Cevdet DÜGER, Caner MİMAROĞLU, Kenan KAYGUSUZ, Özdemir İclal KOL, Sinan GÜRSOY

Bupivakain ile yapılan spinal anesteziye morfin ilavesinin QT aralığına etkilerinin araştırılması

Amaç: Bu çalışmanın amacı, bupivakain gibi kardiyak aritmojenik bir ajana, morfin ilave edilerek yapılacak spinal anestezinin QT intervaline olan etkilerini araştırmaktır. Yöntem: Çalışma alt batın cerrahisi uygulanacak ASA I-II grubu, 30-60 yaş arası 60 hasta üzerinde prospektif, randomize ve çift kör olarak gerçekleştirildi. Hastalar rastgele 30’ar kişilik 2 gruba ayrıldı. Tüm hastalara intratekal alana 12,5 mg %0,5 hiperbarik bupivakain ile kontrol grubunda 0,3 mL %0,9 NaCl, morfin grubunda 0,3 mg morfin hidroklorür (0,3 mL) solusyonundan oluşan toplam 2,8 mL volümde enjeksiyon yapıldı. Çalışma boyunca ortalama arter basıncı, kalp atım hızı, duyusal blok seviyesi, QT ve QTc intervalleri kaydedildi. Bulgular: Spinal anestezi sonrası 5 ve daha sonraki dakikalardaki ortalama arter basıncı morfin grubunda kontrol grubundakilere göre anlamlı olarak düşük bulundu (p

Anahtar Kelimeler:

Bupivakain, Morfin, Rastgele kontrollü çalışmalar, Aritmiler, kardiyak, İleriye dönük çalışma, Çift kör metot

The investigation of the effects of morphine on QT interval at spinal anesthesia with bupivacaine

Objective: The aim of this study is to research the effects on QT interval of intrathecal morphine added to bupivacaine which is known as a cardiac arrhythmogenic agent. Method: The study was performed on 60 patients that are scheduled to have lower abdominal surgery. The patients were randomized into two groups 30 of each. Solution of 12,5 mg 0,5 % hyperbaric bupivacaine and 0,3 mL 0,9 % NaCl at the control group, and 0,3 mg morphine hydroclorur at the morphine group that have a volume of 2,8 mL were administered to the intrathecal area for spinal anesthesia. The mean arterial pressure, heart rates, sensorial block levels, QT and QTc intervals recorded during the study. Results: The mean arterial pressures at the postspinal 5th minute and after were found lower at the morphine group (p<0,05). QTc values of the morphine group were found lower than the control group at 20th, 25th and 30th minutes (p<0,05). The peak sensorial block level was higher, time to reach the block to T10 level was shorter, the two segment regressing time of sensorial block was longer at the morphine group (p<0,05). Itching were seen at 20% patients in morphine group, but no patients of control group (p<0,05). Conclusion: Adding a prototype and cardioprotective opioid agent morphine to cardiotoxic agent bupivacaine for spinal anesthesia may decrease arrythmia incidence.

Keywords:

Bupivacaine, Morphine, Randomized Controlled Trial, Arrhythmias, Cardiac, Prospective Studies, Double-Blind Method,

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