Fentanil, sufentanil ve neostigmin'in spinal anestezinin özellikleri üzerine etkileri

Özet Amaç: Bu çalışmada, intratekal kullanılan adjuvan ajanların özgül yan etkilerini ve spinal anestezinin özellikleri üzerine etkilerini araştırmayı amaçladık.Gereç ve yöntem: 100 olgu rastgele 20 olguluk 5 gruba ayrıldı. Serum fizyolojik Grubu: 15 mg % 0,5 hiperbarik bupivakain + 0,5 mL serum fizyolojik, Bupivakain Grubu: 17,5 mg % 0,5 hiperbarik bupivakain, Fentanil Grubu: 15 mg % 0,5 hiperbarik bupivakain + 25 μg fentanil, Sufentanil Grubu: 15mg % 0,5 hiperbarik bupivakain + 2,5 μg sufentanil, Neostigmin Grubu: 15 mg % 0,5 hiperbarik bupivakain + 250 μg neositigmin. Tüm gruplarda intratekal olarak verilen ilaç volümü 3,5 mL idi. Spinal anestezi sonrası her 5 dakikada bir pin-prik testi ile duyusal blok seviyesi ve Bromage skorlama ile motor blok düzeyine bakıldı. Gruplara ait duyusal ve motor blok süreleri kaydedidi. Oluşan yan etkiler kaydedildi. Bulgular: Farklı adjuvan ajanların spinal anestezinin özellikleri üzerine etkileri farklılıklar gösterdi. Fentanil, duyusal blok süresini diğer gruplara göre istatistiksel olarak anlamlı uzattı. Fentanil ve sufentanil 20. dakika duyusal blok seviyesini diğer gruplara göre istatistiksel olarak anlamlı yükseltti. Bupivakain grubunda 5. dakika motor blok düzeyi diğer gruplara göre istatistiksel olarak anlamlı yüksek bulundu. Her adjuvan ajana ait özgül yan etkiler oluştu. Serum fizyolojik grubunda hipotansiyon diğer gruplara göre istatistiksel olarak anlamlı sayıda fazla bulundu.Sonuç: Farklı adjuvan ajanların spinal anestezinin özellikleri üzerine etkileri farklıdır ve özgül yan etkilere neden olurlar. Fentanil duyusal blok seviyesi ve süresini uzatır. Lokal anestezik dozu arttıkça motor blok düzeyinin artışı hızlanır, anestezi kalitesi azaldıkça hipotansiyon artar.

Fentanyl, Sufentanil and Neostigmine s effects on charecteristics of the spinal anesthesia

Purpose: In the present study, we aimed to investigate the specific side-effects and effects of adjuvant agents used intrathecally on the properties of spinal anesthesia. Materials and methods: 100 cases were randomly divided into 5 groups of 20 cases. Saline group: 15 mg 0.5% hyperbaric bupivacaine + 0.5 mL saline, Bupivacaine Group: 17.5 mg 0.5% hyperbaric bupivacaine, Fentanyl Group: 15 mg 0.5% hyperbaric bupivacaine + 25 μg fentanyl, Sufentanyl Group: 15mg 0.5% hyperbaric bupivacaine + 2,5 μg sufentanyl, Neostigmine Group: 15 mg 0.5% hyperbaric bupivacaine + 250 μg neostigmine, The volume of the intrathecally administered drug was 3.5 mL in all groups. After spinal anesthesia, sensory block level was measured by pin-prick test every 5 minutes and motor block level was measured by Bromage scoring. Sensory and motor block durations of the groups were recorded. The side effects that occurred were recorded. Results: Effects of different adjuvant agents on the properties of spinal anesthesia differed. Fentanyl statistically significantly prolonged sensory block durations compared with other groups. Fentanyl and sufentanyl statistically significantly raised the 20th-minute sensory block level compared with other groups. In the bupivacaine group, the 5th-minute motor block level was detected to be statistically significantly higher than other groups. Specific side-effects occurred for each adjuvant agent. Occurrence of hypotension in the saline group was statistically significantly higher compared with other groups. Conclusion: Effects of different adjuvant agents on the properties of spinal anesthesia are different and they cause specific side-effects. Fentanyl prolongs sensory block level and duration. As the local anesthetic dose increases, the increase in the motor block level accelerates and as the quality of anesthesia decreases, occurrence of hypotension increases.

