Tahsin KAYA, ÜNASE BÜYÜKKOÇAK, Hülya BAŞAR, NEVİN SAĞSÖZ

Sezaryen sonrası ağrı tedavisinde epidural %0.2 ropivakain ile %0.2 ropivakain ve 0.75 µg mL-1 sufentanil kombinasyonunun karşılaştırılması

Sezaryen operasyonları sonrası uygulanacak analjezi teknikleri, annelerin bebeklerinin bakımına izin verecek erken mobilizasyon ile birlikte etkin analjezi sağlamalıdır. Bu çalışmada, hasta kontrollü epidural analjezide (HKEA) kullanılan yalnız %0.2 ropivakain ve %0.2 ropivakain+0.75 µg mL-1sufentanilin karşılaştırılması amaçlandı. 50 kadın olgu (ASA I) çalışmaya dahil edildi. Tüm hastalara kombine spinal-epidural anestezi uygulandı. Duyu bloğu 2 dermatom gerileyince analjezik solüsyonların infüzyonuna başlandı. Hastalar randomize olarak 2 gruba ayrıldı (n=25). Grup-I’de %0.2 ropivakain ve 0.75 µg mL-1sufentanil, Grup II’ de yalnız %0.2 ropivakain kullanıldı (yükleme 1.25 mL, kilit süresi 30 dakika, 2.5 mL saat-1 infüzyon ile). Ameliyat sonrası 24 saat süresince ağrı (vizuel analog skala), motor blok (bromaj skalası) ve sedasyon (four-point skala) değerlendirildi. Hemodinamik ve solunumsal parametreler, yan etkiler, total ilaç tüketimi ve ek analjezik gereksinimi kaydedildi. İstatiksel analizde student-t, chi-square ve Mann Whitney U testleri kullanıldı. Demografik veriler, sedasyon skalaları, hemodinamik ve solunumsal parametrelerde gruplar arasında fark saptanmamıştır. Motor blok ve ağrı skorları 2 ve 4. saatte Grup-II’de anlamlı şekilde yüksek bulunmuştur. Total ilaç tüketiminin Grup-I’de 65.24±4.20 mL, Grup II’de 81.1±6.44 mL olduğu gözlenmiştir (P

Anahtar Kelimeler:

Sezaryen, Karşılaştırmalı çalışma, Ağrı, Ağrı ölçümü, Analjezi, epidural, Analjezi, hasta kontrollü, Sufentanil, Hemodinamikler, Ağrı yönetimi

Comparison of epidural ropivacaine 0.2% and ropivacaine 0.2% in combination with sufentanil 0.75 µg mL-1 for postcaesarean analgesia

Analgesic techniques after c-section must be effective producing early mobilisation to enable mothers to care effort their babies. In this study, the comparison of ropivacaine 0.2% alone, with ropivacaine 0.2%+sufentanil 0.75 µg mL-1 for patient controlled epidural analgesia (PCEA) was aimed. Fifty women (ASA-I) were enrolled in the study. All patients had combined spinal-epidural anaesthesia. Infusion of analgesic solutions was started when sensory level decreased by two dermatome levels. The patients randomly assigned, into two groups (n=25). In Group-I, ropivacaine 0.2% and sufentanil 0.75 µg mL-1, in Group-II, ropivacaine 0.2% alone were applied (bolus 1.25 mL, lockout 30 min, with 2.5 mL h-1 background infusion). Pain, motor blockage and sedation were evaluated during 24 hours after Caesarean, using the scales of visual analogue, bromage, and four-point, respectively. Haemodynamic and respiratory parameters, side effects, total drug consumption and additional analgesic need, were recorded. Statistical analysis included student-t, chi-square, and Mann Whitney U tests. There was no difference in demographic data, sedation scores, haemodynamic and respiratory parameters, between the groups. Motor block and pain scores were significantly higher in Group-II than in Group-I at 2 and 4. h. Total drug consumption was 65.24±4.20 mL for Group-I and 81.1±6.44 mL for Group-II, (P<0.05). Four patients in Group-I and 21 patients in Group-II received additional analgesic. Pruritus was observed more frequently in Group-I. The addition of sufentanil 0.75 µg mL-1 to ropivacaine 0.2% for PCEA after Caesarean led to more effective analgesia and less motor weakness when compared to ropivacaine 0.2% alone, especially during early postoperative period.

Keywords:

Cesarean Section, Comparative Study, Pain, Pain Measurement, Analgesia, Epidural, Analgesia, Patient-Controlled, Sufentanil, Hemodynamics, Pain Management,

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