Hülya ÇELEBİ, Bülent MENTEŞ, Pavel SADALOV

Comparison of spinal anesthesia with isobaric 0.5% bupivacaine in the prone or jackknife position with hyperbaric 0.5% bupivacaine in the sitting position for anorectal surgery

Amaç: Bu çalışma anorektal cerrahi geçiren hastalarda pron veya jackknife pozisyonda %0.5 10 mg izobarik bupivakainle yapılan spinal anestezinin, %0.5 10 mg hiperbarik bupivakainle yapılana gore anestezik ve hemodinamik etki açısından karşılaştırılması amacıyla planlandı. Metod: Oturur (Grup I), pron (Grup II) ve jackknife (Grup III) pozisyonlarda spinal anestezi yapılmak üzere 60 hasta üç gruba ayrıldı. Subaraknoid ponksiyon standart orta hat yaklaşımıyla L4-5 aralığından, 25-gauge kalem uçlu spinal iğneyle yapıldı ve hiperbarik ya da izobarik %0.5 10 mg bupivakain pozisyona göre enjekte edildi. Bulgular: Grup I'de anestezi başlangıcı en hızlı olup, en yüksek seviye Ll ve ortanca değeri 10. dakikada L2 seviyesine ulaştı. En yüksek anestezi se¬viyesi diğer gruplarda da Ll idi. En son ulaşılan anestezi seviyesinin ortanca değeri 15. dakaikada Grup H'de L3, Grup IIFte L2 idi. Bu seviyeler Groups I, II and III de sırasıyla 90, 105 ve 75 dakikaya kadar stabil kaldı. İki seg¬ment gerileme zamanlan Grup I, II ve lll'te sırasıyla 106.40±9,109.65±6 ve IO7.95±7 dk idi. Motor blok derecesi tüm gruplarda 3 olup, Grup II ve IIFte 105 dk.da, Grup I'de ise 120 dk.da 2.dereceye döndü (p

Anorektal cerrahide pron veya jackknife pozisyonda izobarik %0.5 bupivakainle yapılan spinal anestezinin oturur pozisyonda hiperbarik %0.5 bupivakainle yapılan la karşılaştırılması

Purpose: This study was designed to compare the anesthetic behavior, and hemodynamic consequences in spinal anesthesia performed with isobaric bupivacaine 0.5% 10 mg in the prone or jackknife position with those of spinal anesthesia performed with hyperbaric bupivacaine 0.5% 10 mg in the sitting/moved prone position in patients undergoing anorectal surgery. Methods: Sixty patients were allocated into three groups to receive spinal anesthesia in the sitting (Group I), prone (Group II), or jackknife (Group III) position. The subarachnoid puncture was performed using a standard midline approach with a 25-gauge pencil-point spinal needle at L4-5 and hyperbaric or isobaric 0.5% bupivacaine 10 mg was injected according to the position. Results: Onset of anesthesia was significantly faster in Group I, with the highest level at LI and median L2 in 10 min. The highest anesthesia level was at LI in the other groups as well. The final median anesthesia level was L3 and L2 in Groups II and III, respectively, in 15 min. This segmental analgesia remained stable until 90, 105 and 75 min in Groups 1,11 and III, respectively. Two segment regression times were 106.40±9, 109.65±6 and 107.95±7 min in Groups 1, II and III, respectively. Motor block reached 3 in all groups and returned to 2 within 105 min in Groups II and III and within 120 min in Group I. Conclusion: Spinal anesthesia can be performed successfully in the three ced similar anesthesia at L2 or L3 levels, which were suitable for pilonidal cyst excision in the prone position. However, isobaric bupivacaine 0.5% 10 mg was not favorable for ambulatory anorectal surgery in the jackknife position because of higher segmental anesthesia than predicted and long-lasting motor blockade.

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