Torakal epidural ropivakain ile ropivakain ve ketamin kombinasyonunun karşılaştırılması
Amaç: Bu çalışmada amacımız, majör üst batın operasyonu uygulanan olgularda, epidural % 2 ropivakain ile % 1 ropivakain ve 0,4 mg mL-1 ketamin kombinasyonunun analjezik etkinliğinin karşılaştırılmasıdır. Yöntem: Çalışma klinik, prospektif ve randomize olarak planlandı. Elektif majör üst batın cerrahisi planlanan ASA I-III risk grubundan 40 erişkin hasta üzerinde etik komite onayı ile gerçekleştirildi. Bu çalışma torakal epidural (T5-7) kateterden preemptif olarak % 0,2 ropivakain (Grup R) veya % 0,1 ropivakain ve 0,4 mg mL-1 ketamin (Grup RK) kombinasyonu uygulanarak gerçek- leştirildi. Operasyon genel anestezi altında sürdürüldü. Postoperatif analjezi, hasta kontrollü analjezi (HKA) cihazı ile aynı ilaç infüzyonları 48 saat sürdürülerek sağlandı. Hastaların istirahat ve öksürükte VAS ağrı skorları, bloke segment sayıları (BSS), motor blok düzeyleri, HKA ile ilaç tüketimleri ve ek analjezik (meperidin; mg) tüketimleri kaydedildi. Bulgular: Çalışmamızda BSS’ler 1. ve 2. günde R grubunda RK grubuna göre anlamlı şekilde yüksekti (p
The comparison of thoracic epidural ropivacaine with ropivacaine-ketamine combination
BACKGROUND: This study was aimed to compare the analgesic effect of epidurally administered ropivacaine 0,2 % with ropivacaine 0,1 % and ketamine 0,4 mg mL-1 combination in patients following upper abdominal surgery. METHODS: In a prospectively randomised controlled trial, we studied 40 adult, ASA I-III patients undergoing elective major upper abdominal surgery, once we had obtained the approval of the local ethical committee. This study was intended to compare thoracal epidurally administered (Th5-7) 0.2 % ropivacaine with 0.1 % ropivacaine and 0.4 mg mL-1 ketamin combination used preoperatively. Operations were performed under general anesthesia. Patient controlled analgesia (PCA) pumps with same infusion rates continued until postoperative 48th hours. Pain was evaluated using the visual analog score (VAS) on resting and coughing, PCA drug and analgesic consumption, blocked segment numbers (BSN) and motor block were recorded. RESULT: In our study on 1th and 2th days BSNs were significantly higher in group R when compared with group RK (p<0.05). In Group R VAS values at rest for postoperative 1th and 6th hours, and VAS values on coughing for postoperative 1th , 6th and 12th hours were significantly lower (p<0.05). Drug consumption with PCA and need for rescue analgesic were also significantly lower Group R (p<0.05). CONCLUSION: In conclusion, during major upper abdominal surgery, 0,2 % ropivacaine was more effective in providing analgesia than a 0,1 % ropivacaine + 0,4 mg mL-1 ketamine combination in thoracal epidural analgesia (TEA).
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