Rukiye AYDIN, Özdemir İclal KOL, Kenan KAYGUSUZ, Sinan GÜRSOY, Caner MİMAROĞLU

Sezaryen operasyonlarında intratekal uygulanan hiperbarik bupivakain, ropivakain ve levobupivakainin etkilerinin karşılaştırılması

Amaç: Bu çalışmada, elektif sezaryen olgularında intratekal uygulanan hiperbarik bupivakain, ropivakain ve levobupivakainin spinal blok özellikleri ile annede hemodinami, yenidoğanda Apgar ve umblikal ven kan gazı değişiklikleri üzerine etkilerinin karşılaştırması amaçlanmıştır. Gereç ve Yöntem: Etik Kurul ve hastaların onayları alındıktan sonra ASA I-II grubu, 60 gebe 20’şerli rastgele üç gruba ayrıldı. Bupivakain grubundaki olgulara (n=20); %0,5 hiperbarik bupivakain 8mg, ropivakain grubundaki olgulara (n=20); %0,5 hiperbarik ropivakain, 12 mg, levobupivakain grubundaki olgulara (n=20); %0,5 hiperbarik levobupivakain 8 mg intratekal olarak uygulandı. Ameliyat öncesi ve süresince hemodinami, duyusal blok ve motor blok seviyeleri kaydedildi. Ayrıca birinci ve beşinci dakika Apgar skorları, umblikal kan gazı analizi, postoperatif VAS skoru ve yan etkiler kaydedildi. Bulgular: Demografik veriler, duyusal blok ve operasyon süreleri açısından gruplar arası fark yoktu. ‹statiksel olarak gruplar arasında hemodinamik bir farklılık yok iken, her üç grupta sistolik, diastolik ve ortalama arter basıncı değerlerinin bazale göre düştüğü görüldü (p < 0.05). Her üç gruptaki olguların maksimum Bromage skorlaması değerleri karşılaştırıldığında bupivakain grubunda (%95), ropivakain grubunda (%45) ve levobupivakain grubundaki (%75) Bromage skoru 3 bulundu. Motor bloğun ortadan kalkma süresi bupivakain grubunda, ropivakain ve levobupivakain grubundan daha uzun bulundu (p < 0.05). Yenidoğanların Apgar skorları ve umblikal kan gazı değerleri açısından gruplar arasında fark yoktu (p > 0.05). Sonuç: Sezaryen olgularında intratekal uygulanan eşit güçte hiperbarik ropivakain ve levobupivakain annede ve bebekte hemodinamik parametreleri bozmaksızın başarılı bir şekilde kullanılabileceğini, hiperbarik levobupivakain ve ropivakainin bupivakaine benzer spinal anestezi ve daha kısa motor blok süreleriyle erken mobilizasyon açısından bupivakaine alternatif olabileceği kanısına vardık.

Anahtar Kelimeler:

Hemodinamikler, Karşılaştırmalı çalışma, Bupivakain, Enjeksiyon, spinal, Sezaryen, Ameliyat sonrası komplikasyonlar, Kan gazı analizi, Ağrı yönetimi

The comparison effect of inrathecal hyperbaric bupivacaine, ropivacaine and levobupivacaine for cesarean section

Objective: The aim of this study was to compare the effects of intrathecal hyperbaric bupivacaine, ropivacaine and levobupivacaine on the hemodynamic parameters, spinal blockade characteristics, Apgar scores and umbilical veneous blood gases changes in mother and newborn undergoing elective cesarean section. Methods: After the approval of the Ethical Committee and the patients, sixty patients of ASA physical status I-II, undergoing elective cesarean section under spinal anesthesia, were enrolled in this clinical study. Patients were randomized into three groups. Bupivacaine group (n = 20) receiving 8 mg hyperbaric bupivacaine and ropivacaine group (n = 20) receiving 12 mg hyperbaric ropivacaine and levobupivacaine group (n = 20) receiving 8 mg hyperbaric levobupivacaine. Hemodynamic parameters, sensorial and motor blockade characteristics, Apgar scores, umbilical venous blood gas values, postoperative VAS scores, and side effects were recorded. Results: The demographic data, sensorial blockade and duration of surgery of the study groups were comparable (p > 0.05). Also there was no significant difference among the groups with regard to the hemodynamic parameters but in all groups systolic, diastolic and mean arterial blood pressures were decreased when compared with basal values (p<0.05). When Bromage score values were compared between groups in bupivacaine group (%95) values were higher than ropivacaine (%45) and levobupivacaine groups (%75) (p<0.05). The duration of the motor blockade was longer in bupivacaine group than the levobupivacaine and ropivacaine groups (p<0.05). There were no differences among groups with regard to the newborn Apgar scores and umbilical venous blood values (p>0.05). Conclusion: Intrathecally applied equally dosage hyperbaric ropivacaine and levobupivacaine in cesarean sections, could be used successfully without changing the hemodynamic parameters of mothers and newborns. Based on these data, spinal anesthesia with administration of hyperbaric levobupivacaine and ropivacaine can be applied as an alternative to bupivacaine for similar spinal anesthesia conditions, shorter motor blockade duration and earlier patient mobilization times.

