Sema TUNCER, Alper YOSUNKAYA, Ruhiye REİSLİ, Aybars TAVLAN, Hatice KÖSTEKCİ, Şeref OTELCİOĞLU

Çocuklarda kaudal bupivakain ve bupivakain+sufentanilin postoperatif analjezik etkileri

Kaudal blok, çocuklarda alt abdominal, rektal ve urogenital cerrahi sonrası postoperatif analjezi için yaygın kullanılan bir yöntemdir. Bu çalışmada kaudal blok uygulanan çocuklarda, bupivakaine ilave edilen sufentanilin postoperatif analjezi süresine etkisini ve yan etkilerini değerlendirmeyi amaçladık. Bu çalışma fakülte etik kurul onayı alınarak ASA I-II grubu 3- 10 yaşlan arasında alt abdominal ve penoskrotal girişim planlanan 52 olguda yapıldı. Cerrahinin sonunda çocuklar randomize olarak iki gruba ayrıldı ve postoperatif analjezi için kaudal blok yapıldı. Grup l'e (n=26) l ml $kg^-1$ % 0.125 bupivakain, Grup II'ye (n=26) 0.5 $mu$g $kg^-1$ sufentanil + %0.125 bupivakain aynı volümde (l ml $kg^-1$ ) uygulandı. Olgular postoperatif dönemde 24 saat süreyle gözlendi. Postoperatif ağrı Modifiye Pediatrik Objektif Ağrı Skalası (MPOPS) ile değerlendirildi. Analjezi süreleri, ek analjezik ihtiyacı ve yan etkiler kaydedildi. Ayrıca servis hemşirelerinden çocukların davranışlarını ve annelerinden de uyku kalitelerini (0=neşeli/sakin, l=huzursuz, 2=gergin/ağlamaklı) değerlendirmeleri istendi. Olguların demografik verileri benzerdi. Gruplar arasında analjezi süresi ve yan etkiler bakımından farklılık bulunmadı (p>0.05). Fakat sufentanil eklenen gruptaki çocuklar neşeli ve daha sakindi. Kaudal blok uygulanan çocuklarda bupivakaine eklenen sufentanil analjezi süresini etkilememekte fakat daha kaliteli analjezi sağlamaktadır.

Anahtar Kelimeler:

İlaç kombinasyonları, Sufentanil, Bupivakain, Anestezikler, lokal, Ameliyat sonrası dönem

The effects of caudal bupivakaine and bupivakaine +sufentanil on postoperative analgesia in peadiatric patients

Caudal block is a widely used method for postoperative analgesia after lower abdominal, rectal and urogenital surgery in children. The aim of this study was to determine whether the addition of sufentanil to bupivacaine caudally prolongs the duration of analgesia and side effects compared with bupivacaine alone. Aged 3-10, fifty two boys were allocated randomly to two groups at the end of surgery. Children in group I received 0.125 % bupivacaine 1 ml $kg^-1$ ', group II received 0.5 $mu$g $kg^-1$ sufentanil + 0.125 % bupivacaine caudally. Postoperative pain was assessed according to Modified Pediatric Objective Pain Scale (MI-POPS) 2, 4, 6, 8,16 and 24h after operation. Time for first administration of analgesic, total number of analgesic doses requ-ired and side effects were recorded. Demeanor assessment was made according to tree-point scale (0= cheerful/calm, l=rest-less, 2= tense/tearful) by ward nurse. No significant differences were found between two groups for the pain scores. There was no significant difference in the requirement f or additional doses of analgesia. More Patients who had received caudal sufentanil with bupivacaine were cheerful and calm compared with those in bupivacaine group. The addition of sufentanil to bupivacaine for caudal block does not affect the analgesia duration but provides a quality analgesia in children.

Keywords:

Drug Combinations, Sufentanil, Bupivacaine, Anesthetics, Local, Postoperative Period,

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