Fatih ŞAHİN, Havva KOÇYİĞİT, Fikret BAYAR, Ayça Taş TUNA

Sezaryen Doğumlarda Tek Doz Spinal ve Kombine Spinal Epidural Anestezinin Postoperatif Analjezi Kalitesinin Karşılaştırılması

Amaç: Sezaryen doğum analjezisinde sıkça kullanılan intratekal morfin ve epidural morfinin analjezik etkilerinin karşılaştırılması amaçlanmıştır. Materyal ve Metot: Hastalar tek doz spinal (TDS) ve kombine spinal epidural (KSE) anestezi grubuna ayrıldı. TDS anestezide standart olarak 10 mg %0,5 hiperbarik bupivakain, 10 µg fentanyl, 100 µg morfin, KSE’de ise morfin eklenmeden subaraknoid aralığa enjekte edildi. KSE grubundaki hastalara 2. saat ve 24. saatte epidural kateterden 3 mg morfin 10 mL hacimde uygulandı. Ağrı şiddetinin hesaplanması için visual analog skala (VAS) kullanıldı. Bulgular: Çalışmaya toplam 144 hasta dahil edildi. 71 hastaya TDS, 73 hastaya ise KSE anestezi uygulandı. VAS skorlarının karşılaştırılmasında 2., 12. ve 48. saat skorlarında anlamlı fark bulundu. 2.saat VAS skorunda TDS anestezi grubunda daha düşük VAS skoru mevcutken 12., 24., ve 48. saat VAS skorlarında KSE anestezi grubunda daha düşük VAS skoru bulundu. Sonuç: Her iki tedavide iyi analjezi sağladı. Özellikle mobilizasyon sonrasında epidural analjezi uygulaması intratekal opioid kullanımına göre daha iyi sonuçlar vermektedir.

Anahtar Kelimeler:

kombine spinal epidural anestezi, morfin, sezeryan doğum, spinal anestezi

Comparison of Postoperative Analgesia Quality of Single Dose Spinal and Combined Spinal Epidural Anesthesia in Cesarean Deliveries

Objective: It is aimed to compare the analgesic effects of intrathecal morphine and epidural morphine, which are frequently used in cesarean delivery analgesia. Materials and Methods: Patients were divided into single-dose spinal (SDS) and combined spinal epidural (CSE) anesthesia groups. While 10mg 0.5% hyperbaric bupivacaine, 10µg fentanyl, 100µg morphine were administered to SDS anesthesia group as standard, the aforementioned drugs without morphine were injected into the subarachnoid space in CSE group. The patients in CSE group, 3mg morphine in a volume of 10mL was administered through the epidural catheter at the 2nd and 24th hour. Visual analog scale (VAS) was used to calculate pain intensity. Results: Total of 144 patients were included in the study. It was observed that 71 patients were applied SDS anesthesia and 73 patients were applied CSE anesthesia. In the comparison of VAS scores, significant difference was found in the scores at 2nd, 12th and 48th hours. While the 2nd hour VAS score was lower in SDS anesthesia group, 12th, 24th, and 48th hour VAS scores were lower in CSE anesthesia group. The highest difference was found in the 48th hour VAS scores. Conclusion: Both treatments provided good analgesia. Especially after mobilization, application of epidural analgesia gives better results than intrathecal opioid use.

Keywords:

Cesarean Delivery, Combined spinal epidural anesthesia, Morphine, Spinal anesthesia,

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