Ahmet KÖROĞLU, Sami ERDEM, Müslüm ÇİÇEK, Zafer DOĞAN, Nurzen SEZGİN, M. Özcan ERSOY

İntratekal bupivakaine fentanil veya meperidin eklenmesinin hemodinami, postoperatif analjezik gereksinimi, histamin, IgE, bazofil ve eozinofil seviyelerine etkisi

Çalışmamızda, spinal anestezide bupivakainle birlikte uygulanan fentanil ve meperidinin hemodinami, postoperatif analjezik gereksinimi, histamin, IgE, bazofil, eozinofil seviyelerine etkilerini ve komplikasyonları karşılaştırmayı, kaşıntı ile eozinofil, bazofil seviyesi arasındaki ilişkiyi araştırmayı amaçladık. Çalışmaya alınan 45 olgunun kalp atım hızı, ortalama arter basıncı, SpO2 değeri, solunum sayısı spinal anestezi öncesi ve sonrası kaydedildi. Intratekal 10 mg bupivakaine ilave olarak Grup B'ye 0,5 mL %0.9 NaCI, Grup F'ye 25 $mu$g fentanil, Grup M'ye 25 mg meperidin uygulandı. Histamin, IgE, bazofil, eozinofil seviyeleri için spinal anesteziden 30 dk önce, 8 ve 60 dk sonra kan örnekleri alındı. Postoperatif 24. saate kadar VAS ve analjezik gereksinimi değerlendirildi. Histamin ve bazofil seviyeleri Grup M ve F'de spinal anestezi sonrası 8. ve 60. dk'da anlamlı anmakla birlikte, histamin seviyesi spinal anestezi sonrası 8. dk'da Grup M'de diğer gruplara oranla anlamlı olarak yüksekti. Geç postoperatif dönemde VAS skoru, analjezik gereksinimi Grup M'de anlamlı olarak düşüktü. Kaşıntı ve kusma Grup F'de daha fazlaydı, kaşıntı ile eozinofil, bazofil seviyesi arasında ilişki yoktu. Sonuç olarak, intratekal fentanil ve meperidinin hemodinamiyi etkilemediği, meperidinin geç postoperatif dönemde daha iyi analjezi sağladığı saptandı. Meperidin ile daha fazla olmasına rağmen iki opiyoidin de histamin salıverilmesini artırdığı, fentanilin daha fazla kusma ve kaşıntıya neden olduğu, kaşıntı ile eozinofil, bazofil seviyesi arasında ilişki olmadığı kanısına varıldı.

Anahtar Kelimeler:

Fentanil, Meperidin, Analjezi, Kaşıntı, Ameliyat sonrası bulantı ve kusma, Bupivakain, Anestezi, spinal

Effects of intrathecal fentanyl or meperidine addition to bupivacaine on hemodynamic variables, postoperative analgesic requirements, levels of histamine, IgE, basophiles and eosinophiles

The aim of our study is to compare the effects of intrathecal fentanyl and meperidine with bupivacaine on hemodynamics, postoperative analgesic requirement, side effects and levels of histamine, IgE, basophiles, eosinophiles and to investigate a possible relationship between itching and levels of basophiles and eosinophiles. Heart rate, mean arterial pressure, SpO2 values, respiration rates of 45 cases were recorded before and after spinal anesthesia. intrathecal 1O mg bupivacaine heavy was used in combination with 0.5 mL 0.9% NaCI in group B, 25 $mu$g fentanyl in group F, 25 mg meperidine in group M were given. Blood samples were collected to determine the plasma levels of histamine, IgE, basophiles and eosinophiles 30 min before spinal anaesthesia, and at the 8th, 60th minutes of spinal anaesthesia. Analgesic requirement was evaluated for postoperative 24 hours by using VAS. Although plasma levels of histamine and basophiles were significantly higher in group M and F at the 8th, 60th min of spinal anaesthesia, levels of histamine were significantly higher in group M than other two groups at the 8th min of spinal anaesthesia. VAS scores and analgesic requirements were significantly lower in group M than the other two groups at late postoperative period. Itching and vomiting incidences were higher in group F and there was no relationship between itching and levels of eosinophiles and basophiles. In conclusion, we determined that intrathecal fentanyl and meperidine did not effect hemodynamics, and meperidine provided better analgesia in the postoperative period. Although, histamine release increased with both opioids, it was more in meperidine than fentanyl, however fentanyl caused more vomiting and itching. There was no relationship between levels of eosinophiles, basophiles and itching.

Keywords:

Fentanyl, Meperidine, Analgesia, Pruritus, Postoperative Nausea and Vomiting, Bupivacaine, Anesthesia, Spinal,

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