Nefrektomi olgularında levobupivakain ile sağlanan peroperatif epidural analjezinin oksidatif stres üzerine etkisi

Amaç: Bu çalişmada; açik nefrektomi yapilan ürolojik vakalarda genel anestezi ile genel anestezi + peroperatif epidural analjezi kombinasyonunun oksidatif stres yanita etkisinin karşilaştirilmasi amaçlandi. Gereç ve Yöntem: TY‹EAH etik kurul onayi alindiktan sonra nefrektomi operasyonu planlanan ASA I -II grubu 30 hasta, Grup I: genel anestezi- torakal epidural analjezi (n=15) ve Grup II: genel anestezi (n=15) olacak şekilde randomize iki gruba ayrildi. Grup I’deki hastalara operasyondan 1 saat önce T8- L1 intervertebral bölgenin uygun bir araliğindan epidural kateter yerleştirildi. Epidural araliğa levobupivakain (1.25 mg mL-1) +fentanil (2 μg mL-1) içeren mayiden 8-10 mL verilerek epidural analjezi sağlandi ve hasta kontrollü analjezi (HKA) cihaziyla 6-8 mL saat-1 olacak şekilde epidural analjeziye devam edildi. Tüm hastalardan serum MDA, TAK ve SH grubu düzeylerinin ölçümü için; epidural analjezi öncesi (T1), nefrektomiden hemen önce (T2), operasyon sonunda (T3) ve postoperatif 4. saatte (T4) olmak üzere 4 kez kan alindi. Ayrica hastalarin yoğun bakim ve hastane kaliş süreleri kaydedildi. Bulgular: Her iki grupta bazal TAK, SH ve MDA değerleri benzerdi. Her iki grupta; MDA düzeyleri bazal değere oranla diğer dönemlerde anlamli olarak artmiş bulundu (p 0.05). SH düzeylerinde ise; hem grup içi hem de gruplar arasinda anlamli fark saptanmadi (p>0.05). Yoğun bakim ve hastane kaliş süreleri karşilaştirildiğinda; gruplar arasi anlamli fark yoktu (p>0.05). Sonuç: Oksidatif etkiyi gösteren lipid peroksidasyon ürünü MDA ve antioksidan yaniti değerlendirdiğimiz TAK ve SH grubu düzeylerindeki değişim yönünden genel anesteziye eşlik eden torasik epidural analjezinin her iki grup arasinda fark oluşturmadiği belirlendi.

The effect of peroperative epidural analgesia with levobupivacaine on the response of oxidative stress during nefrectomy operations

Objective: In this study; the effect of general anesthesia (GA) and peroperative epidural analgesia (EA) combined with GA on the response of oxidative stress were compared during open nefrectomy operations. Material and method: After TY‹EAH Ethical Committee approval, 30 patients in ASA I-II physical status, who were scheduled for open nefrectomy operation were allocated randomly into two groups, Group I: General Anesthesia (GA) + thoracic epidural anesthesia (EA) (n=15) and group II: GA (n=15). Thoracic epidural catheter was inserted in T8- L1 intervertebral area an hour before surgery. The epidural analgesia was provided by giving 8-10 mL from the solution that has contained levobupivacaine (1.25 mg mL-1) + fentanyl (2 &#956;g mL-1). And epidural analgesia was provided with PCA (patient control analgesia) device and the dose of 6-8 mL h-1. Blood was drawn four times from all patients in order to measure serum levels of malonyldialdehyde (MDA), total antioxidant capacity (TAC) and sulphidryl groups (SH), before epdural analgesia (T1), before nefrectomy (T2), at the end of the operation (T3) and postoperative fourth hour (T4). Also, the time the patients stay in the hospital and intensive care unit was recorded. Result: Basic TAC, SH and MDA values were similar in both groups. The levels of MDA were significantly increased in both of the group when compared with basic data (p <0.05). There was no difference between the two groups in the terms of the levels of MDA. While there was statistically significant increase in the levels of TAC in group I (p=0.02), there were no difference in group II. There was no difference between the two groups in terms of levels of TAC (p>0.05). There was no difference in the groups or between the two groups in the levels of SH also. Conclusion: Thoracic epidural analgesia combined with general anesthesia caused no difference in MDA levels which indicates lipid peroxidation and also TAC or SH levels which shows antioxidant effect.

Kaynakça

1.Hall GM. Effects of anesthesia on the endocrine and metabolic stress response to surgery. In: Nunn JF, Utting JE, Brown BR (eds). General Anesthesia (5th ed). London, Butterworth, 1989; 252-9.

2.Akkufl ‹. Serbest Radikaller ve Fizyopatolojik Etkileri. Konya, Mimoza Yayınları, 1995; s.1-132.

3.Sivacı R, Kahraman A, Serteser M, Sahin DA, Dilek ON. Cyto- toxic effects of volatile anesthetics with free radicals undergoing laparoscopic surgery. Clin Biochem 2006; 39: 293-8.

4.Cross CE, Halliwell B, Borish ET, et al. Oxygen radicals and hu- man disease. Ann Intern Med 1987; 107: 526-45.

5.Feeney L, Berman ER. Oxygen toxicity: Membrane damage by free radicals. Invest Ophthalmol 1976; 15: 789-92.

6.Demirbilek S, Erk G, Reisli R, Postacı A, Gögüs N. Sevofluran ve propofolün stres endokrin yanıta etkileri. Türk Anestezi ve Reanimasyon Cemiyeti Mecmuası 1999; 27: 564-8.

7.Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL. Efficacy of postoperative epidural analgesia: a meta- analysis. JAMA 2003; 290: 2455-63.

8.Buggy DJ, Kerin MJ. Paravertebral analgesia with levobupivaca- ine increases postoperative flap tissue oxygen tesion after imme- diate latissimus dorsi breast reconstruction compared with intra- venous opioid analgesia. Anesthesiology 2004; 100: 375-80.

9.Phlippa Newfield. Handbook of Neuroanesthesia 3nd ed. Lippin- cott Williams & Wilkins 2003; 116-8.

10.Erel O. Clinical Biochemistry 2004; 37: 277-85.

11.Da Costa CM, dos Santos RCC, Lima ES. A simple automated procedure for thiol measurement in human serum samples. J Bras Patol Med Lab 2006; 42: 345-50.

12.Bradley PP, Priebat DA, Christensen RD, Rothstein G. Measure- ment of cutaneous inflammation: estimation of neutrophil con- tent with an enzyme marker. J Invest Dermatol 1982; 78: 206-9.

13.Kehlet H, Holte K. Effect of post-operative analgesia on surgical outcome. Br J Anaesth 2001; 87: 62-72.

14.Chernow B, Alexander HR, Smallridge RC, et al. Hormanal res- ponses to graded surgical stress. Arch Intern Med 1987; 147: 1273-8.

15.Ozdilmac I, Altıntas F, Salihoglu Z, Demiroluk S, Aydın S, Uzun H. Alt batın cerrahisinde genel anestezi ile epdural + genel anes- tezi uygulamasının stres yanıta etkileri. Anestezi Dergisi 2003; 11: 195-200.

16.Demirbas M, Samli M, Aksoy Y, Guler C, Kilinc A, Dincel C. Comparison of changes in tissue oxidative-stress markers in ex- perimental model of open, laparoscopic, and retroperitoneosco- pic donor nepherectomy. J Endourology 2004; 18: 105-8.

17.Yüceyar L, Erolçay H, Konukoglu D, Bozkurt AK, Aykaç B. Epidural anesthesia may attenuate lipid peroxidation during aorto-femoral surgery. Can J Anaesth 2004; 51: 465-471.

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