Hilal Günal SAZAK, Ayşe Funda İSLAMOĞLU, Fatma ULUS, Tülin BİLGİLİ, Canan ÜN, Mehmet ORAL, Eser ŞAVKILIOĞLU

Torakotomi sonrası uygulanan intramüsküler meperidin, epidural bupivakain, morfin - bupivakain ve klonidin - bupivakainin analjezik ve hemodinamik etkilerinin karşılaştırılması

Bu çalışmada torakotomi sonrası olgularda intramusküler meperidin, epidural bupivakain, morfin - bupivakain ve klonidin - bupivakain kullanımının analjezik etkinliği ve hemodinamiye etkileri karşılaştırıldı. Olgular 10'ar kişilik dört gruba ayrıldıktan sonra postoperatif 30. dk' da 1. Gruba 75 mg im meperidin, diğer gruplara torakal epidural kateter yoluyla olmak üzere II. Gruba 30 mg bupivakain, III. Gruba 2 mg morfin sülfat ile 25 mg bupivakain, IV. Gruba 150 mg klonidin ile 25 mg bupivakain uygulandı. Postoperatif vizüel analog skala (VAS) değeri 4 ve üzeri, öksürükle VAS 7 ve üzeri, verbal ağrı skalası (VS) 2 ve üzerinde olduğunda analjezik verildi. Ek doz olarak I. Gruba 25 mg im meperidin, diğerlerine epidural kalelerden 15 mg bupivakain uygulandı. Preoperatif olarak sistolik diyastolik ortalama arter basınçları (SAB, DAB, OAB) ve kalp atım hızı (KAH) kaydedildi. Postoperatif 30. dk,1, 2., 4., 8., 12., 24. saatlerde: VAS, öksürükle VAS, VS, SAB, DAB,OAB ve KAH izlendi. Yan etkiler kaydedildi. VAS, öksürükle VAS ve VS değerlerinde III. Grupta postoperatif 8. ve 12. saatteki; IV. Grupta l. saatteki düşme diğer gruplara göre istatistiksel olarak anlamlıydı (p

Anahtar Kelimeler:

Analjezi, epidural, Torakotomi, Ağrı, Klonidin, Bupivakain, Morfin

Comparison of analgesic and hemodynamic effects of intramuscular meperidine, epidural bupivacaine, morphine - bupivacaine after thoracotomy

In this study we compared analgesic and hemodynamic effects of intramuscular meperidine, epidural bupivacaine, morphine - bupivacaine and clonidine - bupivacaine administered after thoracotomy. The patients were divided into four groups which consisted of ten patients. In the postoperative 30th minute, Group I was given 75 mg im meperidine; Groups II, III, IV received 30 mg bupivacaine, 2 mg morphine plus 25 mg bupivacaine, 150 mg clonidine plus 25 mg bupivacaine via thoracic epidural catheters respectively. When VAS $geq$ 4, VAS during coughing $geq$ 7 and VS $geq$ 2, additional analgesic was given. Additional analgesic was 25 mg im meperidine in Group I and 15 mg bupivacaine epidurally in the other groups. Systolic, diastolic and mean arterial pressures (SAP, DAP, MAP) and heart rate (HR) were recorded preoperatively. In the postoperative 30th min, 1st, 2st, 4st, 8st, 12st, 24st hours VAS, VAS during coughing, VS, SAP, DAP, MAP and HR were noted. Side effects were recorded. In Groups III and IV, VAS, VAS during coughing and VS scores declined significantly in the postoperative 8st, 12st and 1st hour, respectively (p<0.05). In Group IV, MAP value was significantly lower than the other groups in the postoperative 1st hour (p<0.05). We concluded that the morphine - bupivacaine combination given via epidural catheter, provided longer analgesia and stable hemodynamics and therefore was found to be superior for post-thoracotomy pain management.

Keywords:

Analgesia, Epidural, Thoracotomy, Pain, Clonidine, Bupivacaine, Morphine,

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