Abidin KESRİKLİOĞLU, ATEŞ DUMAN, Öztin Cemile ÖĞÜN, Ruhiye REİSLİ, Selmin ÖKESLİ

Epidural anestezide bupivakain-tramadol kombinasyonunun bupivakain-fentanil ve bupivakain ile karşılaştırılması

Bu çalışmada, epidural anestezide kullanılan %0.5 bupivakain ve tramadol kombinasyonu, fentanil-bupivakain veya yalnızca bupivakain ile, epidural anestezi özellikleri, hemodinamik, solunumsal ve yan etkiler açısından karşılaştırıldı. Bu amaçla transüretral prostat rezeksiyonu uygulanacak 63 olgu 3 gruba ayrıldı. Epidural kateter yoluyla; Grup BT'ye (n=22) 70mg (14ml) %0.5 bupivakain+50 mg tramadol, Grup BF'ye (n=21) 70mg (14ml) %0.5 bupivakain+50 $mu$gfentanil ve Grup B'ye (n=20) tek başma70mg (14ml) %0.5'lik bupivakain uygulandı. Tüm gruplarda, kalp atım hızı (KAH), ortalama arter basınçları (OAB), solunum sayısı ve Sp02, duyusal blok düzeyi, maksimum duyusal blok düzeyi ve motor blok dereceleri gözlenerek kaydedildi. Postoperatif dönemde etkin analjezi süresi (VAS 4'e ulaşma zamanı) ve yan etkiler kaydedildi, istatis-tiksel değerlendirmede tek yönlü varyans analizi (ANOVA), Tukey HSD analizi, Kruskall Wallis ve Bonferroni düzeltmeli Mann-Whitney U testi kullanıldı ve p

Anahtar Kelimeler:

Bupivakain, Tramadol, Fentanil, Varyans analizi, Anestezi, epidural, Kalp hızı

The comparison of bupivacaine-tramadol combination with bupivacaine-fentanyl and plain bupivacaine in epidural anesthesia

In this study, the properties of epidural anesthesia mth 0.5% bupivacaine and tramadol was compared with epidural anesthesia using bupivacaine-fentanyl or plain bupivacaine. F or this purpose, 63 patients undergoing transuretral prosta-te resection were divided into three groups. Group BT (n=22 received 70 mg 0.5 % bupivacaine + 50 mg tramadol HCl, Group BF(n=21) received 70 mg 0.5 % bupivacaine + 50 $mu$g fentanyl and Group B (n=20 received only 70 mg 0.5 % bupi-vacaine epidurally. Heart rate (HR), mean arterial pressure (MAP), breath rate (BR), oxygen saturation SpO2 levels of sensorial block, maximum sensorial block level and motor block level were recorded. Time to need for an analgesic supp-lement (effective analgesia) (time to reach VAS 4) was recorded. One way analysis of variance, Turkey HSD, Kruskall Wallis Bonferroni corrected Mann-Whitney- U tests were used. No significant change in HR was seen in between the three groups after the epidural block. A significant decrease of MAP was seen in Group BF beginning at the 40'" minute lasted up to the 60"1 minute. Time to reach T10 sensory block level and time to reach maximum sensory block level was shorter in Group BF than Groups BT and B while Group BT and Groups B were similar. Time to complete motor block was similar in Group BT and BF. The number of patients with complete motor block was similar in Group BT and BF while there was nopatient with complete motor block in Group B. The time to reach VAS 4 was 17.57+7.82 hours in Group BT, 11.79±8.48 hours in Group BF and 5.40+2.67 hours in Gro-up B (p<0.05). Side effects were similar and no treatment was needed. in conclusion, tramadol-bupivacaine combination increases postoperative analgesia time significantly compared mth fentanyl-bupivacaine combination and plain bupivacaine while providing stabile hemodynamic responses and similar side effects.

Keywords:

Bupivacaine, Tramadol, Fentanyl, Analysis of Variance, Anesthesia, Epidural, Heart Rate,

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