Ayşin ALAGÖL, Cavidan ARAR, Alkin ÇOLAK, Zafer PAMUKÇU, Nesrin TURAN

Transdermal nitrogliserinin fentanil ve bupivakain ile epidural anestezi sonrası analjezi üzerine etkisi

Bu çalışmada; alt ekstremite kırığı nedeniyle opere edilen olgularda, transdermal nitrogliserinin (TNG), bupivakain ve fentanil kombinasyonu ile uygulanan epidural anestezi sonrası postoperatif analjezi süresine etkisi araştırılmıştır. Çalışmaya alınan ASA I-II grubundan 37 olguya operasyondan önce Numeric Rating Scale (NRS) ile ağrının değerlendirilmesi öğretilmiştir. Epidural anestezi: L3-L4 aralığından oturur pozisyonda, 20 mL % 0.5 bupivakain ve 50 µg fentanil ile gerçekleştirilmiştir. Hemodinamik stabilite sağlandıktan sonra 1. Gruptaki olgulara 5 mg TNG, II. Gruptaki olgulara ise içi boşaltılmış TNG flasteri yapıştırılmıştır. Epidural enjeksiyondan önce, 10 dk sonra, operasyon süresince 10 dk arayla, postoperatif 30.dk, 12, 18 ve 24.saatlerde sistolik ve diyastolik arter basınçları (SAB, DAB), kalp atım hızı (KAH) değerlendirilmiştir. Postoperatif dönemde NRS>4 olduğunda 75 mg diklofenak im uygulanmıştır. İlk analjezik uygulandığında ve epidural enjeksiyondan 12, 18 ve 24 saat sonra NRS ile 24 saatlik analjezik uygulama sayısı ve yan etkiler kaydedilmiştir, I. Grupta analjezi süresi ileri derecede anlamlı uzun (p

Anahtar Kelimeler:

Nitrogliserin, Bupivakain, Anestezi, epidural, Fentanil

Effect of transdermal nitroglycerin on analgesic period after fentanyl-bupivacaine epidural anesthesia

In this study, transdermal 5 mg nitroglycerine patch was applied to patients undergoing lower extremity operation in order to increase postoperative analgesia period after epidural anesthesia with bupivacaine and fentanyl. ASA I-II group 37 patients were trained for pain evaluation with numeric rating scale (NRS). Epidural anesthesia was administered at the L3-L4 interspace with the patient in the sitting position and with 20 ml of volume containing % 0.5 bupivacaine + 50 µg fentanyl. After haemodynamic stabilization, 5 mg nitroglycerine (TNG) patch was attached to Group I and empty patch to Group II. Before and 10 min. after epidural injection and during intraoperative period, with 10 min. intervals; systolic and diastolic arterial pressure (SABP, DABP), and heart rate (HR) were evaluated at 30 min, 12, 18 and 24. hrs. postoperatively. In postoperative period, when NRS>4, 75 mg diclofenac im was available. NRS at 12, 18 and 24 hrs after epidural injection, total analgesic requirements and side effects were noted. Analgesia period was found to be significantly longer and rescue analgesic demand was found to be significantly lower in Group I (p<0.01, p<0.05). DABP in Group II and SABP in both groups decreased significantly after epidural injection (p<0.01). Intraoperatively in Group I, during 70-120 min, SABP; and during 80-120.min DABP were found significantly lower, but in normal limits. In Group I, HR was higher at 120. min (p<0.01). At postoperative period, SABP was found significantly lower in Group I at 24th hr and DABP at 30th min, 12nd, 18th and 24th hrs (p<0.05). HR was higher at 30th min and 12th hr, postoperatively (p<0.05). As a result, transdermal nitroglycerine application increased epidural fentanyl's analgesic period and decreased analgesic requirements.

Keywords:

Nitroglycerin, Bupivacaine, Anesthesia, Epidural, Fentanyl,

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