Nurettin LÜLECİ, Tuna ERİNÇLER, Remziye GÜL, Koray ERBÜYÜN, Ahmet TUTAN

Sezaryen ameliyatları için yapılan epidural anestezilerde bupivakaine fentanil eklenmesi

Amaç: Çalışmada epidural anestezide bupivakaine tek doz fentanil eklenmesinin analjezi kalitesine etkisini araştırmak amaçlandı. Yöntem: Elektif sezaryen operasyonu planlanmış 23 hasta rastgele iki gruba ayrıldı. Bir gruba (B+F grubu; n=12) epidural kateterden 8 ml % 0.5 lik bupivakain+0.0015 mg/kg fentanil, diğer gruba 8 ml % 0.5’lik bupivakain+2 ml serum fizyolojik verildi (n=11). Ameliyat sırasındaki analjezi kalitesi, bebeğin çıkarılması, uterusun çekilmesi ve kapatılışı ve batın kapatılması süreçlerindeki ağrı durumları vizüel analog skala ile saptandı. Gruplar arasındaki karşılaştırmalar Apgar skorları, umblikal kan gazı analizleri ve annede postoperatif dönemdeki analjezi yönünden yapıldı. Bulgular: Uterusun eventrasyonu ve yaranın kapatılması süreçlerinde ağrı duymama oranı B+F grubunda daha yüksek bulundu. Aynı grupta ameliyat sonrasında ağrı duymama süresinin daha uzun olduğu gözlendi. Annelerde ve bebeklerde solunum depresyonu izlenmedi. Sonuç: Epidural anestezide bupivakaine preoperatif olarak 0.0015 mg/kg fentanil eklenmesiyle sezaryen ameliyatları sırasında daha kaliteli ve ameliyattan sonra daha uzun süreli bir analjezi sağlanabileceği kanısına varıldı.

Addition of fentanyl to bupivacaine for epidural anesthesia in cesarean section

Objective: The aim of this study was to compare the quality of analgesia of a single preoperative dose of 0.0015 mg/kg fentanyl and epidural bupivacaine with that of epidural bupivacaine alone. Methods: 23 elective patients for cesarean section were randomized to two group. In the first group (B+F group, n=12) epidural injections of 8 ml 0.5% bupivacaine + 0.0015 mg/kg fentanyl, in the second group 8 ml 0.5% bupivacaine + 2 ml saline (n=11) was used. Quality of intraoperative pain at delivery, uterine eventration and during uterine and abdominal closure was assessed using a visual analogue scale. Apgar scores, umbilical cord blood gas analyses and duration of postoperative analgesia were compared. Results: Ratios of pain-free patients in the B+F group was higher during uterine eventration and wound closure. Mean postoperative duration of analgesia was significantly longer in the B+F group. Respiratory depression was never detected in mothers or newborns. Conclusion: It may be concluded that preoperative epidural addition of 0.0015 mg/kg fentanyl to 0.5% bupivacaine significantly improves intraoperative pain relief during elective cesarean section and prolongs postoperative analgesia.

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