Emre GÜRCÜ, Tülay KAYACAN ÖRKİ, Füsun GÜZELMERİÇ, Atakan ERKILINÇ, Evşen OVAT, Tuncer KOÇAK

İntratekal Morfin Uygulamasının Koroner Arter Bypass Greft Operasyonlarında Stres Yanıt ve Ağrı Kontrolü Üzerine Etkisi

Koroner arter bypass greft operasyonlarında intratekal morfin uygulamasının cerrahi travmaya stres, hemodinamik yanıt ve postoperatif ağrı üzerine etkileri değerlendirildi. Prospektif, randomize bu çalışmaya etik komite izni ve hastaların bilgilendirilmiş onayı alındıktan sonra, ASA II-III grubu, elektif koroner arter cerrahisi planlanan, 35-70 yaş arası 40 hasta dahil edildi. Operasyon odasında L2-3 aralığından intratekal yolla Grup ITM'ye 20 mcg kg-1 morfin verildi. Grup K'ya hiçbir şey uygulanmadı. Tüm hastalara standart genel anestezi, cerrahi ve kardiyopulmoner bypass teknikleri uygulandı. Operasyon süresince kullanılan toplam fentanil miktarı kaydedildi. Ortalama arter basıncı, kalp hızı, SpO2 değerleri ile plazma kortizol düzeyleri; anestezi indüksiyon öncesi, sternotomi sonrası, KPB ilk 5. dakika, AKK sırasında, KPB ısınma sonu, hastanın YBÜ transferinden sonra, postoperatif 8. saat, postoperatif 1. gün olmak üzere kaydedildi. Hastalara postoperatif dönemde hasta kontrollü anestezi HKA cihazı takıldı. Ekstübasyon sonrası 0-6, 6-12, 12- 24, 24-48. saatlerde kümülatif morfin miktarları kaydedildi. Hastaların ağrı düzeyi; ekstübasyondan hemen sonra ve ekstübasyon sonrası 6, 12, 24, 36, 48. saatlerde Vizüel anolog skala VAS ile değerlendirildi. İstatistiksel değerlendirmede; t- Student testi; Ki-kare testi kullanıldı. Demografik, intraoperatif ve hemodinamik veriler, postoperatif ekstübasyon süreleri, postoperatif komplikasyonlar açısından iki grup benzer bulundu. Operasyon süresince kullanılan fentanil miktarı Grup ITM'de Grup K'ya göre daha düşük bulundu. Postoperatif kümülatif morfin tüketimi ITM Grubunda K Grubuna göre anlamlı olarak düşük bulundu. YBÜ&'39;e transferden sonra, postoperatif 8. saat ve postoperatif 1.gün alınan kan örneklerindeki serum kortizol düzeyleri Grup ITM'39;de K Grubuna göre anlamlı olarak düşük saptandı. Öksürme halindeki VAS değerleri Grup ITM'de Grup K&'39;a göre ekstübasyon sonrası, ekstübasyondan sonra 6, 12, 24 ve 36. saatlerde anlamlı olarak düşük bulundu. p

Anahtar Kelimeler:

intra tekal morfin, kardiyak cerrahi, postoperatif ağrı

The Effect of Intrathecal Morphıne Application Upon Stress Response and Pain Control in The Operations of Coronary Arterial Bypass Graft

Aim: The effects of intrathecal morphine application upon surgical insult stress, hemodynamic response and postoperative pain in the operations of coronary arterial bypass graft have been evaluated. Material and Method: After getting permission of ethics committee and informed consent of patients,a prospective randomized study was planned. A total of 40 patients age range: 35-70 years of whom elective coronary artery surgery ASA II-III groups , have been planned were included into the study. In the operating room, 20 mcg kg-1 morphine has been given to Group ITM within the range of L2-3 by the way of intrathecal. Group “K” received no treatment. Standard general anesthesia, surgical and cardiopulmonary bypass techniques have been applied to all patients. Total amount of fentanyl, used during the operation, has been recorded. The average of blood pressure, heart rate, SpO2 values and the levels of blood plasma cortisol; before induction, after sternotomy, at the initial 5 minutes of CPB during AKK, at the end of CPB warm up, after transfering the patient to Intensive Care Unit ICU at postoperative 8th hour and postoperative 1st day have been recorded. Patient controlled anesthesia device has been mounted to patients during the postoperative period. After extubation, cumulative morphine portions have been recorded at 0-6, 6-12, 12-24, 24-48. hours. Soon after extubation and at 6, 12, 24, 36, 48. hours after etubation; pain levels of patients have been evaluated with Visual Analogue Scale VAS . At statistical evaluation; t-Student test; chi square test has been used. Results: Demographic, intraoperative and hemodynamic parameters, postoperative extubation terms have been found similar in the way of postoperative complications in two groups. Fentanyl dosage, used during the operation, has been found lower in group ITM compared to group K. In group ITM, consumption of postoperative cumulative morphine has been found significuntly low compared to group K. Following the transfer to ICU, serum cortisol levels, in the blood samples drawn at postoperative 8th hour and postoperative 1st day, have been detected superior in ITM group to at group K. Shortly after extubation and at 6, 12, 24, 36 hours after extubation, VAS values during coughing have been detected significantly lower in group ITM compared to group K. p

Keywords:

intrathecal morphine, cardiac surgery, postoperative pain,

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