Aylin İNCESU, Mustafa Nuri DENİZ, Elvan ERHAN, Gülden UĞUR

İntratekal Bupivakain İle Morfinin TUR-M Sonrası Postoperatif Analjeziye Etkisi

Amaç: Bu randomize çalışmada transüretral mesane rezeksiyonu (TUR-M) sonrası analjezi için bupivakain ile iki farklı intratekal (IT) morfin dozu değerlendirildi. Metodlar: Yetmiş beş hasta rastgele üç gruba ayrıldı. IT morfin (100 ug) ile 12,5 mg % 0,5 bupivakain (1. Grup), IT morfin (200 ug) ile 12,5 mg % 0.5 bupivakain (2. Grup) ve morfinsiz IT 12,5 mg % 0,5 bupivakain (3. Grup) alanlar olarak. Postoperatif ağrı 24 saat boyunca VAS ile değerlendirildi ve ağrı şiddeti orta derecede olan her hastaya intravenöz parasetamol ve Dexketoprophen trometamol verildi. Bulgular: Grup I ve II'de VAS skorları 1 saat, 2 saat, 4 saat, 6 saat, 12 saatte Grup III'e göre anlamlı olarak düşüktü (p< 0.05). Analjezi talebi Grup III'te diğer iki gruba göre anlamlı derecede yüksekti (p< 0.05). Grup II'de postoperatif bulantı, diğer iki gruba göre daha fazla rapor edildi (p< 0.05). Sonuç: IT % 12,5 mg % 0.5 bupivakain ile morfin (100 ug ve 200 ug), yanlız IT % 12,5 mg % 0,5 bupivakain’e kıyasla postoperatif ağrı skorlarında anlamlı bir azalma sağladı. TUR-M sonrasında postoperatif ağrı kontrolünde IT 100 ug morfin, IT 200 ug morfinden önemli ölçüde karşılaştırılabilir daha düşük yan etkiler sağladı.

Anahtar Kelimeler:

Spinal anestezi, morfin, postoperative ağrı, transüretral mesane rezeksiyonu

The Efficacy of Intrathecal Morphine With Bupivacaine For Postoperative Analgesia After TUR-B

Objective,: In this randomized study, we evaluated two different doses of intrathecal (IT) morphine with bupivacaine for analgesia after transurethral resection of bladder (TUR-B). Methods: Seventy-five patients were randomly divided into three groups. They were allocated to receive IT morphine (100 µg) with 12.5 mg 0.5% bupivacaine (Group 1), IT morphine (200 µg) with 12.5 mg 0.5% bupivacaine (Group 2), and IT 12.5 mg 0.5% bupivacaine without morphine (Group 3). Postoperative pain was evaluated by VAS during 24 h and each patient was given intravenous paracetamol and Dexketoprophen trometamol if pain severity was moderate. Results: VAS scores were significantly lower in Groups I and II than Group III at 1h, 2h, 4h, 6h, 12h (p< 0.05) (Figure 1). The request for analgesia was significantly higher in Group III than the other two groups (p< 0.05). More patients reported postoperative nausea in Group II than the other two groups (p< 0.05) (Figure 2). Conclusion: IT morphine (100 µg and 200 µg) with 12.5 mg 0.5% provided a significant reduction in postoperative pain scores compared to IT 12.5 mg 0.5% bupivacaine alone. IT morphine 100 µg provided comparable postoperative pain control with significantly lower side effects than IT morphine 200 µg after TUR-B.

Keywords:

Spinal anesthesia, morphine, postoperative analgesia, transurethral resection of bladder,

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