Nevin AYDIN, GÖNÜL ÖLMEZ KAVAK, Mehmet Ali ÖZYILMAZ

TURP ameliyatlarında epidural anestezide ropivakain tercih edilebilir mi?

Amaç: Endoskopik ürolojik girişimlerde; cerrahi kan kaybı ve postoperatif venöz tromboz sıklığını azaltması, mesane perfo-rasyonunun ve transuretral prostat rezeksiyonu (TURP) sendromu belirtilerinin erkenden teşhis edilmesine olanak vermesi ile epidural anestezi uygulaması tercih edilmektedir. Çalışmamızda TURP ameliyatı yapılacak olgularda epidural anestezi uygulamasında ropivakain ve bupivakainin karşılaştırılması amaçlanmıştır. Yöntem: Çalışmamız, benign prostat hipertrofisi tanısıyla transuretral rezeksiyon planlanan, yaş aralığı 45-85 arasında ve ASA I-III risk grubunda olan 48 erkek hastada gerçekleştirildi. Grup I' e 20 mi %0.5'lik ropivakain, Gr,up IVye 20 mi %0.5'lik bupivakain epidural yoldan uygulandı. Her iki ilacın anestezik özellikleri, hemodinami üzerine etkileri, hasta konforu ve yan etkileri karşılaştırıldı. Bulgular: Ropivakain grubunda; cerrahi anestezinin başlangıç süresinin (T 10'a ulaşma süresi), iki segment regresyon süresinin ve T12'ye inme süresinin daha hızlı olduğunu saptadık (p=0.024, p=0.006, p=0.004). Motor blok, bupivakain grubunda daha yoğun idi. Her iki grupta da yeterli cerrahi anestezi ve analjezi sağlandı. Blok kalitesi açısından gruplar arasında fark bulunmadı. En sık görülen yan etkiler, tedaviye cevap veren hipotansiyon ve bradikardi oldu. Gruplar arasında yan etki sıklığı açısından fark bulunmadı. Sonuç: Her iki ilacın da TURP ameliyatlarında etkili ve güvenilir olduğu sonucuna varıldı. Ancak ropivakain bupivakaine göre daha hızlı duyusal blok oluşturmakta, duyusal blok daha hızla gerilemekte ve motor blok yoğunluğu daha az olmaktadır.

Anahtar Kelimeler:

Anestezi, epidural, Ürolojik cerrahi prosedürler, Transüretral prostat rezeksiyonu, Bupivakain, Anestezikler, lokal

Can ropivacaine be prefered for epidural anesthesia for TURP operations?

Objective: Epidural anesthesia is preferred in endoscopic urological procedures as it decreases the incidence of surgical bleeding and venous thrombosis and provides early diagnosis of complications such as bladder rupture and TURP syndrome. The aim of this study is to compare ropivacaine and bupivacaine in epidural anesthesia for cases to undergo TURP surgery. Method: Forty eight ASA I-III male patients aged 45-85 with benign prostate hypertrophy undergoing transurethral resection were included in this study. In Group I, 20 ml of ropivacaine 0.5 %, in Group II20 ml of bupivacaine 0.5 % were administered by epidurally. Hemodynamic parameters, patients' comfort, anesthetic properties and side effects were compared. Results: In Group I, time it took for the anesthesia level to reach Tio, two-segment regression time and regression time to T 12 were found to be faster than in Group II (p=0.024, p=0.006, p=0.004). Motor blockade was more intense in Group II than in Group I. Efficient anesthesia and analgesia were obtained in both groups. There was no difference in terms of side effects and quality of blockade between the groups. The most commonly encountered side effects were hypotension, and bradycardia in both groups. Conclusion: We can say that both medications are safe and effective in TURP surgery. However, ropivacaine has faster sensorial block, dissipates more rapidly and has less motor block density bupivacaine.

