Elektif sezaryen girişimlerinde intratekal hiperbarik bupivakain ile ropivakain'e eklenen sufentanil'in karşılaştırılması

Amaç: Bu çalışmada elektif sezaryen için sufentanil eklenen hiperbarik ropivakain ve bupivakain kombinasyonlarının intratekal verilmesinin motor ve duyusal blok özellikleri, anne ve bebek üzerine etkilerinin karşılaştırılması amaçlandı. Yöntem: Çalışma, ASA I-II, 18-40 yaşları arasında elektif sezaryen operasyonu geçirecek miadında 60 gebe kadında, prospektif ve randomize olarak planlandı. İntratekal olarak 30 gebeye 12.5 mg hiperbarik bupivakain+5 pıg sufentanil 3 mL serum fizyolojik içinde (Grup HBS) ve diğer 30 gebeye de 12.5 mg hiperbarik ropivakain+5 pıg sufentanil 3 mL serum fizyolojik içinde (Grup HRS) kullanıldı. Bulgular: HRS grubunda, HBS grubuna göre maksimum duyusal bloğa ulaşma süresi istatistiksel olarak anlamlı çıkmasa da daha kısa idi. İki segment regresyon süresi HRS grubunda, HBS grubundan daha kısa bulundu. Gruplar arası karşılaştırmada motor blok oluşma süresi ve motor blok kalkış süreleri HRS grubunda anlamlı daha kısa idi (p

A comparison of intrathecal sufentanil combined with either hyperbaric bupivacaine or hyperbaric ropivacaine for cesarean deliveries

Objective: In this study, we aimed to compare the motor and sensorial block characteristics, maternal and fetal effects, of intrathecal sufentanil combinations including either hyperbaric bupivacaine or hyperbaric ropivacaine in pregnant women undergoing spinal block for elective cesarean deliveries. Method: Sixty pregnant women between 18 and 40 years undergoing elective cesarean section were studied in a randomized prospective design. In group HBS, 12.5 mg hyperbaric bupivacaine and 5 pig sufentanil in 3 mL serum physiologic was applied intrathecally in 30 of the women. In group HRS, 12.5 mg hyperbaric ropivacaine and 5 pig sufentanil in 3 mL serum physiologic was applied intrathecally to the other 30. Results: In group HRS, the duration for reaching the maximum sensorial block was shorter in comparison to group HBS, although the difference was not statistically significant. The two-segment regression time was shorter in group HRS, when compared to group HBS. Motor block development time and motor block recovery time were statistically shorter in group HRS (p<0.05). Conclusion: Sufentanil combinations with either intrathecal hyperbaric bupivacaine or intrathecal hyperbaric ropivacaine can be used safely on patients undergoing cesarean deliveries.

