SPİNAL ANESTEZİ ÖNCESİ UYGULANAN KETAMİNİN KALÇA CERRAHİSİ GEÇİREN YAŞLI HASTALARDA POSTOPERATİF ANALJEZİ ÜZERİNE ETKİSİ

Giriş ve amaç:Yaşlı hastalarda ortopedik acil olguların büyük kısmını kalça kırığı operasyonları oluşturur. Buolgularda spinal veya epidural anestezi yöntemleri tercih edilmesine karşılık, hastalara pozisyon verilmesisırasında şiddetli ağrı oluşabilmektedir. Çalışmamızın amacı, kalça kırığı olan yaşlı hastalarda, spinal anesteziöncesi verilen ketamin, fentanil veya meperidinin, postoperatif analjezi üzerine etkisini araştırmaktır.Gereç ve yöntem:Ağustos 2000-Ekim 2001 tarihleri arasında kalça kırığı nedeniyle spinal anestezi altındaartroplasti uygulanan 89 yaşlı hasta retrospektif olarak incelendi. Hastalar spinal anesteziden hemen önce ağrısağaltımı için intravenöz olarak yapılan analjeziklere göre 4 gruba ayrıldı: Grup 1 (Ketamin grubu), Grup 2(Fentanil grubu) , Grup 3 (Meperidin grubu) ve Grup 4 (Kontrol grubu). Postoperatif ilk analjezik ihtiyaç zamanıve ilk 24 saatte kullanılan analjezik miktarları kaydedildi.Bulgular:Olguların yaşları 65-99 arasında değişmekteydi. İlk analjezik ihtiyaç zamanı ketamin grubunda (192dk.), fentanil (132 dk.), meperidin (129 dk.) ya da kontrol (118 dk.) gruplarına göre daha fazla iken (p=0.035),postoperatif ilk 24 saatteki analjezik tüketimi ise daha az olarak bulundu (p=0.035; p0.001).Sonuç:Travma sonrası artroplasti uygulanan yaşlı hastalarda spinal anesteziden hemen önce kullanılan ketamin,aynı amaçla kullanılan opioidlere göre postoperatif dönemde daha iyi ağrı sağaltımı sağlayabilmektedir

Anahtar Kelimeler:

yaşlılık, spinal anestezi, analjezi, ketamin, fentanil, meperidin

The Efects of Ketamine Administration Before Spinal Anesthesia on Postoperative Analgesia In Elderly Patients Undergoing Hip Surgery

Aim and objective: Hip fracture represents the most leading cause of orthopedics urgent casesfor elderly people. Although spinal or epidural anesthesia is preferred in those cases, the pain due to position can cause some difficulty. The aim of our study is to investigate the analgesic effect of ketamine, fentanyl, or meperidine administration when given to facilitate the position before spinal anesthesia on postoperative analgesia in elderly patients underwent hip surgery. Material Methods: Eighty-nine elderly patients who underwent hip surgery by spinal anesthesia were investigated between August 2000 and October 2001 retrospectively. The patients were divided into four groups according to the application of analgesics before spinal anesthesia: Group 1 (Ketamine group), Group 2 (Fentanyl group), Group 3 (Meperidine group) and Group 4 (Control group). The time of first analgesic request for postoperative period and total analgesic consumption at postoperative 24 hour were recorded in all patients. Results: The age range of patients was between 65 and 99. The time to first request for analgesia was significantly longer in the ketamine (192 min) group compared to the fentanyl (132 min), meperidine (129 min) and control groups (118 min) (p=0.035). The analgesic requirements first 24 h were significantly lower in ketamine group compared to other groups (p0.001). Conclusions: Intravenously administration of ketamine before spinal anesthesia may provide better analgesia compared to other opioids during postoperative period in elderly underwent hip surgery.

Keywords:

elderly, spinal anesthesia, analgesia, ketamine, fentanly, meperidine,

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