Keywords:

Anesthesia, Epidural, Urologic Surgical Procedures, Transurethral Resection of Prostate, Bupivacaine, Anesthetics, Local,

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1. Mebust WK, Holtgrewe HL, Cockett ATK, Peters PC. Transurethral prostatectomy: Immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. JUrol 1989; 141:243-7.
2. Monk TG, Weldon BC. The renal system and anesthesia for urologic surgery. In: Barash PG, Cullen BF, Stoelting RK (eds). Clinical Anesthesia. Fourth edition. Philadelphia: Lippincott Williams & Wilkins; 2000, 1005-33.
3. Casati A, Putzu M. Bupivacaine, levobupivacaine and ropivacaine: are they clinically different? Best Pract Res Clin Anaesthesiol 2005; 19: 247-68.
4. Stienstra R. The place of ropivacaine in anesthesia. Acta Anaesthesiol Belg 2003; 54: 141-8.
5. Berde CB, Strichartz GR: Local Anesthetics. In: Miller RD (ed). Anesthesia. 5th edition. Pennsylvania: Churchill Livingstone; 2000,491-521.
6. Owen MD, Dean LS. Ropivacaine. Expert Opin Pharmacother 2000; 1:325-336.
7. Bader AM, Datta S, Flanagan H, Covino BG. Comparison of bupivacaine- and ropivacaine- induced conduction blockade in the isolated rabbit vagus nerve. Anesth Analg 1989; 68: 724-7.
8. Akerman B, Hellberg IB, Trossvik C. Primary evaluation of the local anaesthetic properties of the amino amide agent ropivacaine (LEA 103). Acta Anaesthesiol Scand 1988; 32:571-8.
9. Brown DL, Carpenter RL, Thompson GE. Comparison of 0.5% ropivacaine and 0.5% bupivacaine for epidural anesthesia in patients undergoing lower-extremity surgery. Anesthesiology 1990;72: 633-6.
10. Wolff AP, Hasselstrom L, Kerkkamp HE, Gielen MJ. Extradural ropivacaine and bupivacaine in hip surgery. Br J Anaesth 1995;74: 458-60.
11. McGlade DP, Kalpokas MV, Mooney PH, ve ark. Comparison of 0.5% ropivacaine and 0.5% bupivacaine in lumbar epidural anaesthesia for lower limb orthopaedic surgery. Anaesth Intensive Care 1997; 25:262-6.
12. Kerkkamp HE, Gielen MJ, Edstrom HH. Comparison of 0.75% ropivacaine with epinephrine and 0.75% bupivacaine with epinephrine in lumbar epidural anesthesia. Reg Anesth 1990; 15:204-7.
13. Brockway MS, Bannister J, McClure JH, McKeown D, Wildsmith JA. Comparison of extradural ropivacaine and bupivacaine. Br J Anaesth 1991; 66:31-7.
14. Morrison LM, Emanuelsson BM, McClure JH, ve ark. Efficacy and kinetics of extradural ropivacaine: comparison with bupivacaine. Br J Anaesth 1994;72:164-9.
15. Zaric D, Axelsson K, Nydahl PA, Philipsson L, Larsson P, Jansson JR. Sensory and motor blockade during epidural analgesia with 1%, 0.75%, and 0.5% ropivacaine~a double- blind study. Anesth Analg 1991; 72: 509-15.
16. Whitehead E, Arrigoni B, Bannister J. An open study of ropivacaine in extradural anaesthesia. Br J Anaesth 1990;64:67-71.
17. Schnider TW, Minto CF, Bruckert H, Mandema JW. Population pharmacodynamic modeling and covariate detection for central neural blockade. Anesthesiology 1996; 85: 502-12.
18. Morgan GE Jr, Mikhail MS, Murray MJ. Clinical Anesthesiology. 3rd edition, Los Angeles:Appleton&Lange; 2002, 875-81.
19. Muravchick S. Anesthesia for the Elderly. In: Miller RD (ed). Anesthesia. 5th edition^ Pennsylvania: Churchill Livingstone; 2000,2140-56.
20. Reiz S, Haggmark S, Johansson G, Nath S. Cardiotoxicity of ropivacaine—a new amide local anaesthetic agent. Acta Anaesthesiol Scand 1989; 33: 93-8.
21. Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69 :563-9.
22. Iwama H. A case of normal ropivacaine concentration causing grand mal seizure after epidural injection. Eur J Anaesthesiol 2005; 22: 322-3.
23. Cherng CH, Wong CS, Ho ST. Ropivacaine-induced convulsion immediately after epidural administration—a case report. Acta Anaesthesiol Sin 2002; 40:43-5.
24. Ban M, Hattori M. Delayed hypersensitivity due to epidural block with ropivacaine. BMJ 2005; 330: 229.