Epidural anestezide kullanılan Levobupivakain veya Bupivakain Hemoreoloji ve Koagülasyon faktörlerini etkiler mi?

Amaç: Lokal anestezik ajan olan levobupivakain ve bupivakainin hemoreoloji ve koagülasyon faktörleri üzerindeki etkilerini araştırmayı amaçladık. Yöntemler: Epidural anestezi planlanan ASA I-II grubu, yaşları 18–64 arasında değişen 40 hasta çalışmaya alındı. Hastalar rastgele 2 gruba ayrılarak epidural anestezi için levobupivakain (Grup1) ve bupivakain (Grup2) uygulandı. Kan basıncı, periferik oksijen satürasyonu ve vücut ısısı sürekli monitörize edildi. Motor blok ve duyu seviyelerine bakıldı. Hemoreoloji ve koagülasyon parametreleri için alınan kan örnekleri çalışıldı. Bulgular: Gruplar arasında hemodinamik, kan ve plazma viskozitesi, onkotik basınç ve osmolalite değerleri bakımından istatistiksel olarak anlamlı bir fark saptanmadı. Fibrinojen değerleri Grup 1’de Grup 2’ye göre daha fazla azalma saptandı (p=0.015). aPTT değeri Grup 1’de Grup 2’ye göre anlamlı bir artış görüldü (p=0.017). FVIII açısından gruplar arasında fark bulunmamasına rağmen Grup 2’de daha fazla artış saptandı. Total protein, Hb, Hct, PT ve INR parametreleri açısından gruplar arasında anlamlı bir fark saptanmadı. Sonuç: Levobupivakain ve bupivakain ile yapılan epidural anestezide; hemoreolojik açıdan gruplar arasında anlamlı bir fark saptanmadı. Koagülasyon parametreleri normal sınırlar içerisinde olmasına rağmen, grup 1 ile kıyaslandığında grup 2 de aPTT değerleri düşük, fibrinojen ve FVIII düzeyleri ise daha yüksek saptandı. Sonuç olarak epidural anestezi için kullanılan levovupivakain ve bupivakainin hemoreoloji ve koagülasyon faktörleri üzerine benzer etkiler gösterdiğini ve anestezik ajan seçiminde her ikisinin de tercih edilebileceği kanaatindeyiz.

Levobupivacaine Or Bupivacaine Used In Epidural Anesthesia Affecting The Haemorheology And Coagulation Factors?

Objective: We aimed to investigate the effects of local anesthetic agents’ levobupivacaine and bupivacaine on hemorheology and coagulation factors. Methods: Patients were randomly divided into 2 groups and levobupivacain (Group 1) and bupivacaine (Group 2) were administered for epidural anesthesia. Blood pressure, peripheral oxygen saturation and body temperature were constantly monitored. The motor block and sense levels were checked. Blood samples taken for hemorheology and coagulation parameters were studied. Findings: There was no statistically significant difference between hemodynamic, blood and plasma viscosity, oncotic pressure and osmolality values among the groups. Fibrinogen values were decreased in Group 1 compared to Group 2 (p = 0.015). aPTT value was significantly increased in Group 1 compared to Group 2 (p = 0.017). Although there was no difference between the groups in terms of FVIII, a further increase in Group 2 was observed. Although there was no difference between the groups in terms of FVIII, a further increase in Group 2 was observed. Total protein, Hb, Hct, PT and INR parameters were not significantly different between the groups. Conclusion: Epidural anesthesia with levobupivacaine and bupivacaine; There was no significant difference between groups in terms of hemorheological. Although the coagulation parameters were within normal limits, aPTT values were lower and fibrinogen and FVIII levels were higher in group 2 compared to group 1. We conclude that levovupivacaine and bupivacaine applied for epidural anesthesia show similar effects on hemorheology and coagulation factors, and that both may be preferred in the choice of anesthetic agent.

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