___

  • 1.Morgan P. Spinal anaesthesia in obstetrics. Can J Anaesth 1995; 42:1145-63.
  • 2.Wiliams MJ. Local anesthetics. In; Pain Medicine. A Comprehen­sive Review. Mosby Year Book St. Louis 1996; 162-175.
  • 3.Marsh CR, Hardy PA, Ropivacaine: A new local anesthetic agent. Br J Hosp Medl991; 45:94-5.
  • 4.Bjornestad E, Smedvig JP, Bjerkreim T, Narverud G, Kolleros D, Bergheim R. Epidural ropivacaine 7.5 mg/ml for elective Caesarean section: a double-blind comparison of efficacy and tolerability with bupivacaine 5 mg/ml. Acta Anaesthesiol Scand 1999; 43:603-8.
  • 5.Concepcion M, Arthur GR, Steele SM, Bader AM, Covino BG. A new local anesthetic, ropivacaine. Its epidural effects in humans. Anesth Analg 1990; 70:80-5.
  • 6.Whitehead E, Arrigoni B, Bannister J. An open study of ropivaca­ine in extradural anaesthesia. Br J Anaesth 1990; 64:67-71.
  • 7.Finucane BT, Sandier AN, McKenna J, ve ark. A double-blind comparison of ropivacaine 0.5%, 0.75%, 1.0% and bupivacaine 0.5%, injected epidurally, in patients undergoing abdominal hysterectomy. Can J Anaesth 1996; 43:442-9.
  • 8.Zaric D, Axelsson K, Nydahl PA, Philipsson L, Larsson P, Jansson JR. Sensory and motor blockade during epidural analgesia with 1%, 0.75%, and 0.5% ropivacaine—a double-blind study. Anesth Analg 1991; 72:509-15.
  • 9.Markham A, Faulds D. Ropivacaine. A review of its pharmaco­logy and therapeutic use in regional anaesthesia. Drugs 1996; 52:429-9.
  • 10.Feldman HS, Arthur GR, Pitkanen M, Hurley R, Doucette AM, Covino BG. Treatment of acute systemic toxicity after the rapid intravenous injection of ropivacaine and bupivacaine in the cons­ cious dog. Anesth Analg 1991; 73:373-84.
  • 11.Moller RA, Covino BG. Effect of progesterone on the cardiac electrophysiologic alterations produced by ropivacaine and bupi­ vacaine. Anesthesiology 1992; 77:735-41.
  • 12.Camann WR, Denney RA, Holby ED, Datta S. A comparison of intrathecal, epidural, and intravenous sufentanil for labor analge­sia. Anesthesiology 1992; 77:884-7.
  • 13.D'Angelo R, Gerancher JC, Eisenach JC, Raphael BL. Epidural fentanyl produces labor analgesia by a spinal mechanism. Anest­ hesiology 1998;88:1519-23.
  • 14.Chung CJ, Choi SR, Yeo KH, Park HS, Lee SI, Chin YJ. Hyperbaric spinal ropivacaine for cesarean delivery: a comparison to hyperbaric bupivacaine. Anesth Analg 2001; 93:157-61.
  • 15.Van Zundert A, Vaes L, Van der Aa P, Van der Donck A, Meeuwis H. Motor blockade during epidural anesthesia. Anesth Analg 1986; 65:333-6.
  • 16.Ogun CO, Kirgiz EN, Duman A, Okesli S, Akyurek C. Compari­son of intrathecal isobaric bupivacaine-morphine and ropivacaine- morphine for Caesarean delivery. Br J Anaesth 2003; 90:659-64.
  • 17.Braga Ade F, Braga FS, Poterio GM, Pereira RI, Reis E, Cremonesi E. Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol 2003;20:631-5.
  • 18.Beilin Y, Galea M, Zahn J, Bodian CA. Epidural ropivacaine for the initiation of labor epidural analgesia: a dose finding study. Anesth Analg 1999; 88:1340-5.
  • 19.Khaw KS, Ngan Kee WD, Wong EL, Liu JY, Chung R. Spinal ro­pivacaine for cesarean section: a dose-finding study. Anesthesi­ology 2001; 95:1346-50.
  • 20.Kristensen JD, Karlsten R, Gordh T. Spinal cord blood flow after intrathecal injection of ropivacaine: a screening for neurotoxic ef­fects. Anesth Analg 1996; 82:636-40.
  • 21.Kristensen JD, Karlsten R, Gordh T. Spinal cord blood flow after intrathecal injection of ropivacaine and bupivacaine with or wit­hout epinephrine in rats. Acta Anaesthesiol Scand 1998; 42:685-90.
  • 22.Martin R, Frigon C, Chretien A, Tetrault JP. Onset of spinal block is more rapid with isobaric than hyperbaric bupivacaine. Can J Anaesth 2000; 47:43-6.
  • 23.Erdine S. Doğum Ağrısı ve Analjezisi. Ağrı 2002; 3: 136-143.
  • 24.Hunt CO, Naulty JS, Bader AM, ve ark. Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery. Anesthesiology 1989; 71:535^0.
  • 25.Courtney MA, Bader AM, Hartwell B, Hauch M, Grennan MJ, Datta S. Perioperative analgesia with subarachnoid sufentanil ad­ministration. Reg Anesth. 1992; 17:274-8.
  • 26.Herman NL, Calicott R, Van Decar TK, Conlin G, Tilton J. Deter­ mination of the dose-response relationship for intrathecal sufenta­nil in laboring patients. Anesth Analg 1997; 84:1256-61.
  • 27.Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl, or placebo added to bu­ pivacaine for cesarean section. Anesth Analg 1997; 85:1288-93.
  • 28.Danelli G, Fanelli G, Berti M, et al. Spinal ropivacaine or bupiva­caine for cesarean delivery: a prospective, randomized, doubleblind comparison. Reg Anesth Pain Med 2004; 29:221-6.
  • 29.McClellan KJ, Faulds D. Ropivacaine: an update of its use in re­gional anaesthesia. Drugs 2000; 60:1065-93.
  • 30.McNamee DA, Parks L, McClelland AM, ve ark. Intrathecal ropi­vacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg mL"1 and 10 mg mL"1 solutions. Br J Anaesth 2001; 87:743-7.
  • 31.McClure JH. Ropivacaine. Br J Anaesth 1996; 76: 300-7.
Anestezi Dergisi-Cover
  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Betül Kartal
Sayıdaki Diğer Makaleler

