Semra KARAMAN, İLKBEN GÜNÜŞEN, Meltem UYAR, EBRU BİRİCİK, Vicdan FIRAT

The effects of morphine and fentanyl alone or in combination added to intrathecal bupivacaine in spinal anesthesia for Cesarean section

Amaç: Elektif sezaryenlerde, spinal anestezide intratekal morfin, fentanil yada kombinasyonlarının randomize, çift kör kontrollü olarak karşılaştırılması amaçlandı. Gereç ve Yöntem: Elektif sezaryenlerde 0.5% hiperbarik bupivakain ile spinal anestezi uygulanan 60 gebeye randomize olarak intratekal morphine 0.2 mg, fentanyl 25 μg, yada fentanyl 12.5 μg ile beraber morphine 0.1 mg uygulandı. Spinal bloğun başlangıcı, T10 seviyesine ulaşma zamanı, duyusal ve motor bloğun en üst seviyelerduyusal bloğun T10’a gerilemesi, motor bloğun gerilemesi, cerrahi özellikler, maternal yan etkiler, Apgar ve NAKS skorları, umblikal kan gaz analizlari, ilk analjezik gereksinim zamanı kaydedildi. Bulgular: İntraoperatif dönemde hiçbir hastada ağrı görülmedi. Sensoriyal ve motor bloğun derecesi ve süresi her üç grup arasında benzer olup T10’a gerileme ve motor bloğun kalkma zamanları arasında fark bulunmadı. Postoperatif ilk analjezik gereksinim zamanı fentanilin tek başına kullanıldığı grupta diğer gruplara göre çok kısa olup aralarındaki fark istatistiksel olarak anlamlı idi. Postoperatif yan etkiler ve hemodinamik etkiler açısından her iki grup arasında fark yoktu. Neonatal bulgular açısından APGAR ve umblikal kan gazı değerlerinde fark bulunmadı. Sonuç: Postoperatif analjezide morfinin fentanile göre üstün olduğu; bupivakain/morfin kombinasyonuna fentanil eklenmesinin de ek klinik yarar sağlamadığı kanaatine varıldı.

Sezaryen operasyonlarında spinal anestezide intratekal bupivakaine eklenen morfin, fentanil veya kombinasyonlarının etkileri

Objectives: This randomised double-blind controlled trial examines the effects of fentanyl and morphine, alone and in combination, as adjuncts to spinal anesthesia for elective Cesarean section. Methods: Sixty women undergoing elective Cesarean section, with spinal anesthesia using 0.5% hyperbaric bupivacaine were randomly allocated to receive morphine 0.2 mg, fentanyl 25 μg, or fentanyl 12.5 μg plus morphine 0.1 mg, intrathecally. The start of spinal block, the time to T10 level, the highest sensorial and motor block level, time to regresion of sensory block to T10, the time to resolution of motor block, surgical characteristics, maternal side-effects, Apar and NACS scores, umbilical blood gas evaluations, time to first analgesic requirement were recorded. Results: There was no patient having pain during the intraoperative period. The degree and time of sensorial and motor block was similar in both groups and there was no difference in the time to T10 level and the time to reversal of motor block. The difference in time to first postoperative analgesic requirement was statistically significant. There was no difference between groups in postoperative side effects. There was no neonatal difference in Apgar, NACS and umbilical blood gas evaluations. Conclusions: The quality of postoperative analgesia with morphine, when used alone, was found to be superior to that with fentanyl. The combination of opioids offered no advantages over morphine alone.

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