Namık ÖZCAN, Mustafa KOTANOĞLU, Hülya BAŞAR, Fatih GENECİ, Bülent BALTACI

LOMBER DİSK CERRAHİSİ GEÇİREN HASTALARDA KOMBİNE SPİNAL EPİDURAL ANESTEZİ VE GENEL ANESTEZİ UYGULAMALARININ KARŞILAŞTIRILMASI

AMAÇ: Bu çalışmada, lomber disk cerrahisi geçiren, kombine spinal-epidural yöntem ile standart genel anestezi yöntemi uygulanan hastalarda retrospektif olarak, cerrah ve hasta memnuniyeti ile derlenme dönemindeki hasta analjezisi ve konforu incelenmiştir. GEREÇ VE YÖNTEMLER: Lomber disk cerrahisi geçiren 70 yetişkin hasta retrospektif olarak incelendi. Genel anestezi uygulanan olan hastalarda (Grup 1= GA) standart anestezi indüksiyonunu anestezi idamesi N2O/O2 kombinasyonu ve sevoflorane ile sağlandı. Hastaların postoperatif analjezisi operasyon sonunda derlenme ünitesine alınmadan önce 20 mg iv tenoksikam ve 50 mg tramadol ile sağlandı. Kombine spinal epidural anestezi uygulanan hastalar ise (Grup 2 KSA), 27 gauce pencil point iğne ile 4ml 0,5% bupivacain kullanılarak spinal anestezi gerçekleştirildi. Epidural anestezi seviyesine cerrahi ekip ile karar verildi. Tüm hastalar PACU ünitesine alındıktan sonra 1 saat boyunca VAS değerleri kaydedildi. VAS değeri 3 üzerinde olduğunda GA grubunda ek analjezi tramadol ile sağlandı. KSA grubunda ise postoperatif analjezisi epidural aralıktan 5 ml 0,5% bupivakain verilerek sağlandı. Tüm hastalar derlenme odasında 60 dakika gözlendi. Hastalara postoperatif 1. gün anestezi şeklinden memnun olup olmadıkları (iyi/orta/kötü), cerraha rejyonel anestezi memnuniyeti (iyi/orta) soruldu, hasta analjezisi not edildi. İstatistiksel değerlendirme Student's T testi kullanılarak gerçekleştirildi. P

THE COMPARISON OF COMBINED SPINAL EPIDURAL ANESTHESIA AND GENERAL ANESTHESIA IN PATIENTS UNDERGOING LUMBAR DISC SURGERY

OBJECTIVE:In the present study, patient and surgeon satisfaction and patient comfort and analgesia in the recovery period were assessed in patients undergoing lumbar disc surgery under either combined spinal-epidural or general anesthesia. MATERIAL AND METHODS: Seventy adult patients undergoing lumbar disc surgery were assessed retrospectively. In patients receiving general anesthesia (Group 1, GA), anesthesia was maintained with sevoflurane in oxygen-nitrous oxide combination. At the end of surgery tenoxicam 20 mg iv and tramadol 50 mg iv were administered for postoperative analgesia in this group of patients. In patients receiving combined spinal-epidural anesthesia (Group 2, CSA), spinal anesthesia was performed with 4 ml 0,5% bupivacaine using 27 Gauge pencil point spinal needle. Epidural anesthesia level was determined with the surgeon. Visual Analog Scale (VAS) levels were recorded in all patients during 1 hour in postanesthesia care unit (PACU). If VAS value was greater than 3, tramadol and 5 ml 0.5% bupivacaine were given as a rescue analgesic in general anesthesia group and combined spinal-epidural anesthesia group, respectively. Patient satisfaction (good/moderate/poor) and surgeon satisfaction about regional anesthesia (good/moderate) was assessed, analgesia of patients was recorded. Student's t-test was used for statistical analysis. P< 0.05 was accepted significant.RESULTS:Demographic characteristics of he patients were similar in two groups. VAS values at the 10th, 20th and 30th minutes were significantly lower in CSA group (P< 0.05), but values were similar between groups at 60th min. Patient and surgeon satisfaction scores were similar between groups. CONCLUSION: Although general anesthesia and combined spinal-epidural anesthesia techniques are performed in lumbar disc surgery, both have useful and adverse effects. Surgeon team and patients view might be different for these techniques. An optimal preoperative examination is important before surgery. The selection of the appropriate patient and surgery is important. The duration of the operation should not be long because of the position needed for surgery. The surgery that will be performed under regional anesthesia will be more comfortable and well tolerated by the patient and the surgeon after appropriate preoperative preparations compared.

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