesth. 2003;90: 309–13.
• Esmaoglu A, Boyacı A, Ersoy O et al. Unilateral spinal anesthesia with hyperbaric bupivacaine. Acta Anesthesiol Scand 1998; 42,1083–87.
• Reisner LS, Lin D. Anesthesia for Cesarean Section in Chestnut OH. Obstetric Anesthesia Principles and Practice. Mosby, Inc. Second Edition: 1999; 6592.
• Kaya S, Ölmez G, Uludag Ö. Sezeryan operasyonlarinda in- tratekal levobupivakainin fentanil ile kombine edilmesinin duyusal ve motor blok üzerine olan etkileri. TARD dergisi. 2006;253: 154.
• Karaman S, Kocabas S, Uyar M, Hayzaran S, Fırat V. The effects of sufentanil or morphine added to hyperbaric bupi- vacaine in spinal anaesthesia for caesarean section. Eur J Anaesthesiol 2006; 23: 285–91.
• Kireçci FB. İntratekal bupivakaine eklenen fentanil ve morfinin anestezi kalitesi ve analjezi süresine etkisi. Uzmanlık Tezi. İstanbul 2001.
• Ishiyama T, Yamaguchi T, Kashimoto S, Kumazawa T. Ef- fects of epidural fentanyl and intravenous flurbiprofen for visceral pain during cesarean section under spinal anesthe- sia. J Anesth 2001; 15.69–73.
• Stoelting RK. Pharmacology-Physiology in Anesthetic Practice, Third Edition, Philadelphia: Lippincott Company; 1999; 177–81.
• Gürkan Y, Canatay H, Özdamar D, Solak M, Toker K. Spi- nal anesthesia for arthroscopic knee surgery, Acta Anaest. Scand 2004;48:513–17.