Ayşin AĞRITMIŞ, Ercan TÜRECİ, Ercüment YENTÜR

Epidural anestezide ropivakain, bupivakain ve lokal anestezik-fentanil kombinasyonları ile duyusal ve motor blok: Randomize çalışma

Bu çalışmada, ortopedi ameliyatlarında eşit konsantrasyonlarda kullanılan ropivakain ve bupivakain ile elde edilen epidural blok özellikleri ile birlikte, her iki lokal anestezik ilacın fentanil ile kombinasyonunun epidural blok kalitesi üzerine etkisi; prospektif, rasgele, çift kör yöntemle değerlendirildi. Alt ekstremite ameliyatı planlanan yaşları 16-70 yıl arasında değişen ASA sınıflaması I-II olan 80 hasta rasgele 4 gruba ayrıldı. Grup R'de (n=20) % 0.5 ropivakain, Grup RF'de (n=20) % 0.5 ropivakain+50 $mu$g fentanil, Grup B'de (n=20) % 0.5 bupivakain, Grup BF'de (n-20) % 0.5 bupivakain+50 $mu$g fentanil; "single shot" yöntemiyle epidural aralığa verildi. Ardından epidural kateter yerleştirilerek; duyusal blok, motor blok ve postoperatif ağrı değerlendirildi. Dört grubun da duyusal blok seviyeleri T10-S1 dermatom düzeyinde eşdeğer olarak bulundu. Ancak erken postoperatif dönemde, ağrı skorları (VAS) 5 ve üzerinde olan hasta sayısı yönünden, Grup R ve B ile fentanil eklenen gruplar (Grup RF ve BF) arasında fark bulunmadı. Motor blok dereceleri yönünden 4 grup arasında istatistiksel anlamlı bir fark bulunmamasına rağmen (p=0.5), Grup R ve RF ile Grup B ve BF karşılaştırıldığında, ropivakain kullanılan grupta motor blok derecelerinin istatistiksel olarak anlamlı derecede zayıf olduğu tespit edildi (p

Sensory and motor blockade with ropivacaine, bupivacaine and local anaesthetic-fentanyl combinations in epidural anaesthesia: A randomized trial

The aim of this study was to determine the clinical efficacy of 0.5 % ropivacaine and 0.5 % bupivacaine in epidural anaesthesia and to evaluate if the addition of 50 $mu$g fentanyl to the local anaesthetic would improve the quality of epidural block in orthopedic lower limb surgery. Eighty patients aged between 16-70 years, ASA l-ll, scheduled for lower limb surgery were admitted in this prospective, double blind study. Patients were randomly divided into four groups with 20 in each; the first twenty patients received 0.5 % ropivacaine (Group R), the second group received 50 $mu$g fentanyl in 0.5 % ropivacaine (Group RF), the third group received 0.5 % bupivacaine (Group B), the fourth group received 50 $mu$g fentanyl in 0.5 % bupivacaine (Group BF). After that epidural catheter was inserted the upper and lower levels of analgesia were tested 5 min after the injection was completed and at 5 min intervals for 30 min. Lower limb motor block was recorded using Bromage scale at the intervals started above. Postoperative pain at rest was assessed using a visual analogue scale (VAS). The sensory block levels were equal to T10-S1 dermatome for all the groups. The time of onset and duration of analgesia were similar in all groups. The difference in motor block between 0.5 % ropivacaine and 0.5 % bupivacaine was statistically significant. However, it was detected that the motor block was less intense in the ropivacaine groups. Change in heart rate and blood pressure significantly decreased in both groups. No unexpected adverse events were recorded. Consequently, the fentanyl added to 0.5 % ropivacaine and 0.5 % bupivacaine conferred no advantage for analgesia However, 0.5 % bupivacaine provided more intensive motor block as well as more effective analgesia in the postoperative period. Hence, 0.5 % bupivacaine should be preferred for orthopedic surgery requiring full motor blockade.

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