Feyhan ÖKTEN, Asuman UYSALEL, Melek TULUNAY, Enver ÖZGENCİL

Diz protez cerrahisinde preinsizyonel ve postinsizyonel epidural, bupivakain verapamil ve ketamin postoperatif analjezik tüketimine etkileri

Hastalar ve Yöntem: Çalışmaya total diz artroplastisi planlanan 164 hasta dahil edilmiş, hastalarrastgele 8 gruba ayrılmıştır. Grup 1(preB), preinsizyonal bupivakain, postinsizyonal serumfizyo- lojik (SF); grup 2 (postB), preinsizyonal SF, postinsizyonal bupivakain; grup 3 (preBK), preinsiz- yonal bupivakain+ketamin, postinsizyonal SF; grup 4 (postBK), preinsizyonal SF, postinsizyonalbupivakain+ketamin; grup 5 (preBKV), preinsizyonal bupivakain+ketamin+verapamil, postinsizyo- nal SF; grup 6 (postBKV), preinsizyonal SF, postinsizyonal bupivakain+ketamin+verapamil; grup 7(preBV), preinsizyonal bupivakain+verapamil, postinsizyonal SF; grup 8 (postBV), preinsizyonal SF,postinsizyonal bupivakain+verapamil olarak planlanmıştır. Epidural uygulanan ajanların dozları şuşekildedir: bupivakain, %0.5lik 50 mg; ketamin 60 mg; verapamil 5 mg ; serum fizyolojik 10 ml.Hastaların epidural kateterleri yerleştirildikten sonra standart monitorizasyon ile genel anestezi ve- rilmiş, preinsizyonal uygulama için cerrahi insizyondan 15 dk. önce, postinsizyonal uygulama içinsecerrahi insizyondan 30 dk. sonra epidural ilaçlar uygulanmıştır. Derlenme, ağrı düzeyi ve analjezikgereksinimi, yan etkiler, hasta ve hekim memnuniyeti kaydedilmiştir. Bulgular: Bupivakaine kıyasla,ketamin ve/veya verapamilli kombinasyonların analjezik etkinlikleri daha iyi bulunmuştur. Postope- ratif 24 saat kombinasyon gruplarının analjezik tüketimleri benzer iken, ikinci 24 saatte verapamil- li kombinasyonlarınki daha düşüktür. Tüm preemptif gruplarda analjezik tüketimi postinsizyonelolanlara göre daha düşük, global değerlendirmede ise hasta ve hekim memnuniyeti açısından eniyi grup preBKV bulunmuştur.Sonuç: Epidural bupivakaine ketamin ve verapamil eklenmesi ile daha etkin ve uzun analjezi sağ- lanmakta, preemptif uygulama ile postinsizyonel uygulamaya göre postoperatif analjezik gereksi- nimi azalmaktadır.

Preincisional and postincisional epidural bupivacaine, ketamin and verapamil effects on postoperative analgesic consumption in knee replacement surgery

atients and method: 164 patients undergoing total knee arthroplasty were randomly dividedinto 8 groups. The study groups are, group 1 (preB), preincisional bupivacaine, postincisional saline;group 2 (postB), preincisional saline, postincisional bupivacaine; group 3 (preBK), preincisional bu- pivacaine+ ketamine, postincisional saline; group 4 (postBK), preincisional saline, postincisional bu- pivacaine+ ketamine; group 5 (preBKV), preincisional bupivacaine+ ketamine+ verapamil, postin- cisional saline; group 6 (postBKV), preincisional saline, postincisional bupivacaine+ ketamine+verapamil; group 7 (preBV), preincisional bupivacaine+ verapamil, postincisional saline; group 8(postBV), preincisional saline, postincisional bupivacaine+ verapamil. Doses of epidural adminis- tered drugs are: 50 mg 0.5% bupivacaine solution, 60 mg ketamine, 5 mg verapamil, 10 mL saline.After placing epidural catheter, general anesthesia was administered with standart monitorisation.Epidural drugs were administered, 15 minutes before surgical incision for preincisional applicationand 30 minutes after surgical incision for postincisional application. Emergence, pain score and an- algesic requirement, side effects, patient and practitioner satisfaction were recorded.Findings: Ketamine and/or verapamil combinations analgesic effects are better than bupivacaineadministered alone. Analgesic consumptions of combination groups are similar in the first 24 hourperiod but in the second 24 hour period combinations of verapamil have lesser consumption. An- algesic consumptions of all preemptive groups are lesser than postincisional groups, in the globalevaluation, group preBKV is the best group in patient and practitioner satisfaction.Result: Adding ketamine and verapamil to epidural bupivacaine enhances effectiveness and dura- tion of analgesia, preemptive administration is more effective than the postincisional administra- tion on postoperative analgesic requirements.

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