Leyla HOTAMAN, Gürkan TÜRKER, Alp GURBET, Tijen YILMAZLAR, Gülhan BAYRAK, Tuğçe ÖZBEY

Eşideğer dozdaki izobarik levobupivakainin farklı volümlerinin spinal anestezi karakteristikleri üzerine etkileri

Amaç: Çalışmamızda, endoskopik transüretral rezeksiyon cerrahisi geçirecek spinal anestezi uygulanan olgularda, 15 mg izobarik levobupivakainin farklı volümlerinin spinal anestezi karakteristikleri üzerine etkileri değerlendirildi. Yöntem: 75 olgu 3 eşit gruba ayrıldı: Grup L-2 mL: 2 mL % 0.75 izobarik levobupivakain, Grup L-3 mL: 3 mL % 0.5 izobarik levobupivakain ve Grup L-6 mL: 6 mL % 0.25 izobarik levobupivakain. Spinal anestezi, sollateral pozisyonda, L3-4 intervertebral aralığından uygulandı. Duyusal blok dermatom seviyesi ve motor blok derecesi değerlendirildi. Spinal anestezi derlenme zamanları ve komplikasyonlar kaydedildi. Bulgular: Ortalama en üst duyu bloğu seviyesi, Grup L-6 mL de diğer iki gruba göre anlamlı olarak daha yüksekti (her ikisi için p< 0.05). Duyu blok başlangıç zamanı Grup L-6 mL de diğer iki gruba göre daha kısa olarak bulundu (her ikisi için p< 0.01). Grup L-6 mL de spinal anestezi sonrası 8, 10, 12, 14 ve 16. dakikalarda diğer iki gruba göre ortalama duyu bloğu dermatom seviyesi anlamlı olarak daha yüksek bulundu (tüm zamanlar için p< 0.05). Postoperatif duyusal ve motor blok derlenme zamanları ve komplikasyonlar açısından farklılık saptanmadı. Sonuç: Yüksek volümde izobarik levobupivakain uygulanan grupta diğer iki gruba göre duyu blok başlangıç zamanının daha kısa ve en üst duyu bloğu seviyesinin daha yukarıda olduğu gösterilmiş ancak anesteziden derlenme zamanları üzerine belirgin bir etkisi görülmemiştir.

The effect of different volumes of similar dose isobaric levobupivacaine on spinal anaesthesia characteristics

Aim: In our study, we evaluated the effect of different volumes of 15 mg isobaric levobupivacaine on spinal anaesthesia characteristics in elective endoscopic transurethral resection surgery. Method: 75 adults randomized into three groups: Group L-2 mL: 2 mL 0.75 % isobaric levobupivacaine; Group L-3 mL: 3 mL 0.5 % isobaric levobupivacaine and Group L-6 mL: 6 mL 0.25 % isobaric levobupivacaine. Spinal anaesthesia was performed with patients placed in the lateral decubitis position at L3-L4 interspace. The level of sensory block dermatome and the degree of motor block was evaluated. Postoperative recovery time and complications were evaluated. Results: The mean highest level of sensory blockade was significantly higher in Group L-6 mL (p< 0.05 for both groups). Sen- sory block on set time in Group L-6 mL was shorter (p< 0.01 for both groups). At 8, 10, 12 and 16 minutes after the spinal anesthesia mean sensory block level were higher in Group L-6 mL (p< 0.05 for all points time). There were no significant differences among the groups in terms of postoperative recovery times and complications. Conclusion: Our results showed that, the onset time of sensory block was shorter and the highest sensory block level was higher with high volumes of isobaric levobupivacaine without any change on the spinal anaesthesia recovery time.

