Zeki KAHRAMANOĞLU, M. Caner MİMAROĞLU, Hüseyin Veysel KARA

Alt ekstremite cerrahilerinde tek taraflı spinal anestezi için izobarik ve hiperbarik bupivakainin karşılaştırılması

Çalışmamızda tek bacağı ilgilendiren alt ekstremite cerrahisi uygulanacak olgularda tek taraflı spinal anestezi oluşturmak için % 0.5 izobarik ve hiperbarik bupivakain karşılaştırıldı. Tüm olgulara spinal anestezi, lateral pozisyonunda 22G Quincke-Babcock tipi spinal iğne ile L 4-5 vertebra aralığından uygulandı. Yan yatırılan hastalar 2 gruba ayrıldı. I. gruba (n=25) etkilenen bacak üst tarafa alınarak 8 mg. % 0.5 izobarik bupivakain, II. gruba (n=25) ise etkilenen bacak alt tarafa alınarak 8 mg % 0.5 hiperbarik bupivakain uygulandı. Her iki grupta da kullanılan spinal iğnenin uç açıklığı etkilenen bacağa yönlendirilerek lokal anestezik solüsyon yaklaşık 45 sn.de intratekal aralığa enjekte edildi. Hastalar yan pozisyonda yatarak 20 dk. bekletildikten sonra sırt üstü pozisyona alındı. Tüm olguların; ortalama kan basınçları, kalp atım hızlan, motor blok (bromage skalası) ve duyusal blok derecesi (pin-prick testi) yan pozisyonda yattığı 20 dk. süresince 3 dk. aralarla, sırt üstü pozisyonda 5 dk. aralarla kaydedildi. Sonuç olarak % 0.5 hiperbarik bupivakain kullanılan olgularda, daha fazla tek taraflı spinal anestezi oluşması ile beraber motor bloğun çözülme zamanlarının % 0.5 izobarik bupivakain kullanılan olgulardan daha kısa olduğu gözlendi.

Anahtar Kelimeler:

Bacak, Anestezi, spinal, Bupivakain, Cerrahi işlemler, operatif

Comparison of isobaric and hyperbaric bupivacaine for unilateral spinal anaesthesia in lower extremity surgery

In this study we compared 0.5 % isobaric and hyperbaric bupivacaine for unilateral spinal anaesthesia in patients undergoing lower extremity surgery. Spinal anaesthesia was performed with 22G Quincke-Babcock spinal needles from L 4-5 intervertebral space. Patients were divided randomly into two groups. Patients in Group I were (n=25) turned to lateral decubitus position, upper leg being the dependent leg and 8 mg 0.5 % isobaric bupivacaine was injected. Patients in Group II were turned to (n=25) lateral decubitus position, lower leg being the dependent leg and 8 mg 0.5 % hyperbaric bupivacaine was injected. In both groups, the bevel of spinal needle was turned towards dependent leg and drug was injected in 45 seconds. Patients stayed in lateral decubitus position for 20 minutes and then were turned to supine position. Mean blood pressure, heart rate, motor blockade (Bromage scale), sensorial blockade (pin-prick test) with 3 minutes intervals in lateral position and 5 minutes intervals after turning supine were recorded. As a result more unilateral spinal anaesthesia was observed with 0,5 % hyperbaric bupivacaine and recovery from motor block was shorter than patients receiving 0,5 % isobaric bupivacaine.

