Gülen GÜLER, Cihangir BİÇER, Aynur AKIN, Zeynep TOSUN, Aliye ESMAOĞLU, Adem BOYACI

Çocuklarda peritonsiller bupivakain infiltrasyonunun sevofluran anestezisi sonrası postoperatif ağrı ve ajitasyon üzerine etkileri

Çalışmamızda, çocuklarda peritonsiller bupivakain infiltrasyonunun postoperatif ağrı ve ajitasyon üzerine etkisini araştırmayı amaçladık. Elektif günübirlik adenotonsillektomi planlanan, 3-6 yaş arası, ASA I grubu 40 çocuk rasgele iki gruba ayrıldı. Her iki grupta da anestezi indüksiyonu % 60/40 N2O/O2 karışımı içinde % 8 konsantrasyonda sevofluran kullanılarak gerçekleştirildi ve % 2-3 konsantrasyonda devam edildi. Cerrahi işlem başlamadan önce Grup I (n-20) olgulara 0.5 mL/kg %0.25'lik bupivakain, Grup II (n-20; olgulara ise 0.5 mL/kg % 0.9'luk salin, en fazla 10 mL olacak şekilde, her iki tonsile eşit olarak, enjekte edildi. Olgular per ve postoperatif dönemde KAH, SAB, DA yönünden bir saat monitörize edildi ve 6 saat gözlendi. Ağrı 3'lü skala ile, ajitasyon ise 1-4 skala üzerinden değerlendirildi, 3-4 şiddetli ajitasyon olarak kabul edildi. Analjezik ihtiyacı ile ajitasyon ve bulantı kusma gibi istenmeyen etkiler her iki grup arasında karşılaştırıldı. Kalp atım hızı intraoperatif 10. dakikadan başlayarak postoperatif 30. dakikaya kadar, grup I'de grup Il'ye göre düşük, başlangıç değerlerine göre Grup I'de anlamlı değişiklikler göstermezken Grup Il'de ekstübasyon sonrasında yüksek bulundu (p>0.05). Postoperatif dönemde bulantı-kusma ve ajitasyon sıklığı benzer bulundu. Ağrı skorları ilk 10 dakika hariç anlamlı bir farklılık göstermedi, ilk 6 saat içinde analjezik gereksinimi olan olgu sayısı Grup I'de Grup Il'ye göre azalmıştı (p>0.05). Peritonsiller bupivakain infiltrasyonu erken postoperatif analjezide etkili olmaktadır, ancak ajitasyonıın şiddetini ve ajitasyon görülme sıklığını önemli ölçüde değiştirmemiştir.

The effects of peritonsillar infiltration with bupivacaine for paediatric tonsillectomy on pain and agitation after sevoflurane anaesthesia

The aim of our study was to invastigate the effect of peritonsiller bupivacaine infiltration on postoperative pain and agitation. Fourty children of ASA class I, aged between 3-6 years, who were scheduled for elective adenotonsillectomy were randomized into two groups. Anaesthesia was induced with 8 % sevoflurane in 60/40 % N2O/O2 and maintained with % 2-3 sevoflurane in both groups. Before the surgical procedures, Group I (n=20) patients received peritonsillar infiltration of 0.25 % bupivacaine 0.5 mL/kg and Group II (n=20) patients received 0.9 % saline 0.5 mL/kg to a maximum of 10 mL. In per and postoperative period, heart rates (HR), sistolic (SAP) and diastolic arterial pressures (DAP) were monitorized for one hour and observed for six hours. Patients were assessed by giving apain score from 1 to 3 and agitation score from 1 to 4. If a child scored 3 or 4, it was judged to be in severe agitation. Analgesic requirement, agitation and vomiting comparisons were done in both groups. Between the intraoperative 10th minutes and postoperative 30th minutes, the heart rates of Group I patients were significantly lower when compared with Group II. Although there were no significant alterations from baseline in Group I, it was significantly high in Group II after extubation. Agitation and vomiting inciddhces were similar in postoperative period. There were no significant differences in pain scores except the first 10 min period. Analgesic requirements were significantly lower in Group I in postoperative 6 hours period. We conclude that peritonsillar bupivacaine infiltration is effective on early postoperative analgesia, but it dose not markedly change the incidance and severity of agitation.

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