Ali GÖRMÜŞ, Caner MİMAROĞLU, Özdemir İclal KOL

Sezaryenlerde intratekal bupivakain'e fentanil ilavesinin etkileri

Bu çalışmada sezaryenlerde, tek başına hiperbarik bupivakainle, farklı dozlarda hiperbarik bupivakaine fentanil ilavesinin intraoperatif anestezi, erken postoperatif analjezi ve komplikasyonlar yönünden etkilerinin karşılaştırılması amaçlandı. Hastanemiz etik kurul onayı alındıktan ve hastalar bilgilendirildikten sonra ASA I-II grubunda, sezaryen planlanan 45 gebede 15'er kişilik rasgele üç grupta yapıldı. Tüm gruplarda toplam volüm 2.4 mi olacak şekilde; I. gruba; 10 mg % 0.5 hiperbarik bupivakain, II. gruba; 10 mg % 0.5 hiperbarik bupivakain ve 20 jıg fentanil, III. Gruba; 5 mg % 0.5 hiperbarik bupivakain ve 20 jıg fentanil intratekal yoldan verildi. Hastaların kan basıncı, nabız, solunum sayısı, periferik oksijen satürasyonu, duyusal ve motor blok dereceleri, peroperatif ağrı, kas gevşemesi ve yan etkiler kaydedildi. Yenidoğanlar, Apgar skoru ve umbilikal kord kan gazıyla değerlendirildi. Postoperatif analjezide Hasta Kontrollü Analjezi cihazıyla intravenöz morfin sülfat kullanıldı. Her 3 grupta, tüm hastalarda yeterli duyusal blok ve cerrahi anestezi sağlandı. İntraoperatif ağrı fentanil uygulanan gruplarda daha düşüktü. Grup IF de postoperatif analjezi süresi de uzundu (p

Anahtar Kelimeler:

Anestezikler, lokal, Bupivakain, Fentanil, Sezaryen

The effects of fentanil addition to the bupivacaine intrathecally administered for the ceserean operations

In this study, we aimed to compare the intraoperative and early postoperative analgesia and complications of hyperbaric bupivacaine alone and hyperbaric bupivacaine plus fentanyl for cesarean sections. After the approval of the ethical committee and the patients, 45 ASA I-II patients were divided into three groups consisting of 15 patients. In all groups, a total drug volume of 2.4 ml was given intrathecally. Group I was given 10 mg 0.5 % hyperbaric bupivacaine, Group II was given 10 mg 0.5 % hyperbaric bupivacaine plus 20 fig fentanyl, Group III was given 5 mg 0.5 % hyperbaric bupivacaine plus 20 jug fentanyl. Blood pressure, heart rate, respiratory rate, SpO2, sensorial and motor block levels, peroperative pain, muscle relaxation and side effects were recorded. The newborns were evaluated according to Apgar score and umblical cord blood gases. Morphine sulphate iv was used for postoperative patient controlled analgesia. In all groups, sensorial block and anesthesia were satisfactory. The intraoperative analgesia was lower in the fentanyl groups. Group II had a longer postoperative analgesia duration (p<0.05). Group HI had a lower motor blockade than the others and hypotension requiring ephedrine was less (p<0.05). There were no differences regarding postoperative morphine consumption and no life threatening side effects were observed. Itching was observed in the fentanyl groups. The newborns' evaluations were normal in all groups. To sum up, in cesarean operations the addition of 20 fig fentanyl to 10 mg hyperbaric bupivacaine may improve anesthesia quality and provide longer postoperative analgesia. It was concluded that the addition of 20 fig fentanyl 05 mg hyperbaric bupivacaine provides lower level motor blockade and decreases the incidence of hypotension.

Keywords:

Anesthetics, Local, Bupivacaine, Fentanyl, Cesarean Section,

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