Keywords:

Leg, Anesthesia, Spinal, Bupivacaine, Surgical Procedures, Operative,

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1. Bernards CM, Epidural and spinal anesthesia. Barash PG, Cullen BF, Stoelting RK. ed. Clinical Anesthesia, Philadelphia, Lippincott Williams & Wilkins, 2001; 689-713.
2. Morgan GE, Mikhail MS. Clinical Anesthesiology. Connecticut Appleton & Lange, 1996; 211-44.
3. Christopherson R, Battie C, Frank S. Perioperative morbidity in patients randomized to epidural ör general anesthesia for lower extremity vascular surgery. Anesthesiology 1993; 79(3): 422-34.
4. Rosenfeld B, Beattle C, Christopherson R. The efFects of different anesthetic regimen on fibrinolysis and the development of postoperative arterial thrombosis. Anesthesiology 1993; 79(3): 435-45.
5. Casati A, Fanelli G, Berti M. Cardiac performance during unilateral lumbal spinal block after crystalloid preload. Can J Anaesth 1997; 44(6): 623-8.
6. Durmuş M, Türköz A, Toğal T, Ersoy MÖ, Ayaş A. Öztürk E. Bupivakaine fentanil ilave edilmesi tek taraflı spinal bloğu etkilermi? Türk Anest ve Rean Cem 2001; Cilt 29, Sayı 2, 65-8.
7. Kuusniemi KS, Pihlajamaki KK, Pitkanen MT. A low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia. Reg Anesth Pain Med 2000; 25(6): 605-10.
8. Coşar A, Kurt E, Krk K, Bilgin F, Güzeldemir ME. Diz artroskopisi uygulanan olgularda semispinal ve spinal blok tekniklerinin hemodinami ve komplikasyonlar yönünden karşılaştırılması. Anestezi Dergisi 1999; 7(2): 113-7.
9. Cousins MJ, Brindenbaugh PO. Neural Blockade in clinical anesthesia and management of pain. Philadelphia, Lippincott-Raven Publisher 1998; 203-42.
10. Pitkanen MT. Body mass and spread of spinal anesthesia with bupivacaine. Anesth Analg 1987; 66: 127-31.
11. Roberts FL, Brown EC, Davis R, and Cousins MJ. Comparison of hyperbaric and plain bupivacaine with hyperbaric cinchocaine as spinal anaesthetic agents. Anaesthesia 1989; 44: 471-4.
12. Casati A, Fanelli G, Aldegheri G. Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth and Pain Med 1999; 24(3): 214-9.
13. Casati A, Fanelli G, Cappeleri G, Leoni A. Does speed of intrathecal injection affect the distribution of 0,5% hyperbaric bupivacaine ? Br J Anaesth 1998; 81(3): 355-7.
14. H.Moller IW, Fernandes A, and Edström HH. Subarachnoid anesthesia with 0.5% bupivacaine: effects of density. Br J Anaesth 1984; 56: 1191-5.
15. Kuusniemi KS, Pihlajamaki KK, Pitkanen MT, and Korkella JE. Low dose bupivacaine: a comparison of hypobaric and near isobaric solutions for arthroscopic surgery of the knee. Anaesthesia 1999; 54: 540-5.
16. Casati A, Fanelli G, Cappeleri G, Borghi B. Low dose hyperbaric bupivacaine for unilateral spinal anaesthesia. Can J Anaesth 1998; 45(9): 850-4.
17. Niemi L, Tuominen M, Pitkanen M, Rosenberg PH. Effect of late posture change on the level of spinal anaesthesia with plain spinal bupivacaine. Br J of Anaesthesia 1993;71: 807-9.
18. Povey HMR, Jacobsen J, Westergaars-Nielsen J. Subarachnoid analgesia with hyperbaric 0,5% bupivacaine: effect of a 60-min period of sitting. Acta Anaesth Scand 1989, 33: 295-7.
19. Fanelli G, Borghi B, Casati A, Bertini L. Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Italian study group on unilateral spinal anesthesia. Can J Anaesth 2000; 47(8): 746-51.
20. Tok D, Turhanoğlu S, Özyılmaz MA, Bayhan N, Akça T. Tek yanlı spinal anestezi uygulanan ortopedik girişimlerde 1, 1.5 ve 2 mL % 0,5 hiperbarik bupivakain'in etkileri. Türk Anest ve Rean Cem 1997; 25:277-80.
21. Chambers WA, Edström HH, Scott DB. Effects of baricity of spinal anaesthesia with bupivacaine. Br J Anaesth 1981; 53: 279-82.