Aslı DÖNMEZ, Zeynep KAYHAN, Arash PİRAT

Koroner arter cerrahisi uygulanan olgularda torasik epidural ve sistemik morfinin pulmoner fonksiyonlara etkileri

Bu prospektif randomize çalışmada; koroner arter cerrahisi geçiren 30 olguda postoperatif analjezi amacıyla uygulanan intravenöz ve epidural morfin sülfatın, arteriyel kan gazı (AKG) ve solunum fonksiyon testleri (SFT) üzerindeki etkileri karşılaştırıldı. Tüm olgulara standart anestezi ve cerrahi protokolleri uygulandı. Torasik epidural morfin grubuna (Grup TEM) alınan 15 olguya postoperatif analjezi için 2 mg bolus ve 0.6 mg sa-1 infüzyon seklinde morfin epidural yolla verildi. Kontrol grubu olarak seçilen intravenöz morfin grubuna (Grup İVM) ise aynı amaçla 5 mg bolus ve 2.5 mg.sa-1 infüzyon seklinde intravenöz morfin verildi. Olguların postoperatif 2, 6, 12 ve 24'üncü saatlerde alınan AKG'ları, 12, 24 ve 72'nci saatlerde ağrı düzeyinin belirlenmesi için kullanılan, görsel benzerlik skalası (Visual Analogue Scale, VAS) skorları ile preoperatif 3 ve 7'nci günlerde yapılan solunum fonksiyon testleri (SFT) değerlendirmeye alındı. Her iki grubun postoperatif SFT değerleri, preoperatif değerlere göre düşük bulundu (p < 0.05). Ancak iki grup arasında VAS, SFT ve AKG sonuçları bakımından herhangi bir fark saptanamadı. Sonuç olarak; kardiyak cerrahide postoperatif analjezi için, bu çalışmada kullanılan dozlarda, TEM sistemik morfine göre postoperatif analjezi, SFT ve AKG sonuçları bakımından üstünlük sağlamamaktadır.

Anahtar Kelimeler:

Analjezi, Anestezi, epidural, Solunum fonksiyon testleri, Kan gazı analizi, İleriye dönük çalışma, Koroner arter köprüleme

Effect of thoracic epidural VS systemic morphine on pulmonary function after coronary bypass surgery

In this prospective study, we compared the effects of intravenous versus epidural morphine sulphate on arterial blood gases (ABG) and pulmonary function tests (PFT) in patients who underwent coronary artery bypass graft surgery. Standard anesthetic and surgical protocols were used in all patients. Thoracic epidural cathether was inserted in 15 patients (the TEM group). This group received a 2 mg bolus of epidural morphine sulfate followed by a constant epidural infusion of 0.6 mg hr<sup>-1</sup>. The control group (the IVM group, n = 15) received a 5 mg bolus and 2.5 mg hr<sup>-1</sup> constant infusion of intravenous morphine for postoperative pain management. ABG were obtained at postoperative 3, 6,12, and 24th hours. PFT were performed preoperatively and on postoperative days 3 and 7. Visual analogue scale was used for evaluation of postoperative pain in these patients. In both groups, the postoperative PFT were significantly decreased compared to preoperative values. However, there was no significant difference between TEM and IVM patients in terms of VAS scores, PFT, and ABG at any time during the study. Using TEM for postoperative pain management in cardiac surgery patients offers no advantage over IVM with regard to PFT and ABG.

Keywords:

Analgesia, Anesthesia, Epidural, Respiratory Function Tests, Blood Gas Analysis, Prospective Studies, Coronary Artery Bypass,

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