Çocuklarda kaudal anestezide bupivakaine eklenen fentanil ile ketaminin karşılaştırılması

Çalışmamızda, çocuklarda kaudal bupivakaine eklenen fentanil veya ketaminin kaudal anestezi kalitesi, duyusal blok seviyesi, motor blok süresi, postoperatif analjezi süresi ve analjezik gereksinimi ile ortaya çıkan yan etkilerini karşılaştırmayı amaçladık. İnguinal herni onarımı yapılacak 1-8 yaş arasında 122 olgu çalışmaya alındı. Damar yolu açılırken sevofluran ile maskelenen olgulara kaudal anestezi ve cerrahi sırasında l-3mg $kg^-1$ $sa^-1$ propofol infüzyonu yapıldı. Grup I'e (n=43) 2mg $kg^-1$ %0.25 bupivakain grup II'ye (n=40) 1$mu$g $kg^-1$ fentanil+2mg $kg^-1$ %0.25 bupivakain, grup III'e (n=39) 0.5 mg $kg^-1$ ketamin + 2mg $kg^-1$ %0.25 bupivakain verildi. Olguların kaudal blok yapılmadan önce ve kaudal blok sonrası l0 dk arayla ortalama kan basıncı, kalp atım hızı, periferik oksijen satürasyonu, solunum sayısı, ETCO2 değerleri ve kullanılan toplam propofol miktarı kaydedildi. Blok başlama zamanı, duyusal blok seviyeleri, motor blok süresi, postoperatif analjezi süresi, kullanılan toplam analjezik miktarları ve komplikasyonlar kaydedildi. Ortalama duyusal blok seviyesi grup II ve III'de I'e göre anlamlı olarak daha yüksekti. Operasyon sonrası analjezik gereksinimi grup III'de T e göre anlamlı olarak daha azdı. Postoperatif analjezi süresi grup III'de diğer iki gruba göre anlamlı olarak daha uzundu. Sonuç olarak, bupivakaine eklenen fentanil veya ketamin kaudal anestezi kalitesini etkilemediği, ancak ketaminin postoperatif analjezi süresini uzatarak analjezik gereksinimini azalttığı kanısına varıldı.

Anahtar Kelimeler:

Anestezi, kaudal, Karşılaştırmalı çalışma, Çocuk, Bupivakain, Fentanil, Ketamin

Comparison of fentanyl and ketamine addition to bupivacaine for caudal anesthesia in children

In our study, we aimed to compare the effects offentanyl and ketamine addition to bupivacaine on the quality of anesthesia, level of sensorial block, dumtion of motor block, postoperative analgesic requirement and duration of postoperative analgesia for caudal anesthesia in children. One hundred twenty two paüents aged between 1-8 years old undergoing İnguinal hernia repair were included in the study. Mask anesthesia with sevoflurane was applied during intravenous catheter placement and propofol infusion l-3mg $kg^-1$ $h^-1$ was given while performing caudal anesthesia and during the operation. in group I (n=43) 2mg $kg^-1$ 0.25% bupivacaine, in group II (n=40) 1$mu$g $kg^-1$ fentanyl and 2mg $kg^-1$ 0.25% bupivacaine, in group III (n=39) 0.5 mg $kg^-1$ ketamine and 2mg $kg^-1$ 0.25% bupivacaine was given. Mean blood pressure, heart rate, peripheral oxygen saturation, respiration rate, ETCO2 and total döşe of propofol used were recorded. Onset time of block, levels of sensorial block, duration of motor block and postoperative analgesia, total analgesic amount and complications were recorded. Mean level of sensorial block was significantly higher in group II and III than group I. Analgesic requirenıent after operation was significantly lovoer in group III than group I. Duration of postoperative analgesia was significantly longer in group III than the other groups. As a conclusion, we decided that fentanyl ör ketamine addition to bupivacaine does not affect the guality of caudal anesthesia, but ketamine decreased the analgesic requirement by extending duration of postoperative analgesia

Keywords:

Anesthesia, Caudal, Comparative Study, Child, Bupivacaine, Fentanyl, Ketamine,

___

1. Tobias JD. New insights into regional anesthesia in children: new techniques and new indications. Current Opinion in Anaesthesiology 2001;14:345-52.
2. Morray JP, Geiduschek JM, Ramamoorthy CMB, et al. Anesthesia-related cardiac arrest in children: Initial findings of the pediatric perioperative cardiac arrest (POCA) registry. Anesthesiology 2000;93:6-14.
3. Beer DAH, Thomas ML. Caudal additives in children-solutions or problems? Br J Anaesth 2003;90:487-98.
4. Barış S, Karakaya D, Kelsaka E, Güldoğus F, Arttürk E, Tür A. Comparision of fentanyl-bupivacaine or midazolam-bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children. Paediatr Anaesth 2003; 13:126-31.
5. Rowney DA, Doyle E. Epidural and subarachnoid blockade in children. Anaesthesia 1998;53:980-1001.
6. Anand KJS. Hormonal and metabolic functions of neonates and infants undergoing surgery. Curr Opin Cardiol 1986; 1:681 -9.
7. Lönnqvist PA, Ivani G, Moriarty T. Use of caudal-epidural opioids in children: stili state of the art or the beginning of the end? Paediatr Anaesth 2002; 12:747-9.
8. Enneking FK. Local anesthetics and additives. Anesth Analg 2001:92:32-6.
9. Cook B, Grubb DJ, Aldridge LA, Doyle E. Comparision of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesia produced by bupivacaine in children. Br J Anaesth 1995:75:698-701.
10. Wilson E, David A, Mackenzie N, Grand IS. Sedation during spinal anaesthesia: comparision of propofol and midazolam. Br J Anaesth 1990:64:48-51.
11. Johnston P, Findlow D, Aldridge LM, Doyle E. The effect of ketamine on 0.25% and 0.125% bupivacaine for caudal epidural blockade in children. Paediatr Anaesth 1999:9:31-4.
12. Russell SCS, Doyle E. Recent advances: Paediatric Anaesthesia. BMJ. 1997;314:201-3.
13. Ivani G, Mereto N, Lampugnani E, et al. Ropivacaine in paediatric surgery: preliminary results. Paediatr Anaesth 1998;8:127-9,
14. Carr AS, Fear DW, Sikich N, Bissonnette B. Bupivacaine 0.125% produces motor block and weakness with fentanyl epidural analgesia in children. Can J Anaesth 1998;45:1054-60.
15. Naguib M, Sharif AMY, Seraj M, Gammal ME, Dawlatly AA. Ketamine for caudal analgesia in children: comparision with caudal bupivacaine. Br J Anaesth 1991:67:559-64.
16. Özbek H, Bilen A, Özcengiz D, Güneş Y, Özalevli M, Akman H. The comparision of caudal ketamine, alfentanil and ketamine plus alfentanil admînistration for postoperative analgesia in children. Paediatr Anaesth 2002; 12:610-6.
17. Constant I, Gall O, Gouyet L, Murat I. Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children. Br J Anaesth 1998;80:294-g.
18. Campbell FA, Yentis SM, Fear DW, Bissonnette B, Analgesic efficacy and safety of caudal bupivacaine-fentanyl mixture in children. Can J Anaesth 1992;39:661-4.
19. Malinovsky JM, Lepage JY, Cozian A, Mussini JM, Pînaudt M, Souron R. Is ketamine or its preservative responsible for neurotoxicity in the rabbit? Anesthesiology. 1993;78:109-15.