Kaudal analjezide iki farklı konsantrasyonda bupivakain’in stres yanıt ve postoperatif analjezi üzerine etkilerinin karşılaştırılması

Amaç: Kaudal epidural blok; yaygın olarak kullanılan ve çocuklarda perioperatif ağrı kontrolu için etkili ve yeterli analjezi sağlayan cazip bir metoddur. Bu çalışmada; inguinal herni operasyonu geçirmesi planlanan ve kaudal blok uygulanan çocuklarda, bupivakainin iki farklı dozunun, cerrahi strese bağlı hormonal yanıta ve postoperatif analjezi süresi üzerine etkilerinin karşılaştırılması planlandı. Gereç: Etik komite ve işlem için ebeveynlerinden izin alınan ASA I-II, 4-10 yaş arası 80 hasta rastgele iki gruba ayrıldı. Anestezi indüksiyonu sevoşuran ve sisatrakuryum ile gerçekleştirildi. Entübe edilen olgular, sol lateral pozisyona çevrildi. 1.grupta (Grup A) olgulara % 0.125’lik, 2. grupda (Grup B) ise % 0.25’lik bupivakain 1 ml kg-1 dozda uygulanarak kaudal blok gerçekleştirildi. Anestezi idamesinde opioid ajan uygulanmaksızın % 1-2 minimum alveolar konsantrasyon (MAK) sevoşuran ve % 50 O2-N2O kullanıldı. Olguların kaudal blok öncesi ve postoperatif 30. dk’da kan glukoz, kortizol düzeylerine bakıldı. Olguların postoperatif ağrısı objektif ağrı skalası (OPS) ile değerlendirildi ve skor 5’ün üzerinde ise rektal yolla parasetamol (30 mg kg-1) uygulandı. Bulgular: Olgular arasında demografik veriler ve operasyon süresi açısından anlamlı bir fark yoktu (p>0.05). Stres hormonlarının seviyeleri ile ağrı skorları ve ek analjezik ihtiyaçları arasında istatistiksel olarak anlamlı fark olmamakla birlikte Grup B’de Grup A’den daha düşük değerler saptandı. Sonuç: Çocuklarda kaudal epidural blokta % 0.125 konsantrasyonda bupivakainin daha az toksisite ve eşdeğer analjezi özellikleri nedeniyle tercih edilebileceği sonucuna vardık.

Comparison of the effect of the different consantrations of bupivacaine on stress response and postoperative analgesia in caudal analgesia

Introduction: Caudal epidural anaesthesia is used worldwide and is an attractive method to provide effective and satisfactory analgesia for perioperative pain in control children. The procedure was administered for caudal block in children scheduled for inguinal hernia operation and designed to compare two different dose regimens of bupivacaine on hormonal reaction according to stress and to asses its effect on post-operative analgesia. Method: 80 ASA I-II, aged betwen 4-10 years old patients were randomly divided into two different groups after the approvel of the ethic committee and parents’ informed consent. Anesthesia induction was achieved by sevofluorane and cisatracurium, after intubation, cases were set to lateral decubitus position. Caudal block achieved 0.125 % bupivacaine in the first group (Group A) and 0.25 % in the second group (Group B) at 1mL kg-1 dosage. Cases were treated with sevufluorane 1-2 % minimum alveolar concentration (MAC) and 50 % O2-N2O without any opioid agents for the anesthesia continuation. Cases were examined for blood glocose, cortisole levels before caudal block and at 30 minutes after the discontinuation of the surgery. Cases were evaluated by objective pain scala (OPS) in the first 24 hours after the surgery and with scores greater than 5 were treated with intrarectal paracetamol (30 mg kg-1) Results: There were no statistically significant differences among the demographic data and surgery time of the cases (p>0.05). Stress hormones levels and pain scores and also avarage supplemental analgesic requirements were less in group B than group A but this was not statistically significant (p>0.05). Conclusion: We believe that 0,125 % bupivacaine can be used in the caudal epidural block of pediatric cases because of its less toxicity and equivalant analgesic properties.

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