Yaşamı tehdit eden akut lityum intoksikasyonu ve tedavi yaklaşımları (Olgu sunumu)

Şahin Tülay YILDIZ, Tülay HOŞTEN, Kamil TOKER, Mine SOLAK

Yaşlı hastalarda kalça protezi cerrahisinde sürekli spinal, sürekli epidural ve izofluran-remifentanil anestezisinin karşılaştırılması

PELİN KARAASLAN, Arash PİRAT, Reha TANDOĞAN, Ahu Miray KOÇAY, Gülnaz ARSLAN

Kalp pilleri, implante edilebilir kardiyoverter defibrilatörler ve cerrahi

Bülent ÖZİN, Fatma YİĞİT

Orta süreli ameliyatlarda sevofluran ve desfluranla sağlanan düşük akım anestezinin böbrek ve karaciğer işlevlerine etkisi

SEVTAP HEKİMOĞLU ŞAHİN, İnci PAKSOY, Özer Surhan ÇINAR, Sibel OBA, Ayşe HANCI

Prekürarizasyon süksinilkoline bağlı gelişen postoperatif miyaljiyi önler mi?

Bünyamin MUSLU, Selda MUSLU, Aslı DEMİR, Pınar DURAK, Özcan ERDEMLİ

Hastaların en kolay anladığı ağrı değerlendirme yöntemi hangisidir?

Sevda TAN, Gürayten Özyurt

Kemik segment kaydırmasında oluşan ağrının tedavisinde uzun süreli periferik sinir bloğunun yeri olabilir mi? (olgu sunumu)

Şebnem ATICI, Nurcan DORUK, İrfan AYAN, Pelin DELİAĞA, Uğur ORAL

Elektif sezaryen girişimlerinde intratekal hiperbarik bupivakain ile ropivakain'e eklenen sufentanil'in karşılaştırılması

Feray HAYIT, Yavuz DEMİRARAN, GÜLBİN SEZEN, Buket KOCAMAN, Abdulkadir İSKENDER, İsmail ÖZDEMİR

Günübirlik cerrahi ünitesinde pediatrik hastaların ailelerinin memnuniyetinin değerlendirilmesi

İ. Aydın ERDEN, A. Gülsün PAMUK, Turgay ÖCAL, Ülkü AYPAR

Amfizematöz piyelonefrit (olgu sunumu)

ŞULE AKIN ENES, Anış ARIBAOĞAN, Tuba CANPOLAT, Ferhat KILINÇ