Hale BORAZAN, Tuba B. ERDEM, Işıl DAVARCI, Şeref OTELCİOĞLU

Transüretral prostat rezeksiyonunda intratekal düşük doz levobupivakain ve bupivakainin etkilerinin karşılaştırılması

Amaç: Transüretral prostat rezeksiyonu (TURP) operasyonu geçirecek yaşlı hastalarda düşük dozda uygulanan levobupivakain ve izobarik bupivakainin etkilerinin karşılaştırılması amaçlanmıştır. Gereç ve yöntem: Benign prostat hiperplazisi (BPH) nedeniyle opere edilecek ASA II-III grubu 60 hasta rastgele iki gruba ayrılıp, birinci gruba (Grup L)10 mg (2 mL) % 0.5 levobupivakain (Chirocaine % 0.5, Abbott), ikinci gruba (Grup B) 10 mg (2 mL) % 0.5 izobarik bupivakain (Marcaine % 0.5,Astra-Zeneca) 22 G spinal iğne ile L3-4 aralığından intratekal aralığa verildi. Hastaların kalp atım hızı, noninvaziv kan basınçları, duyusal blok seviyesi ve motor blok seviyesi kaydedildi. Duyusal blok seviyesi T10 olduğunda operasyona izin verildi. Sonuçlar: Hastaların demografik verileri, cerrahi süreleri ve ASA fiziksel durumlarında, kalp atım hızı, sistolik arter basıncı, diastolik arter basıncı ve ortalama arter basıncı ölçümlerinde gruplar arasında istatistiksel olarak anlamlı fark bulunmadı (p >0.05). Duyusal blok özellikleri karşılaştırıldığında, duyusal blok başlama zamanı levobupivakain grubunda, bupivakain grubundan anlamlı olarak kısa bulundu (p < 0.05). Motor blok başlama zamanı, komple motor blok kalkma zamanı ve cerrahi sonunda Bromage skorlarında levobupivakain grubu ile bupivakain grubu arasında istatistiksel olarak anlamlı fark bulunmadı (p > 0.05). Yan etkiler açısından iki grup arasında anlamlı farklılık yoktu (p >0.05). Tartışma: BPH nedeniyle opere edilecek hastalarda spinal anestezide levobupivakain ve bupivakainin, bu dozlarda yan etkilerinin az olduğu ve hemodinamiyi bozmadan yeterli anestezi sağladıkları sonucuna ulaştık. Yaşlı hastalarda her ikisinin de bu dozlarda güvenle kullanılabileceğini düşünüyoruz.

Anahtar Kelimeler:

Bupivakain, Kalp hızı, Anestezi, spinal, Karşılaştırmalı çalışma, Transüretral prostat rezeksiyonu

Comparison the effects of low dose intrathecal levobupivacaine and bupivacaine in transurethral resection of prostate

Background: To compare the clinical efficacy of low dose levobupivacaine and bupivacaine in spinal anesthesia for transurethral resection of the prostate (TURP) in elderly patients. Methods: In this prospective, randomized, double-blinded, controlled study, sixty ASA II-III patients were randomly assigned into two groups by using levobupivacaine 10 mg (2 mL) (Group L), and bupivacaine 10 mg (2 mL) (Group B) with 22 G spinal needle for spinal anesthesia. Heart rate, noninvasive blood pressure, sensorial and motor block levels were recorded. When the sensorial block level reached to T10 dermatome, the operation started. Results: There was no statistically significant difference between patients demographic data, operation time, ASA status, heart rate, sistolic, diastolic and mean arterial pressures (p >0.05). When sensorial blocks were compared, sensorial block onset time shorter in levobupivacaine group than bupivacaine and results were statistically significant (p < 0.05). Motor block onset time, motor block ending time and postoperative Bromage scores of levobupivacaine and bupivacaine groups were not statistically significant (p > 0.05). There were no difference between side effects of both the groups (p > 0.05). Conclusions: We concluded that same dose of bupivacaine and levobupivacaine maintained enough anesthesia without disturbing haemodynamics and had little side effects in these doses, in patients operated for bening prostate hiperplasy with spinal anesthesia. We suggest that both of them can be used confidently in elderly patients.

Keywords:

Bupivacaine, Heart Rate, Anesthesia, Spinal, Comparative Study, Transurethral Resection of Prostate,

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