Hasta kontrollü analjezide epidural bupivakain, bupivakain-fentanil ve bupivakain-ketaminin etkilerinin karşılaştırılması

Amaç: Çalışmamızda, total abdominal histerektomi (TAH) operasyonu uygulanan olgularda postoperatif analjezi amacıyla hasta kontrollü epidural analjezi (HKEA) yöntemi kullanılarak bupivakain, bupivakain+fentanil ve bupivakain+ketamin kombinasyonlarının analjezik etki ve yan etkilerinin karşılaştırılması amaçlandı. Yöntem: ASA I ve II grubu, 18-65 yaş arası 60 olgu çalışmaya alındı. Genel anestezi altında operasyonu planlanan olgulara operasyon öncesinde epidural kateter yerleştirildi. Operasyon bitiminde derlenmeye alınan olgular postoperatif ağrı tedavisi için randomize ve çift kör olarak 3 gruba ayrıldı. HKEA solüsyonları 100 mL %0.9 NaCl içerisinde, Grup B'de (kontrol) %0.125 bupivakain, Grup BF'de %0.125 bupivakain + 0.1 mgfentanil ve Grup BK %0.125 bupivakain + 40 mg ketamin olarak hazırlandı. HKEA pompası 5mL bolus doz ve 10 dakika kilitli kalma (bazal infüzyon yok, 4 saat limiti 30 mL) ve 10 mL yükleme dozu (çalışma solüsyonundan) şeklinde standart olarak programlanıp uygulanmaya başlandı. 24 saat boyunca hemodinamik parametreler, VAS skorları, toplam analjezik kullanımları, ek analjezik gereksinimi, sedasyon skorları, memnuniyet skorları ve görülen yan etkiler kaydedildi. Bulgular: Fentanil eklenen grupta toplam analjezik tüketimi diğer gruplardan düşük bulundu (p

A comparison of bupivacaine, bupivacaine-fentanyl and bupivacaine-ketamine in patient-controlled epidural analgesia

Background: In this study, the analgesic and side effects of bupivacaine with combinations ofketamine and fentanyl using patient-controlled-epidural analgesia (PCEA) methods in the postoperative period of total abdominal hysterectomy (TAH) operations were compared. Method: Sixty ASA I-II patients aged between 18-65 years were included. Following epidural catheterization the patients were operated under general anesthesia. After surgery, patients were randomly allocated to 3 groups in a double-blinded fashion to receive PCEA as Group B: 0.125% bupivacaine, Group BF: 0.125% bupivacaine plus 0.1 mg fentanyl and Group BK: 0.125% bupivacaine plus 40 mg ketamine solutions (10 mL loading dose, 5 mL bolus dose, 10 min lockout time, 30 mL in a 4 hour limit) in 100 mL salin. Hemodynamic parameters, VAS scores, total analgesic consumption, additional analgesic requirements, sedation scores, satisfaction scores and probable side-effects were evaluated for 24 h. Results: Total analgesic consumption was lower in the fentanyl group (p<0.05). Therefore VAS scores in the fentanyl group were lower than the other groups at the 1 hour and the 24 hour assessments (p<0.05). Postoperative analgesic consumption was lower in the ketamine group compared to the control group. There was no difference in side effects and additional analgesic requirement between the groups. Conclusion: Fentanyl and ketamine may be used safely by PCEA for postoperative analgesia. These adjuncts increase analgesic quality and patient satisfaction without increased side effects.

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Anestezi Dergisi-Cover
  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Betül Kartal
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