PDF

___

1.King HK, Wooten DJ. Effects of drug dose, volume and concent- ration on spinal anesthesia with isobaric tetracain. Reg Anaesth 1995; 20: 45-9.
2.Chambers WA, Edstrom HH, Scott DB. Effect of baricity on spi- nal anesthesia with bupivacaine. Br J Anaesth 1981; 53: 279-82.
3.Stienstra R, Grene NM. Factors affecting the subarachnoid spre- ad of local anesthetic solutions. Reg Anaesth 1991; 16: 1-6.
4.Stienstra R, van Porten JF. The temperature of bupivacaine 0.5 % affects the sensory level of spinal anestesia. Anesth Analg 1988; 67: 272-6.
5.Pargger H, Hampl KF, Aeschbach A, Paganoni R, Schneider MC. Combined effect of patient variables on sensory level after spinal 0.5 % plain bupivacaine. Acta Anaesthesiol Scand 1998; 42: 430-4.
6.Denson DD, Behbehani NM, Gregg RV. Enantiomer-spesific ef- fects of an intravenously administered arrhythmonegic dose of bupivacaine on neurons of the nucleus tractus solitarius and the cardiovascular system in the anesthetized rat. Reg Anaesth 1992; 17: 311-6.
7.Thomas JM, Schung SA. Recent advances in the pharmacokine- tics of local anaesthetics long-acting amide enantiomers and con- tinuous infusions. Clin Pharmacokinet 1999; 36: 67-83.
8.Lee YY, Muchhal K, Chan CK. Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intensive Care 2003; 31: 637-44.
9.Foster RH, Markham A. Levobupivacaine: A review of its phar- macology and use as a local anaesthetic. Drugs 2000; 59: 531-79.
10.Opas Vana M, Lamia Chumsang B, Sarinra Thongmee B. Levo- bupivakain and bupivakain in spinal anesthesia for transurethral endoscopic surgery. J Med Assoc Thai 2006; 8: 1333-9.
11.Erdil F, Bulut S, Demirbilek S, et al. The effects of intrathecal le- vobupivacaine and bupivacaine in the elderly. Anaesthesia 2009; 64: 942-6.
12.Andre A, Van Zundert, Andre M. Extent of anesthesia and he- modynamic effects after subarachnoid administration of bupiva- caine with epinephrine. Anesth Analg 1988; 67: 784-7.
13.Bromage PR. A comparison of the hydrochloride and carbondi- oxide salts of lidocaine and prilocaine in epidural analgesia. Act Anaesthesiol Scand (suppl) 1965; 16: 55-9.
14.Povey HM, Olsen PA, Pihl H, Jacobsen J. High dose spinal ana- esthesia with glucose free 0.5 % bupivacaine 25 and 30 mg. Acta Anaesthesiol Scand 1995; 39: 45761.
15.Khaw KS, Ngan Kee WD, Wong EL, Liu JY, Chung R. Spinal ropivacaine for cesarean section: a dose-finding study. Anesthesi- ology 2001; 95: 134650.
16.Parpaglioni R, Grazia M, Lemma A. Effect of different volumes of intrathecal levobupivacaine in early labor. Anesthesiology 2005; 103: 1233-7.
17.Schmidt A, Schwagmeier R, Broja E, Nolte H. The effect of vo- lume and dosage of isobaric bupivacaine on the sensory spread of spinal anesthesia. Reg Anaesth 1990; 13: 159-62.
18.Runza M, Albani A, Tagliabue M, et al. Spinal anesthesia using hyperbaric 0.75 % versus hyperbaric 1 % bupivacaine for cesare- an section. Anesth Analg 1998; 87: 1099103.
19.Richardson MG, Thakur R, Abramowicz JS, Wissler RN. Mater- nal posture influences the extent of sensory block produced by intrathecal dextrose-free bupivacaine with fentanyl for labor analgesia. Anesth Analg 1996; 83: 122933.
20.Wildsmith JA, McClure JH, Brown DT, Scott DB. Effects of posture on the spread of isobaric and hyperbaric amethocaine. Br J Anaesth 1981; 53: 2738.
21.Miyabe M, Sonoda H, Namiki A. The effect of lithotomy positi- on on arterial blood pressure after spinal anesthesia. Anesth Analg 1995; 81: 968.
22.Sanderson P, Read J, Littlewood DG, McKeown D, Wildsmith JA. Interaction between baricity (glucose concentration) and ot- her factors influencing intrathecal drug spread. Br J Anaesth 1994; 73: 7446.
23.Taivainen T, Tuominen M, Rosenberg PH. Influence of obesity on the spread of spinal analgesia after injection of plain 0.5 % bupivacaine at the L34 or L45 interspace. Br J Anaesth 1990; 64: 5426.
24.Chin KW, Chin NM, Chin MK. Spread of spinal anaesthesia with 0.5 % bupivacaine: influence of the vertebral interspace and spe- ed of injection. Med J Malaysia 1994; 49: 1428.
25.Taivainen TR, Tuominen MK, Kuulasmaa KA, Rosenberg PH. A prospective study on reproducibility of the spread of spinal anesthesia using plain 0.5 % bupivacaine. Reg Anaesth 1990; 15: 124.
26.Pitkanen M, Haapaniemi L, Tuominen M, Rosenberg PH. Influ- ence of age on spinal anaesthesia with isobaric 0.5 % bupivaca- ine. Br J Anaesth 1984; 56: 27984.
27.Racle JP, Benkhadra A, Poy JY, Gleizal B. Spinal analgesia with hyperbaric bupivacaine: influence of age. Br J Anaesth 1988; 60: 508-14.
28.Pitkanen MT. Body mass and spread of spinal anesthesia with bupivacaine. Anesth Analg 1987; 66: 12731.
29.Schiffer E, Van Gessel E, Gamulin Z. Influence of sex on cereb- rospinal fluid density in adults. Br J Anaesth 1999; 83: 9434.
30.Gaggero G, Van Gessel E, Forster A, Gosteli P, Gamulin Z. Com- parison of 5 mg tetracaine diluted in 1 mL, 2 mL and 4 mL of 10 % glucose for spinal anesthesia. Acta Anaesthesiol Scand 1993; 37: 697-701.
31.McClure JH, Brown DT, Wildsmith JAW. Effect of injected vo- lume and speed of injection on the spread of spinal anaesthesia with isobaric amethocaine. Br J Anaesth 1982; 54: 917-20.
32.Malinovsky JM, Renaud G, Le Corre P, et al. Intrathecal bupiva- caine in humans: influence of volume and baricity of solutions. Anesthesiology 1999; 91: 1260-6.
33.Danelli G, Baciarello M, Di Cianni S, et al. Effects of baricity of 0.5 % or 0.75 % levobupivakain on the onset time of spinal anesthesia: a randomized trial. Can J Anaesth 2008; 55: 501-6.
34.Atefl Y. Spinal, epidural ve kaudal bloklar. (eds.) Tulunay M ve Cuhruk M, Klinik Anesteziyoloji. Ankara, Günefl Tp Kitabevi 2008: 289-324.
35.Logan MR, McClure JH, Wildsmith JAW. Plain bupivacaine: an unpredictable spinal anaesthetic agent. Br J Anaesth 1986; 58: 292-6.
36.Malmqvit LA, Bengtsson M, Björnsson G, Jorfeldt L, Löfström JB. Sympathetic activity and haemodynamic variables during spinal analgesia in man. Acta Anaesthesiol Scand 1987; 31: 467-73..