Eser ŞAVKILIOĞLU, Mehtap TUNÇ, Şaziye ŞAHİN, Hilal SAZAK, Serdar KOKULU

TORAKS CERRAHİSİ İÇİN UYGULANAN EPİDURAL LOKAL ANESTEZİKLERİN KARŞILAŞTIRILMASI: BUPİVAKAİN İLE LEVOBUPİVAKAİN

Amaç: Göğüs cerrahisinin pre, intra ve postoperatif dönemlerinde uygulanan epidural bupivakain ve levobupivakainin analjezik, hemodinamik ve yan etkilerinin karşılaştırılmasıdır. Gereç ve yöntem: Elektif torakotomi uygulanan 30 eriﬂkin hasta torakal epidural bupivakain veya levobupivakain alan iki gruba ayrıldı. Hem cerrahi insizyondan 15 dk önce, hem de toraks kapatılırken Grup I’e bupivakain, Grup II’ye levobupivakain bolusları verildi. Fentanil ile bupivakain ya da levobupivakain kombine edilerek yoğun bakım ünitesinde sürekli epidural infüzyonla verildi. Ayrıca bütün hastalara hasta kontrollü analjezi cihazıyla iv morfin bolusu verildi. Dirençli omuz ağrısı olduğunda diklofenak sodyum uygulandı. Hemodinamik veriler, ağrı skorları ve yan etkiler preoperatif dönemden epidural infüzyonun 24. saatine kadar kaydedildi. Bulgular: Ortalama arter basıncı, kalp atım hızı, ağrı skorları ve morfin tüketiminde gruplar aras›ndaki farklılık anlamlı değildi (p > 0.05). Her iki grup içinde postoperatif dönemde bazal de¤erlere göre vizüel analog skaladaki azalma istatistiksel olarak anlaml› bulundu (p < 0.05). Ciddi bir yan etki ile karşılaşılmadı. Sonuç: Bupivakain ve levobupivakain, göğüs cerrahisi için analjezi, hemodinami ve yan etkiler yönünden benzer bulundu. Torakal epidural fentanil ile kombine edildiğinde levobupivakainin sürekli infüzyonu bupivakaine iyi bir alternatif olabilir.

A COMPARISON OF EPIDURAL LOCAL ANESTHETICS ADMINISTERED FOR THORACIC SURGERY: BUPIVACAINE VERSUS LEVOBUPIVACAINE

Aim: We aimed to compare the analgesic efficacy, hemodynamia, and side effects of epidural bupivacaine and levobupivacaine given preoperative, intraoperative, and postoperative periods of thoracic surgery. Materials and methods: Thirty adult patients undergoing elective thoracotomy were divided into two groups receiving thoracal epidural bupivacaine or levobupivacaine. Group I received bupivacaine, whereas Group II received levobupivacaine boluses both 15 min before surgical incision and during the closure of thorax. Continuous epidural infusion of fentanyl combined with either bupivacaine or levobupivacaine was given in intensive care unit. In addition, all patients received iv morphine bolus with patient controlled analgesia device. If shoulder pain persisted, diclofenac sodium was administered. Hemodynamic data, pain scores, and side effects were recorded from preoperative period to 24th hr of epidural infusion. Results: The difference in mean arterial pressures, heart rates, pain scores, and morphine consumptions were not significant between the groups (p > 0.05). Decrease in visual analog scale was statistically significant compared to the basal values within the groups during the postoperative period (p < 0.05). There were no serious side effects. Conclusion: Bupivacaine and levobupivacaine were found to be comparable in the analgesia, hemodynamia, and side effects for thoracic surgery. In combination with thoracic epidural fentanyl, a continuous infusion of levobupivacaine may be considered as a good alternative to bupivacaine.

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