Transüretral rezeksiyon uygulanan hastalarda spinal anestezide levobupivakain ve levobupivakaine eklenmiş farklı fentanil dozlarının karşılaştırılması

Amaç: Transüretral prostat rezeksiyonu (TURP) yapılacak hastalarda, spinal anestezide uygulanan 10 mg izobarik % 0.25 levobupivakaine eklenen 12.5 $mu$ g ve 25 $mu$g fentanilin duyusal, motor blok ve analjezi süreleri ile hemodinamiye ve solunum fonksiyonlarına etkilerini araştırmak, hasta ve cerrah memnuniyetini değerlendirmektir. Yöntem: Spinal anestezi altında TURP yapılacak 30 hasta üç gruba çift kör olacak şekilde randomize edilip, Grup I'e intratekal 10 mg levobupivakain, Grup ITye 10 mg levobupivakain ile 12.5 $mu$g fentanil ve Grup III 'e 10 mg levobupivakain ile 25 $mu$g fentanil verildi. Kalp atım hızı (KAH), noninvaziv ortalama arter basıncı (OAB), periferik oksijen satürasyonu (SpO2), duyusal blok seviyesi ve motor blok dereceleri, duyusal ve motor blok gerileme süreleri, solunum fonksiyon testi (SFT) değerleri ve hasta, cerrah memnuniyeti kaydedildi, perioperatif yan etkiler araştırıldı. Bulgular: Her üç grupta KAH, OAB ve SpO2 değerleri benzerdi. Duyu bloğunun iki segment gerileme süresi Grup III'de Grup Ve göre, T10'a gerileme süresi ise Grup II ve III' de Grup T e göre anlamlı olarak uzundu. Duyusal bloğun sonlanma süresi Grup T de Grup II ve Grup III' e göre belirgin olarak kısaydı ve ölçülen VAS değerleri Grup T de anlamlı olarak düşüktü. Motor blok sonlanma zamanı Grup Fde diğer gruplara göre belirgin olarak kısaydı. Tüm gruplarda hasta ve cerrah memnuniyeti sağlandı. Solunum fonksiyon test değerleri her üç grupta da benzer bulundu. Sonuç: Olgularda 10 mg levobupivakain yeterli spinal anestezi sağlamışsa da, daha alt torakal segmentlerde sınırlı duyusal blok oluşturabilecek levobupivakain dozlarının SFT değerlerinde etki yapmayan 12.5 $mu$g fentanille kombinasyonunun yaşlı olgularda TURP girişimleri için uygun olduğu düşünüldü.

Anahtar Kelimeler:

Hemodinamikler, Transüretral prostat rezeksiyonu, Solunum fonksiyon testleri, Fentanil, Anestezi, spinal, Hasta memnuniyeti

A comparison of levobupivacaine and levobupivacaine with different doses of fentanyl for spinal anesthesia in transurethral resection patients

Objective: To investigate the effects of isobaric levobupivacaine, 12.5 $mu$g, and 25 $mu$g fentanyl were added to 0.25 % 10 mg levobupivacaine to examine sensorial and motor block duration, analgesia period, haemodynamia and respiratory functions, patient and surgeon satisfaction when used for spinal anaesthesia in transurethral resection patients. Method: This prospective, randomized, double blinded study compared the clinical efficacy of using intratechal 10 mg lev¬obupivacaine (Group 1), 10 mg levobupivacaine + 12.5 $mu$g fentanyl (Group 2), 10 mg levobupivacaine + 25 $mu$g fentanyl (Group 3) in 30 patients for spinal anaesthesia in transurethral resection surgery. Heart rate, non-invasive mean artery pressure, peripheral oxygen saturation, sensorial and motor block levels and decrement durations, respiratory function tests, as well as patient and surgeon satisfaction were recorded and the perioperative side effects were investigated. Results: There were no significant differences between the three groups in the heart rate, non-invasive mean artery pressure and peripheral oxygen saturation. Sensorial block decrement times in two segments were elongated in Group III compared to Group I and decrement times to T 10 were significantly elongated in Group II and III compared to Group I. The sensorial block decrement time in Group I was short, and VAS scores were significantly lower in Group I. Motor block ending time was shorter than in the other groups. The satisfaction of patients and surgeons was good in all groups. There were no significant differences between the three groups in the respiratory function tests. Conclusion: Although 10 mg levobupivacaine provided effective spinal anesthesia, levobupivacaine doses combined with fentanyl for limited sensorial block in lower thoracal segments, may be used for TURP operations in elder patients without distressing respiratory functions.

Keywords:

Hemodynamics, Transurethral Resection of Prostate, Respiratory Function Tests, Fentanyl, Anesthesia, Spinal, Patient Satisfaction,

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