The effects of epidural bupivacaine administration for postoperative pain after major abdominal surgery

Abstract

Aim: Postoperative pain is a major problem after major abdominal surgery and conventional intramuscular analgesic therapy is usually not enough. We investigated the effectiveness and timing of epidural patient control analgesia on intraoperative analgesic consumption and postoperative pain, after major abdominal surgery.

Methods: We studied 41 patients prospectively. This was a prospective cohort study. The patients, after ethics committee approval, who were planned to have major abdominal surgery, aged between 35 and 75, were included to the study. 37 patients’ data were included to the study; because two patients were excluded because of motor block developed during research, and 2 patients were excluded because catheter tips were migrated from the epidural space. Epidural catheters were applied to all patients, at proper levels for the surgery, preoperatively. In the first group; bupivacaine infusion was administered postoperatively, via patient controlled analgesia (PCA) machine. In the second group 25 mg bupivacaine bolus was administered before surgery and bupivacaine infusion via PCA was administered at the postoperative period. In the third group 25 mg bupivacaine bolus was administered preoperatively and bupivacaine infusion was administered intra and postoperatively via PCA. Pain levels of the patients were evaluated by using numeric rating scale (NRS). In NRS, patients were asked to evaluate their pain levels between 0 to 10, as 0; no pain and 10 is the worst pain ever.

Results: In all groups postoperative NRS levels were below 4, and sufficient postoperative analgesia was provided. In the third group significant lower analgesia scores and lower intraoperative analgesic consumptions were achieved (P<0.05). In this group arterial blood pressures were lower than the other groups, but they were not lower than the physiologic limits.

Conclusion: Epidural bupivacaine administration is a safe and effective method for postoperative pain management for patients who will have major abdominal surgery.

Keywords

• Epidural analgesia,Bupivacaine,Major abdominal surgery

Majör abdominal cerrahide epidural bupivakain uygulamasının postoperatif ağrı üzerine etkileri

Öz

Amaç: Majör abdominal cerrahi sonrası, postoperative analjezi önemli bir problemdir ve konvansiyonel intramüsküler analjezik tedavisi genellikle yetersizdir. Biz bu çalışmada, majör abdominal cerrahide, hasta kontrollü epidural analjezi uygulanım zamanının ve şeklinin, intraoperatif analjezik ihtiyacı ve postoperatif ağrı üzerine etkilerini araştırdık.

Yöntemler: 41 hasta prospektif olarak çalışıldı. Bu, prospektif kohort bir çalışmadı. Elektif majör abdominal cerrahi uygulanacak yaşları 35-75 arasında değişen 41 hasta etik komite izni alınarak çalışmaya dahil edildi. Motor blok gelişmesi sebebiyle iki hasta ve epidural kateterin yerinden çıkması sebebiyle iki hasta çalışmadan çıkarıldı. 37 hastadan elde edilen veriler değerlendirmeye alındı. Bütün gruplara preoperatif, cerrahiye uygun dermatomda blok oluşturacak şekilde epidural kateter takıldı. 1. gruba bupivakain infüzyonu postoperatif dönemde hasta kontrolü analjezi (HKA) aleti ile uygulandı. 2. gruba cerrahi başlamadan 25 mg bupivakain bolus uygulamasının ardından postoperatif HKA aletine bağlandı. 3. gruba ise cerrahi öncesi 25 mg bupivakainin bolus uygulamasının ardından intraoperative ve postoperative dönemde HKA aleti ile bupivakain uygulandı. Hastaların ağrı düzeyleri “numeric rating scale (NRS)” ile değerlerlendirindi. NRS’de hastalara, 0: hiç ağrı yok, 10: bugüne kadar hissedilen en şiddetli ağrı olacak şekilde, ağrılarına 1 ile 10 arasında bir değer vermeleri istendi. 

Bulgular: Bütün gruplarda NRS değerleri 4’ün altındaydı ve yeterli analjezi sağlandı. 3.grupta, diğer gruplara göre anlamlı olarak daha düşük ağrı skorları ve intraopertif analjezik tüketimi görüldü (P<0.05). Bu grupta, fizyolojik sınırlar içinde olmakla beraber, daha düşük kan basıncı değerleri gözlendi.

Sonuç: Bu sonuçlar ile HKA ile epidural bupivakain, majör abdominal cerrahi uygulanacak hastalara, analjezik tedavisi olarak kullanılabilir.

Anahtar Kelimeler

• Epidural analjezi,Bupivakain,Majör abdominal cerrahi

Kaynakça

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