Kombine spinal epidural ile doğum analjezisinde ropivakaine eklenen farklı dozlarda intratekal morfinin etkileri
Doğum analjezisinde kombine spinal epidural(KSE) tekniğini kullanarak, intratekal iki farklı dozda morfin ve ropivakain kombinasyonunun analjezi süresi, yan etkiler ve yenidoğan etkilerini değerlendirdik. Çalışmamız 40 gebede gerçekleştirildi. İntratekal olarak Grup I’ e %0,2 ropivakain 3 mg + morfin 50 μg, Grup II’ ye %0,2 ropivakain 3 mg + morfin 100 μg uygulandı. VAS değeri 30 mm ve üzerine çıktığı zaman %0,1 konsantrasyonundaki ropivakain ile HKEA(Hasta kontrollü epidural analjezi) yöntemine başlandı. Analjezi süresi açısından gruplar arasında anlamlı fark bulunmadı. Doğumun birinci evresi Grup II’ de Grup I’ e göre anlamlı olarak daha kısa bulundu ve epidural yoldan kullanılan lokal anestezik miktarı Grup II’ de anlamlı olarak daha düşük bulundu. En fazla görülen yan etki kaşıntıydı. Kullandığımız ilaçların yenidoğanlar üzerinde olumsuz etkisi izlenmedi. KSE teknik ile intratekal ropivakaine eklenen 50 ve 100 μg morfin dozları yeterli analjezi sağladı. Ancak 100 μg morfin kullanılan grupta servikal açılmanın daha hızlı olduğu ve kullanılan lokal anestezik miktarının da daha az olduğu tespit edildi. 3mg %0,2 ropivakain + 100 μg morfin kullanımının yan etki insidansını da arttırmadığını gözlemlediğimizde bu kombinasyonun doğum analjezisi için tercih edilebileceğini düşünmekteyiz.
Anahtar Kelimeler:
Anestezi, blok, Analjezi, epidural, Morfin, Anestezi, spinal, Çift kör metot, İleriye dönük çalışma, Doğum, obstetrik, Doğum ağrısı, Rastgele kontrollü çalışmalar
The effects of various doses of intrathecal morphine in addition with ropivacaine in combined spinal-epidural technique for labour analgesia
We evaluated the duration of analgesia, side effects and neonatal effects of intrathecal ropivacaine combined with two different doses of morphine using combined spinal epidural (CSE) technique for labour analgesia. Fourty term parturients were enrolled. Group I received 0,2% ropivacaine 3 mg + morphine 50 μg and Group II received 0,2% ropivacaine 3 mg + morphine 100 μg intrathecally.When VAS for pain was equal or above 30 mm, PCEA(Patient controlling epidural analgesia) was started using 0,1% ropivacaine. There wasn't any statistical significant difference considering the duration of analgesia between two groups. The first stage of labour was significantly shorter in Group II then Group I, and the epidural local anaesthetic volume was significantly lower in Group II. The most common side effect in both groups was pruritis. There was not any side effect of local anaesthetic and opioid on the newborns. Adequate analgesia was obtained during labour with CSE technique, using ropivacaine combined with 50 and 100 μg morphine intrathecally. However cervical dilatation was faster and epidural local anaesthetic volume was lower in the group in which 100 μg morphine was used. Also considering the unchanged incidence of the side effects, 3 mg 0,2% ropivacaine + 100 μg morphine may be a useful combination for labour analgesia.
Keywords:
Anesthesia, Conduction, Analgesia, Epidural, Morphine, Anesthesia, Spinal, Double-Blind Method, Prospective Studies, Delivery, Obstetric, Labor Pain, Randomized Controlled Trial,
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- ISSN: 1300-0012
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 2018
- Yayıncı: Ali Cangül
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