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1. Kaya FN, Uçkunkaya N, Şahin Ş. İntratekal neostigmin, morfin ve kombinasyonunun postoperatif analjezik özellikleri ve spinal anestezi üzerine etkisi. Türk Anest Rean Der Dergisi 2002;30: 353-359.
2.Bigat Z, Boztuğ N, Hadimioğlu N, Ertok E. Günübirlik artroskopi girişimleri için spinal anestezide düşük doz bupivakain ve bupivakain+fentanil kombinasyonunun değerlendirilmesi. Türk Anest Rean Der Dergisi 2004;32: 289-295.
3.Lee JH, Chung KH, Lee JY, Chun DH, Yang HJ, Ko TK et al. Comparision of fentanyl and sufentanil added to % 0,5 hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesaren section. Korean J Anesthesiol 2011;60: 103-108.
4.Bakan N, Özpolat S, Ayas A, Ersoy MÖ. Sezeryan ameliyatlarında intratekal uygulanan fentanilin etkileri. Türk Anest Rean Der Dergisi 2000;28: 430-436.
5.Bromage PR, Burfood MF, Ceowell DE. Quality of epidural blockade.I. Influance of physical factors. Br J Anaesth 1964;36: 342.
6.Motiani P, Chaudhary S, Bahl N, Sethi AK. Intrathecal sufentanil versus fentanyl for lower limb surgeries - a randomized controlled trial. J Anaesthesiol Clin Pharmacol 2011;27: 67-73.
7.Goel S, Bhardwaj D and Grover VK. Intrathecal fentanyl added to intrathecal bupivacaine for day case surgery: a randomized study. Eur J of Anaesth 2003;20: 294-297.
8. Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine. J Anaesthesiol Clin Pharmacol 2011;27: 339-343.
9. Schug SA, Saunders D, Kurowski I, Paech MJ. Neuraxial drug administration: a review of treatment options for anaesthesia and analgesia. CNS Drugs 2006;20: 917-933.
10. Camorcia M, Capogna G, Berritta C, Columb MO. The relative potencies for motor block after intrathecal ropivacaine, levobupivacaine, and bupivacaine. Anesth Analg 2007;104: 904-907.
11. Dizman S, Türker G, Gurbet A, Mogol EB, Türkcan S, Karakuzu Z. Comparison of two different doses of intrathecal levobupivacaine for transurethral endoscopic surgery. EAJM 2011;43: 103-108.
12. Sönmez B, Akça M, Akçaboy Y, Akçaboy ZN, Küçük Z, Göğüş N. Effects of unilateral spinal anesthesia with low dose bupivacaine and bupivacaine-fentanyl combination on recovery. Klin Deney Ar Derg 2011;2: 22-29.
13. Kim SY, Cho JE, Hong JY, Koo BN, Kim JM, Kil HK. Comparison of intrathecal fentanyl and sufentanil in low dose dilute bupivacaine spinal anesthesia for transurethral prostatectomy. Br J Anesth 2009;103: 750-754.
14. Borazan H, Davarcı I, Keçecioğlu A, Otelcioğlu S. The effects of low dose levobupivacaine with or without sufentanil intrathecally in transurethral resection of prostate. Eur j Gen Med 2011;8: 134-140.
15. Akcaboy EY, Akcaboy ZN, Goüs N. Low dose levobupivacaine % 0,5 with fentanyl in spinal anesthesia for transurethral resection of prostate surgery. J Res Med Sci 2011;16: 68-73.
16. Lauretti GR, Lima IC. The effects of intrathecal neostigmine on somatic and visseral pain: İmprovoment by association with a peripheral anticholinergic. Anesth Analg 1996;82: 617-620.
17. Hood DD, Eisenach JC, Tuttle R. Phase I safetyassessment of intrathecal neostigmine in humans. Anesthesiology 1995;82: 331-343.
18. Hye MA, Masud KM, Banik D, Banik D, HaqueMF, Akhtaruzzaman KM. Intrathecal neostigmine for postoperatrive analgesia in caesarean section. Mymensingh Med J 2010;19: 586-593.
19. Chen-Scarabelli C, Scarabelli TM. Neurocardiogenic syncope. BMJ 2004;329: 336-341.
20. Takase H, Kudoh A, Takazawa T. A case of severe bradycardia and AV block during administration of propofol. Masui 2003;52: 1000-1002.
21. Niibuchi K, Kawamata M, Watanabe H, Namiki A. A case of AV block (Mobitz II type) during recovery from general anesthesia combined with epidural anesthesia. Masui 2002;51: 414-417.
22. Imarengiaye CO, Asudo FD, Akpoguado DD, Akhideno II, Omoifo CE, Ogunsakin AT. Subarachnoid bupivacaine and pethidine for caesarean section: assessment of quality of perioperative analgesia and side effects. Niger Postgrad Med J. 2011; 18: 200-204.
23. Atalay C, Aksoy M, Aksoy AN, Dogan N, Kürsad H. Combining intrathecal bupivacaine and meperidine during caesarean section to prevent spinal anaesthesia-induced hypotension and other side- effects. J Int Med Res. 2010; 38: 1626-1636.
24. Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anesth 1995;42: 891-903.
25. Keskin K, Aydınlı BI. Hypothermia, shivering and sweating during longterm intratechal morphine and bupivacaine infusion. Anestezi Dergisi 2008;16: 219-222.
26. Kamphuis ET, Kuipers PW, van Venrooij GE, Kalkman CJ. The effects of spinal anesthesia with lidocaine and sufentanil on lower urinary tract functions. Anesth Analg 2008;107: 2073-2078.
27. Bedirli N, Akkaya T. Postspinal headache. Anestezi Dergisi 2010;18: 135-140.