Hilmi Ömer AYANOĞLU, NÜZHET SEDEN KOCABAŞ, Sezgin ULUKAYA, Özlem ALDEMİR, Ahmet Zeki ÇÖKMEZ

Saddle blokta lokal anesteziye eklenen fentanilin postspinal baş ağrısına etkisi

Perianal cerrahi geçirecek olgularda bupivakain veya bupivakain-fentanil ile saddle blok uygulamaları sonrasında postspinal baş ağrısı insidansının karşılaştırılması amaçlandı. Perianal cerrahi geçirecek 18-65 yaşlarındaki 90 olgu çalışmaya dahil edildi. Omurganın uzun eksenine paralel olarak ilerletilen 25 G Quincke iğne ile lomber ponksiyon uygulandı ve deneme sayısı birden fazla olan olgular çalışma dışında bırakıldı. Intralekal % 0.5 bupivakain (6 mg) (Grup I) veya % 0.5 bupivakain (6 mg) + fentanil (25 $mu$g) (Grup II) ile saddle blok uygulandı. Duyusal blok iğne batırma testi ile, motor blok ise Bromage'in skalası ile değerlendirildi, ilk analjezik gereksinimine, miksiyona ve ambulasyona dek geçen sureler ve komplikasyonlar kaydedildi. Postspinal başağrısının konservatif tedavisi ve gereğinde epidural kan yaması uygulanması planlandı. Grupların duyusal blok başlangıcı, miksiyon ve anıbıılasyon süreleri benzer olmakla beraber, ilk analjezik gereksinim zamanı Grup II'de anlamlı olarak uzun bulundu (156 dk'ya karşı 283 dk) (p

Anahtar Kelimeler:

Fentanil, Anestezi, spinal, Baş ağrısı, Bupivakain

Incidence of postdural puncture headache after saddle block with bupivacaine or bupivacaine plusl fentanylin patients undergoing perianal surgery

This study aimed to determine the incidence of postspinal headache after saddle block using bupivacaine 0.5 % with or without fentanyl in ninety patients undergoing perianal surgery. The patients had saddle block with 0.5 % bupivacaine (6mg) in Group I and + 25 $mu$g of fentanyl in Group II. Quincke 25 G needles were used for dural punctures with needle bevels parallel to the dural fibres. Patients who experienced multiple needle insertions were excluded from the study. Sensory blockade was assessed by pinprick test and motor function was assessed by Bromage's scale. Times to first analgesic requirement, urination, ambulation and complications were noted. Postspinal headache was planned to be treated conservatively and by epidural blood patch, when needed. Times to onset of sensory blockade, to urinate and to ambulate were similar between groups. Time to first analgesic requirement was longer in Group II (156 vs. 283 min). Two patients in Group I and one patient in Group II developed postspinal headache. Twenty-eight patients in Group II had pruritus. The addition of 25 $mu$g fentanyl to 0.5 % bupivacaine spinal anesthesia prolonged the duration of analgesia, increased the incidence of pruritus but had no effect on the incidence of postspinal headache.

Keywords:

Fentanyl, Anesthesia, Spinal, Headache, Bupivacaine,

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