Reyhan FİDAN, İlknur R. SÖZENOĞLU, Nurten BAKAN, Melek ÇELİK

Sezaryen operasyonlarında intratekal bupivakaine eklenen fentanil, morfin ve alfentanilin etkileri

Bu çalışmada sezaryen operasyonu geçiren 60 olgu üzerinde, intratekal 7.5 mg %0.5 bupivakaine eklenen fentanil, morfin ve alfentanilin etkileri karşılaştırıldı. Olgular rastgele 15'er kişilik 4 gruba bölündü. Grup K'ya (kontrol grubu) intratekal % 0.5 bupivakain heavy (7.5 mg), Grup F"ye % 0.5 bupivakain heavy (7.5 mg) ve fentanil (25$mu$g). Grup M' ye % 0.5 bupivakain heavy (7.5mg) ve morfin (0.2mg), Grup A' ya % 0.5 bupivakain heavy (7.5 mg) ve alfentanil (0.25 mg) uygulandı. Olgularda duyusal bloğun başlama, maksimuma ulaşma, iki segment gerileme süreleri ve maksimum blok seviyesi, motor blok başlama ve iyileşme süreleri kaydedildi. Hemodinamik değerler, VAS, sedasyon skoru, ilk efedrin ihtiyacı süresi ve toplam efedrin ihtiyacı, 1. ve 5. dakika Apgar skoru ve umblikal ven kan gazı, postoperatif analjezi süresi, komplikasyonlar (bulantı, kusma, anksiyete, kaşıntı) değerlendirildi. Duyusal blok başlama, maksimum dermatoma ulaşma ve motor blok başlama süreleri kontrol grubunda diğer üç gruba göre istatistiksel olarak anlamlı derecede uzun iken (p

Anahtar Kelimeler:

Fentanil, Sezaryen, Alfentanil, Anestezi, spinal, Bupivakain, Morfin

Effects of addition of fentanyl, morphine and alfentanyl to intratecal bupivacaine in cesarean section

In this study the effects of fentanyl morphine and alfentanyl added to intrathecal 7.5 mg 0.5% bupivacaine on 60 patients who underwent cesarean sections are investigated. Patients were randomly divided into 4 groups each containing 15 women. Intrathecally, Group K ( control group) received 0.5 % bupivacaine heavy (7.5 mg), Group F received 0.5 % bupivacaine heavy (7.5 mg) and fentanyl (25$mu$g ), Group M received 0.5 % bupivacaine heavy (7.5 mg) and morphine (0.2 mg), Group A received 0.5 % bupivacaine heavy (7.5 mg) and alfentanyl (0.25 mg). Times for the beginning, reaching maximum and two dermatoms regression and maximum level of sensory block, times for the beginning and regression of motor block were recorded. Haemodynamic values, VAS, sedation score, time for first ephedrine administration and total ephedrine amount, APGAR scores and umblical vena blood gases at 1st and 5th minutes, postoperative analgesia period, complications (nausea, vomitting, anxiety, pruritis) were evaluated. In Control group ( Group K ) times for the beginning, reaching maximum dermatom of sensory block and the onset of motor block were statistically significantly longer (p<0.001) and times for two dermatoms regression of sensory block were shorter (p<0.001) than those in other 3 groups. Maximum dermatom level was significantly lower (p<0.001) in Control group. Times for regression of motor block in morphine and fentanyl groups were longer when compared with alfentanyl and control groups (p<0.001). Postoperative analgesia period was significantly short in control group and significantly long in morphine group while there was no difference between fentanyl and alfentanyl groups. VAS value in control group and sedation score values in other groups were high. Additional administered analgesic amount in Group K was greater than those in other groups. Nausea was more in Groups K and M while pruritis was remarkable in Groups M and A. For the other parameters there were no significant differences. In conclusion; in cesarean sections addition of fentanyl, morphine and alfentanyl to 7.5 mg 0.5% bupivacaine provides suffecient peroperative analgesia without depressing the baby, and compromising the haemodynamy of the mother and longers postoperative analgesia period.

Keywords:

Fentanyl, Cesarean Section, Alfentanil, Anesthesia, Spinal, Bupivacaine, Morphine,

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