İsmet TOPÇU, E. Alp YENTÜR, Selcen TEKİN, Zuhal ÇAVUŞ, N. Zeynep EKİCİ, Melek SAKARYA

Hasta kontrollü epidural doğum analjezisi için bupivakain fentanil ile ropivakain fentanilin etkinliğinin karşılaştırılması

Bu prospektif, randomize, çift kör çalışmada, %0.125 ropivakain ve l$mu$g mL~'fentanil ile %0.125 bupivakain ve l$mu$g m$L^-1$ fentanilin doğum analjezisi için hasta kontrollü epidural analjezi (HKEA) yöntemiyle uygulanmasının etkinliğini değerlendirmeyi amaçladık. Çalışma ASAI/II grubu, verteks pozisyonunda ve normal bir fetal nabız paterni taşıyan, 36-41 haftalık sağlıklı tekfetusu olan, doğumun aktif fazında ve servikal dilatasyonu 3-6 cm olan 20'ger kişilik 2 grupta yapıldı. Grup I'e %0.125 ropivakain ve l$mu$g m$L^-1$1 fentanil ve Grup II'ye %0.125 bupivakain ve l$mu$g m$L^-1$ fentanil ile hazırlanan solüsyon uygulandı. HKEA 5mL bolus doz ve 10 dk kilitli kalma (bazal infüzyon yok, l- 4 sa sınırı yok) ve 10 mL yükleme doz olarak programlandı. Hastanın ağrısı VAS ile (vizüel analog skala) (0-100mm), duyusal bloğu pin prik testi (0-3) ile ve motor bloğu ise Modifiye Bromage skalası ile değerlendirildi. Maternal ortalama arter basıncı (OAB), kalp atım hızı (KAH) ve fetal KAH doğum işlemi boyunca kaydedildi. Umblikal arter pH ve bebeğin APGAR'ı ve doğum sonrası hasta işlem memnuniyeti (1-5) değerlendirildi. Doğumun şekli (normal, müdahaleli ve sezaryen), yan etkiler, doğum süreleri ve analjezik tüketimi doğumun birinci ve ikinci evresi için HKEA cihazından hesaplanarak kaydedildi. Gruplar arasında O AB, KAH, fetal KAH, VAS, duyusal blok, kullanılan anestezik solüsyon miktarı, doğum şekli, doğum süreleri, gelişen yan etki ve memnuniyet değerlendirmesi açısından f ark saptanmadı. Ancak ropivakainlfentanil grubunda bupivakainı f entanil grubuna göre daha az motor blok görüldü (p

Anahtar Kelimeler:

Fentanil, Doğum, normal, Anestezikler, lokal, Bupivakain

The comparison of efficiency of bupivacaine-fentanyl with ropivacaine-fentanyl in patient controlled epidural analgesia for labour

In this prospective, randomized, double-blinded study we aimed to evaluate the efficiency of 1 $mu$g m$L^-1$fentanyl with 0.125% bupivacaine and l$mu$g m$L^-1$ fentanyl with 0.125% ropivacaine by patient controlled epidural analgesia (PCEA)for labour. The study was performed in 2 groups; each consisted of 20 pregnants which had healthy, single fetus in 36-41 gestational weeks with normal fetal pulse pattern in vertex position, 3-6 cm of cervical dilatation and at active phase of labour. Solution of lug mL' fentanyl with 0.125% ropivacaine was applied to Group I and lug m$L^-1$ fentanyl with 0.125% bupivacaine to Group II. PCEA was programmed as 5 ml bolus dose, 10 minutes lock-out (without basal infusion, and 1-4 h limit) and 10 mL loading dose. Patients' pain was evaluated by VAS (visual analog scale) (0-100mm), sensory block by PinPrick test (0-3) and motor block by modified Bromage scale. Maternal mean arterial pressure (MAP), heart rate (HR) and fetal HR were recorded during the labour. Umblical artery blood pH, APGAR of fetus and patient satisfaction after delivery (1-5) were assessed. Mode of delivery (normal, operative and cesarean), side-effects, duration of labour and analgesics consumption f or the first and second stages of labour were recorded by calculating the values via PCEA. No differences were obtained in the evaluation of MAP, HR, fetal HR, VAS, sensory block, amount of analgesics solution, mode of delivery, duration of labour, side effects and patient satisfaction between the groups. However, lesser motor block was observed in ropivacaine/fentanyl group rather than bupivacaine/fentanyl group (p<0.05). Consequently, both lug m$L^-1$ fentanyl with 0.125% ropivacaine and l$mu$g m$L^-1$ fentanyl with 0.125% bupivacaine by patient controlled epidural analgesia (PCEA) for labour, provided sufficient and trustworthy analgesia. Similar effects were obtained on hemodynamics but because of lesser motor block effect, we propose that ropivacaine more superior for labour analgesia.

Keywords:

Fentanyl, Labor, Obstetric, Anesthetics, Local, Bupivacaine,

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