İNGUİNAL HERNİ VAKALARINDA SPİNAL ANESTEZİDE KULLANILAN LEVOBUPİVAKAİNİN İZOBARİK VE HİPERBARİK FORMLARININ KARŞILAŞTIRILMASI

Amaç: Bu çalışmada, inguinal herni onarımında intratekal izobarik ve hiperbarik levobupivakainin sensoriyal ve motor blok üzerine olan etkilerinin prospektif, randomize ve çift kör karşılaştırılması amaçlandı. Yöntem: Hastalara intratekal olarak 3 mL %0,25 izobarik (L Grubu, n=20) veya hiperbarik (D Grubu, n=20) levobupivakain uygulandı. Duyusal blok pinprik testiyle ve motor blok modifiye Bromage skorlamasıyla değerlendirildi. Bulgular: Maksimum motor blok derecesi Grup L’de Grup D’ye göre anlamlı olarak yüksek bulunurken [2,2 ± 0,8 (1-3) ve 1,3 ± 1,1 (0-3),p=0,005] maksimum seviyeye ulaşma zamanı ve maksimum motor blok oluşma zamanı benzer olarak bulundu. Maksimum motor blok derecesi iki grup arasında karşılaştırıldığında; Grup L’de %45 Grup D’de ise %20 hastada motor blok derecesi 3, Grup L’de %0 Grup D’de %25 hastada motor blok derecesi 0 olarak bulundu. ‹ki grup karşılaştırıldığında motor blok derece yüzdelerinde istatistiksel anlamlılık bulundu (p=0,035). Sonuç: Çalışmamızda intratekal izobarik ve hiperbarik levobupivakain karşılaştırıldığında, hiperbarik levobupivakain kullanılan grupta, motor blok gelişimi daha az görüldü. Toplam duyusal ve motor blok süresi, hiperbarik grupta daha kısaydı ancak gruplar arasında istatistiksel fark izlenmedi. Bulgular değerlendirildiğinde, daha az motor blok gelişimi nedeniyle, günübirlik spinal anestezi uygulamalarında, hiperbarik levobupivakainin uygun bir seçenek olduğunu düşünmekteyiz.

A COMPARISON OF ISOBARIC AND HYPERBARIC FORMS OF LEVOBUPIVACAINE USED IN SPINAL ANAESTHESIA PROCEDURES FOR INGUINAL HERNIA INTRODUCTION

Objective: This study aimed to compare the effects of isobaric and hyperbaric levobipuvacaine on sensory and motor blockade during intrathecal administration for elective inguinal hernia repair in a prospective, randomized, and double-blinded design. Methods: Patients were allocated to receive 3 mL of either 0.25 % isobaric levobupivacaine (L Group, n=20) or hyperbaric levobupivacaine (D Group, n=20) intrathecally. The pin-prick test for sensory block and modified Bromage score for motor blocks were used. Results: Comparisons of the groups showed that the degree of maximum motor blockade was statistically significant, and it was higher in Group L [2.2 ± 0.8 (1-3) and 1.3 ± 1.1 (0-3), p=0.005], while the time intervals to attain maximum degree of motor blockade and the period of motor block of the groups were similar. The degree of maximum blockade was 3 in 45% of the patients in Group Land 20% of the patients in Group D, while it was 0 in none of the patients in Group Land 25 % of the patients in Group D. The rates of motor blockade attained in the two groups were statistically significantly different (p=0.035). Conclusion: In this study, motor blockade development was significantly lower in the patients who received hyperbaric levobupivacaine; the regression times for sensory and motor blockade were shorter in the hyperbaric group; however, the difference was not statistically significant. We conclude that hiperbaric levobupivacaine is a suitable choice in out-patient spinal anaesthesia practice with regards to less motor block degree and duration than with isobaric levobupivacaine.

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