Keywords:

Hemodynamics, Comparative Study, Bupivacaine, Injections, Spinal, Cesarean Section, Postoperative Complications, Blood Gas Analysis, Pain Management,

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1. Uysalel A, Aşık ‹, Çakar KS. Obstetrik ve Jinekolojik Cerrahide Anestezi.Türkiye Klinikleri J Surg Med Sci 2006,2(6): 81-93.
2. Kayhan Z. Klinik Anestezi. Santral Bloklar. II. Baskı, Logos Yayıncılık, Ankara 1997; s:477–89.
3. Erdine S: Sinir Blokları. İstanbul, Emre Matbaacılık 1993: 9-24.
4. Yegül İ: Obstetride Rejyonal Analjezi ve Anestezi. VI. Uludağ Kış Sempozyumu, 5-8 Aralık 1996, Bursa: Özet Kitabı 1996: 80-5.
5. Celleno D, Parpaglioni R, Frigo MG, Barbati G. Intrathecal levobupivacaine and ropivacaine for cesarean section. Minerva Anestesiol 2005; 71: 521-5.
6. Foster RH, Markham A. Levobupivacaine a review of its parmacology and use as a lcal anaesthetic. Drugs 2000; 59: 551-79.
7. Gautier P, Kock MD, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for caesarean section. Br J of Anaesth 2003; 91: 684-9.
8. Hansen TG. Ropivacaine: a pharmacological review. Expert Rev Neurother 2004; 4: 781-91.
9. Morgan GE, Mikhail MS. Klinik Anesteziyoloji; Ağrı tedavisi, 2002; 274-316.
10. Chen XZ, Chen H, Lou AF. Dose-response study of spinal hyperbaric ropivacaine for cesarean section. J Zhejiang Univ Sci B 2006; 7: 992-7.
11. Chung CJ, Choi SR, Yeo KH, Park HS. Lee SI, Chin YJ. Hyperbaric spinal ropivacaine for cesarean delivery: a comparison to hyperbaric bupivacaine. Anesth Analg 2001; 93: 157-61.
12. Milligan KR. Recent advances in local anaesthetics for spinal anaesthesia. Eur J Anesthiol 2004; 21: 837-47.
13. Russell IF. Inadvertent total spinal for Cesarean section. Anaest- hesia.1985; 40: 199-200.
14. Kallio H, Snäll EV, Tuomas CA, Rosenberg PH. Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery. Br J Anaesth 2004; 93: 664- 9.
15. Khaw KS, Ngan Kee WD, Wong M, Ng F, Lee A. Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solutions. Anesth Analg 2002; 94: 680-5.
16. McDonald SB, Liu SS, Kopacz DJ, Stephenson CA. Hyperbaric spinal ropivacaine: a comparison to bupivacaine in volunteers. Anesthesiology 1999; 90: 971-7.
17. Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg 2002; 94: 188-93.
18. Coppejans HC, Vercauteren MP. Low-dose combined spinal-epidural anesthesia for cesarean delivery: a comparison of three plain local anesthetics. Acta Anaesthesiol Belg 2006; 57: 39-43.
19. Glaser C, Marhofer P, Zimpfer G et al. Levobupivacaine Versus Racemic Bupivacaine for Spinal Anesthesia. Anesth Analg 2002; 94: 194-8.
20. Fattorini F, Ricci Z, Rocco A, Romano R, Pascarella MA, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. Minerva Anestesiol 2006; 72:637-44.
21. Danelli G, Fanelli G, Berti M. Spinal ropivacaine or bupivacaine for cesarean delivery: a prospective, randomized, double-blind comparison. Reg Anesth Pain Med 2004; 29: 221- 6.
22. Parpaglioni R, Frigo MG, Lemma A, et al.Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for cesarean section. Anaesthesia 2006;61:110-5.
23. Camorcia M, Capogna G, Berritta C, Columb MO. The relative potencies for motor block after intrathecal ropivacaine, levobupivacaine, and bupivacaine. Anesth Analg. 2007;104:904-7.
24. Casati A, Moizo E, Marchetti C, Vinciguerra F. A prospective, rndomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine foriInguinal herniorrhaphy. Anesth Analg 2004; 99: 1387-92.
25. Seyhan TÖ, Şentürk E, Şenbecerir N, Başkan İ, Yavru A, Şentürk M. Sezaryen operasyonlarında farklı fentanil ve bupivakain kombinasyonları ile spinal anestezi. Ağrı Dergisi 2006;18: 37- 43.
26. Lopez-Soriano F, Lajarin B, Rivas F, Verdu JM, Lopez-Robles J. Hyperbaric subarachnoid ropivacaine in ambulatory surgery: comparative study with hyperbaric bupivacaine. Rev Esp Anestesiol Reanim. 2002; 49: 71-5.
27. Oğün CO, Kirgiz EN, Duman A, Okesli S, Akyürek C. Comparison of intrathecal isobaric bupivacaine-morphine and ropivacainemorphine for cesarean delivery. Br J Anaesth. 2003; 90: 659- 64.
28. Liao RZ, Peng JH, Chen YX, et al. Comparison of the block characteristics of levobupivacaine vs bupivacaine for unilateral spinal block. Di Yi Jun Yi Da Xue Xue Bao. 2005; 25: 1563-7.
29. Ratcliffe FM, Evans JM: Neonatal well being after elective caesarean delivery with general, spinal, and epidural anaesthesia. Eur J Anaesthesiol 1993; 10: 175- 81.
30. Mueller MD, Bruhwiler H, Schupfer GK, Luscher KP: Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery. Obstetric Gynecology 1997; 90: 131-4.