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Uzun süreli intratekal morfin+bupivakain infuzyonunda hipotermi, titreme ve terleme

Giriş: Genel anestezi hipotalamustaki termoregülasyon merkezini doğrudan etkileyerek hipotermiye neden olurken, nöroaksiyel anestezi oluşturduğu nöral blok ile otonomik termoregülasyonu bozarak bu probleme neden olmaktadır. Termoregülasyonun bozulması özellikle intratekal anestezi sırasında beklenen bir sorun olarak karşımıza çıkarken, uzun süreli intratekal analjezide olağan değildir. Olgumuzda uzun süreli devamlı intratekal morfin+bupivakain tedavisi altında geç dönemde hipotermi ile beraber aşırı terleme ve titreme gelişen kanser hastası bildirilmektedir. Olgu Sunumu: Sağ iliak kanatta kondrosarkom tanılı bel, sağ kalça ve sağ alt ekstremitede şiddetli ağrısı olan hastaya ağrı tedavisi sürecinde bupivakain ve morfin kombinasyonu ile intratekal tedavi (‹T) uygulandı. ‹T tedavinin ellibeşinci gününde (23.4 mg morfin + 96mg bupivakain/gün) hastada aşırı titreme, terleme ve hipotermi (dış kulak yolundan bakılan ısı: 34.6°C) gelişti. Meperidin ve midozolama yanıt vermeyen hastanın intratekal infüzyonu durdurularak tedaviye salt intratekal morfin ile devam edildi. 72 saat içinde önce terleme ve hipotermisi düzelen hastanın titremesi dört gün sonra azalarak kayboldu. Sonuç: Kronik kanser ağrısı nedeniyle intratekal morfin + bupivakain infüzyonu uygulanan hastada gelişen hipotermi, aşırı titreme ve terlemenin bupivakaine bağlı uzun süreli sempatik blok sonucu geliştiği kanaatindeyiz. Uzun süreli intratekal analjezide lokal anestezik ilavesinin spinal anestezi uygulamasında olduğu gibi takip edilmesi gerekmektedir.

Anahtar Kelimeler:

Bupivakain, Genç erişkin, Terleme, Titreme, Hipotermi, Kadın

Hypothermia, shivering and sweating during longterm intratechal morphine and bupivacaine infusion (case report)

Introduction: General anesthesia may causes hypothermia by affecting thermoregulatory center in hypothalamus. During spinal anesthesia, however, hypothermia is caused by neural blockade that impaired autonomic thermoregulation. As this impaired thermoregulation was seen as a common problem during intratechal anesthesia, it was not usual during long term intratechal analgesia. We report a case of late hypothermia with excessive sweating and shivering in patients taking long term continuous intrathecal morphine plus bupivacaine infusion. Case report: 24-year old women with diagnosis of chondrosarcoma of ileum had pain in lowback, right hip and right lower extremity. She was treated with intratechal morphine and bupivacaine PCA by infusion. At the 55th day of intratechal treatment (23.4 mg morphin plus 96 mg bupivacaine / day) she had hypothermia (from auricular space, temperature was 34.6 °C) with excessive sweating and shivering. After no response to meperidine and midazolam, intratechal infusion was stopped and treatment continued on by only intratechal morphine infusion. Within 72 hours, firstly hypothermia and sweating ameliorated, and then shivering was diminished gradually throughout 4 days. Conclusion: Long term sympathetic block by long term intratechal bupivacaine may cause hypothermia with excessive sweating and shivering in patients taking long term continuous infusion intrathecal morphine plus bupivacaine infusion.

Keywords:

Bupivacaine, Young Adult, Sweating, Shivering, Hypothermia, Female,

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