Berna ÖNAL, Taylan AKKAYA, Emine ARIK, Haluk GÜMÜŞ

Total kalça protezi olgularında sürekli spinal anestezi ve kombine spinal-epidural anestezi tekniklerinin postoperatif analjezi üzerine etkileri

Amaç: Rejyonal anestezi total kalça protezi (TKP) olgularında intraoperatif kan kaybını peri-operatif tromboemboliyi azaltması ve postoperatif dönemde pulmoner ve serebral fonksiyonları daha iyi koruması gibi avantajları nedeniyle tercih edilen bir anestezi yöntemidir. Bu çalışmada TKP uygulanan olgularda sürekli spinal anestezi (SSA) ve kombine spinal-epidural anestezinin (KSEA) postoperatif'analjezi kalitesi ve bu dönemdeki olası komplikasyonlar üzerine olan etkileri karşılaştırılmıştır. Yöntem: Çalışma TKP planlanan ASA I-II risk grubunda 36 hastada gerçekleştirildi. Hastalar Grup SSA (n=18) ve Grup KSEA (n=18) olacak şekilde randomize biçimde iki gruba ayrıldı. Her iki gruptaki hastalara spinal anestezi amacıyla % 0.5 bupivakain 15 mg uygulandı. Grup SSA'da operasyon bitiminden itibaren ilk 24 saatte, intratekal kateterden 8 saat ara ile 0.1 mg morfin uygulandı. Grup KSEA'de ise operasyon bitiminden itibaren ilk 24 saatte, epidural kateterden 8 saat ara ile 1 mg morfin verildi. Heriki grupta da kilitli kalma süresi 15 dakika, bolus dozu 1 mg morfin olacak şekilde İV hasta kontrollü analjezi uygulandı. Postoperatif dönemde ağrı, ilk analjezik ihtiyaç zamanı ve 24 saatlik morfin tüketim miktarı, motor blok takibi ve olası yan etkiler ile hasta memnuniyeti takip edildi. Bulgular: Çalışmamızda postoperatif VAS değerleri, ilk analjezik ihtiyaç zamanları, 24 saatlik morfin kullanım miktarları SSA grubu lehine anlamlıydı. Dura delinmesi sonrası baş ağrısı SSA grubunda daha sık ortaya çıkarken, bulantı-kusmaya KSEA grubunda daha fazla rastlandı. Çalışmadaki her iki grubun hasta memnuniyeti benzerdi. Sonuç: Çalışmamızda total kalça protezi uygulanan hastalarda SSA ile KSEA yöntemine göre analjezi kalitesi yönünden daha iyi bir postoperatif dönem elde edilmiştir. Ancak her iki gruptaki yüksek hasta memnuniyet oranları KSEA'nin de bu grup hastalarda iyi bir anestezi yöntemi olabileceğini düşündürmüştür.

Anahtar Kelimeler:

Artroplasti, replasman, kalça, Anestezi, spinal, Bupivakain, Ağrı, ameliyat sonrası, Ameliyat sonrası bakım, Analjezi, hasta kontrollü, Hasta memnuniyeti, Ameliyat sonrası bulantı ve kusma

Effects of continuous spinal anesthesia and combined spinal-epidural anesthesia techniques on post-operative pain in total hip replacement patients

Objective: Regional anesthesia techniques in total hip replacement (THR) surgery are preferred as they reduce the risk of perioperative thromboembolism, limit intraoperative blood loss and preserve cerebral and pulmonary functions postoperatively. In this study, we aimed to compare the continuous spinal anesthesia (CSA) and combined spinal-epidural (CSE) anesthesia techniques based on the postoperative quality of pain relief and complications during THR surgery. Method: ASA I-II 36 patients were included in this study. Patients were randomly allocated to 2 groups; the CSA group (n=18) and the CSE group (n=18). In both groups, 15 mg of 0.5 % bupivacaine was administered to maintain spinal anesthesia. In the CSA group 0.1 mg and in the CSE group 1 mg morphine was given via intrathecal and epidural catheter every 8 hours within the first 24 hours. Postoperative analgesia was provided by intravenous patient-controlled analgesia (PCA) induced by morphine (Img dose; lockout interval of 15 min) in both groups. Postoperative pain scores, time to first morphine analgesia, 24-h morphine consumption, degree of motor block, incidence of side effects and patient comfort were evaluated. Results: In our study, postoperative VAS values and the first analgesic requirement were significantly better for the CSA group. In the CSA group, postpuncture headache and in the CSE group nausea and vomiting occurred more frequently. Patient comfort was similiarfor both groups. Conclusion: The CSA method is associated with more efficient postoperative analgesia in THR patients, However, in the CSA group postpuncture headache, in the CSE group nausea and vomitting were more frequent. Since patient comfort in the CSE group is better, the CSE anesthesia technique can be preferred in THR cases.

Keywords:

Arthroplasty, Replacement, Hip, Anesthesia, Spinal, Bupivacaine, Pain, Postoperative, Postoperative Care, Analgesia, Patient-Controlled, Patient Satisfaction, Postoperative Nausea and Vomiting,

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