İlkay CÖMERT, Koray ERBÜYÜN, GÜLAY OK, idil TEKİN, Demet TOK

Serum fizyolojikle epidural top-up uygulamasının tek yanlı spinal anesteziye etkileri

Tek yanlı spinal anestezide önceden yerleştirilen epidural kateterden serum fizyolojiğin farklı zamanlarda uygulanması (top-up) ile anestezinin süresini ve kalitesini alt ekstremite cerrahisi için yeterli düzeyde sağlamak ve bu uygulamaların, hemodinami üzerindeki etkilerini belirlemek amaçlandı. ASA I-II grubunda, yaşları 18-65 arasında 60 olgu, rastgele üç eşit gruba ayrıldı. Her üç grupta tek yanlı spinal anestezi için 6 mg %0,5 ‘heavy’ bupivakain ve epidural top-up amacıyla 10 mL serum fizyolojik uygulandı. I.gruba epidural kateter yerleştirildikten sonra tek taraflı spinal anestezi uygulandı. II.gruba, önce tek taraflı spinal anestezi ve 1 dakika sonra, daha önceden yerleştirilen epidural kateterden epidural top-up uygulandı. III.gruba, epidural kateter yerleştirilip epidural top-up uygulandı ve 1 dakika sonrasında tek taraflı spinal anestezi yapıldı. Anestezi öncesinden başlanarak hemodinamik veriler, anesteziyi takiben duyusal ve motor blok seviyeleri kaydedildi ve değerlendirildi. Her üç grup hastada, kalp atım hızları ve ortalama arter basıncının tüm gruplarda kontrol değerlerine oranla bazı ölçümlerde anlamlı farklılıklar gösterdiği ancak verilerin klinik kabul edilebilir sınırlar içinde kaldığı; gruplar arası karşılaştırmalarda ise istatistiksel olarak anlamlı farklılık oluşmadığı görüldü. Duyusal blok düzeyinin II. grupta en yüksek, III. grupta ise en düşük seviyede kaldığı, gruplar arasındaki farkın anlamlı olduğu (p

Anahtar Kelimeler:

Anestezi, spinal, Enjeksiyon, epidural, Kalp hızı, Hemodinamikler

The effects of epidural top-up technique with serum physiological on unilateral spinal anesthesia

This study was designed to investigate the influence of saline injections as epidural top-up on the sensory block duration, quality and hemodynamic effects of unilateral spinal anesthesia. The cases from ASA I-Il containing of 18-65 age group were randomly separated into three groups. For the purpose of unilateral spinal anesthesia, 6 mg 0.5% ‘heavy’ bupivacaine and for the purpose of epidural top-up, 10 mL saline were applied to the each patients of the groups. The study protocol was designed as: Ist group: Coming after the epidural catheter installation, unilateral spinal anesthesia was applied (n=20). IInd group: At first, unilateral spinal anesthesia was applied and after one minute, epidural top-up was done via the pre-installed epidural catheter (n=20). IIIrd group: At first the epidural catheter was installed and epidural top-up was applied. After one minute, unilateral spinal anesthesia was fulfilled (n=2O). Starting from the pre-anesthesic period, the hemodynamic data and following the anesthesia, the sensorial and motor block levels were recorded and evaluated. As the outcome of the inter-groups comparison of heart rate and mean arterial pressure, a statistically note-worthy differance was not determined; statistically significant but clinically acceptable hemodynamic changes were observed in intra-group evaluations, when the data was compared with control levels. The sensorial block levels were significantly higher in group II and significantly lower in group III. The application of 10 mL saline via epidural catheter 1 minute after the unilateral spinal anesthesia and remaining the patient leaning on the side of the extremity to be operated for 15 minutes improves the sensory block level of unilateral spinal anesthesia. It is determined that, for the lower extremity surgical operations with 1-1.5 hour estimated period, this method alone can be a worthwhile alternative.

Keywords:

Anesthesia, Spinal, Injections, Epidural, Heart Rate, Hemodynamics,

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