Berrin GÜNAYDIN, Ece TAN DUMANLAR, Hülya ÇELEBİ

Vajinal histerektomilerde intratekal bupivakainin, izobarik ve/veya hiperbarik formlarının karşılaştırılması*

Amaç: Vajinal histerektomiler için spinal anestezide intratekal morfinin izobarik, hiberbarik veya izobarik+hiperbarik bupivakaine eklenmesinin; duyusal ve motor blok özellikleri, hemodinamik stabilite, yan etkiler, komplikasyonlar ve postoperatif ilk analjezik gereksinimi yönünden üstün olup olmadığının gösterilmesi amaçlandı. Yöntem: Yaşları 40-70 arasında 48 ASA I - III risk grubunda rejyonal anestezi için kontrendikasyonu bulunmayan hastaların kalp atım hızı (KAH) ve ortalama arter basıncı (OAB) monitörizasyonu yapıldıktan sonra rastgele 3 gruba ayrıldı. İntratekal 100 μg morfinle birlikte 15 mg % 0.5 hiperbarik bupivakain (Grup H), 7.5 mg % 0.5 izobarik bupivakain + 7.5 mg (1.5 mL) % 0.5 hiperbarik bupivakain (Grup H+P) veya 15 mg % 0.5 izobarik bupivakain (Grup P) uygulandı. Bulgular: Grupların efedrin ihtiyacı ve toplam kullanılan efedrin miktarları benzerdi. Tüm ölçüm zamanlarında gruplar arasında KAH değerlerinde fark olmamasına rağmen OAB değerleri karşılaştırıldığında hem Grup H+P hem de Grup Pnin 15.dkdaki ölçümlerinin Grup Hden daha yüksek olduğu gözlendi (p=0.0166). Grup H+Pnin 20. ve 25.dklardaki ölçümleri de Grup Hden daha yüksek bulundu (p

A comparison of intrathecal bupivacaine, isobaric, hyberbaric and/or isobaric forms in vaginal hysterectomy

Objective: The aim of this study was to demonstrate whether addition of intrathecal morphine to either isobaric, hyperbaric or isobaric+hyperbaric bupivacaine during spinal anesthesia would be superior for the the sensory and motor block characteristics, hemodynamic stability, side effects, complications and postoperative first analgesic requirement during vaginal hysterectomy. Method: After monitoring heart rate (HR) and mean arterial pressure (MAP) of the 48 ASA I-III patients aged between 40-70 years having no contraindication for regional anesthesia, they were randomly assigned to three groups. Intratechal morphine 100 μg was administered with either hyperbaric bupivacaine 15 mg % 0.5 (Group H) or isobaric bupivacaine 7.5 mg % 0.5 + hyperbaric bupivacaine 7.5 mg (1.5 mL) % 0.5 (Group H+P) or isobaric bupivacaine 15 mg % 0.5 (Group P). Results: Ephedrine requirement and total amount of ephedrine used were comparable among the groups. Although HR values did not differ among the groups at all times, according to the comparison of MAP values of the groups, measurements at 15 minutes in both Groups H+P and P were significantly higher than in Group H (p=0.0166). Measurements at 20 and 25th minutes in Group H+P were significantly higher than in Group H (p<0.0166). While sensory block reached T6 in all patients of the Group H, it was at T8 in only 2 patients from Groups P and Group H+P, respectively. Motor block in Group H+P developed later compared to Group H (p<0.05). Perioperative and postoperative complications, first analgesic requirement, mobilization and flatulans times were not significantly different among the groups. Conclusion: Since similar sensory and motor block characteristics, hemodynamic stability, and perioperative and postoperative follow up due to administration of morphine 100 μg as an adjuvant with hyperbaric, isobaric or hyperbaric+ isobaric bupivacaine were achieved; all three solutions can be used successfully for spinal anesthesia during vaginal hysterectomy.

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