Pınar ACAR, Emine ÖZYUVACI, Şule VATANSEVER, Naile TOPRAK, Onat AKYOL

Sezaryenlerde intratekal levobupivakaine ilave edilen fentanil ve morfinin postoperatif ağrı üzerine etkisinin değerlendirilmesi

Amaç: Prospektif, randomize, çift-kör çalışmamız sezaryen için intratekal levobupivakaine ilave edilen fentanil ve morfinin postoperatif ağrı üzerine etkisini değerlendirmek amacıyla yapıldı. Gereç ve Yöntem: Hastanemiz etik kurul onayı ve hastaların yazılı onayları alındıktan sonra sezaryen ameliyatı geçirecek ASA I-II grubunda, spinal anestezinin kontrendike olmadığı ve lokal anestezik duyarlılığı olmayan 60 olgu çalışmaya alındı. Hastalar 2 gruba ayrıldı. I. gruba (Grup M, n=30) intratekal 10 mg %5 levobupivakain + 0.1 mg morfin, II. guruba (Grup F, n=30) intratekal 10 mg %5 levobupivakain + 20 mcgr fentanil uygulandı. Postoperatif ilk analjezi gereksinimine kadar geçen efektif analjezi süresi, modifiye Bromage skalasına göre motor bloğun tamamen ortadan kalkma süresi, hastaların ek analjezik ihtiyacı, kullanılan ek analjezik miktarı, yan etkiler ve postoperatif hasta memnuniyeti değerlendirilerek kaydedildi. Bulgular: Morfin grubunda ek analjezi istem süresi fentanil grubuna göre anlamlı derecede daha uzun olarak belirlendi (p

Assessment of the effect of intrathecal levobupivacaine combined with fentanyl or morphine on postoperative analgesia in patients undergoing cesarean section

Objectives: Our prospective, randomized, double-blind study aimed to detect the effect of intrathecal levobupivacaine combined with fentanyl or morphine on the postoperative analgesia in patients undergoing cesarean section. Methods: After approval by the hospital ethics committee and obtaining written informed consent, ASA I-II parturients undergoing elective cesarean section were enrolled in this study. None of the patients had any contraindication for spinal anesthesia or sensitivity to local anesthetics. Patients were randomly assigned in a double-blinded fashion to receive either intrathecal 10 mg 5% levobupivacaine + 0.1 mg morphine (Group M, n=30) or 10 mg 5% levobupivacaine + 20 mcg fentanyl (Group F, n=30). The onset of sensorial block and anesthesia, interval of effective analgesia until the first analgesic requirement, disappearance of motor block according to modified Bromage scale, duration of spinal analgesia, additional analgesic requirement, amount of additional analgesic, adverse effects, and postoperative patient satisfaction were recorded. Results: The additional analgesic requirement period was significantly longer in Group M than Group F (p<0.001). Intraoperative and postoperative complications were significantly higher in Group F than Group M (p<0.05). Intended, delivered and total analgesic amount values were significantly higher in Group F than Group M (p<0.001). Patient satisfaction and presentation elsewhere were significantly higher in Group M than Group F (p<0.01). Conclusion: Despite more adverse effects, additional analgesic requirement is lower in Group M, and the long-term painless postoperative period accounts for the choice by mothers.

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