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 Neostigmines 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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