İntratekal Hiperbarik Bupivakaine Eklenen Farklı Adjuvan Ajanların ve Total İntravenöz Anestezinin, Postoperatif Analjezik Özellikler Üzerine Etkileri

Abdulkadir Yektaş; Enver Belli

EN TR

EFFECTS OF ADJUVANT AGENTS IN DIFFERENT ADDED TO INTRATHECAL HYPERBARIC BUPIVACAINE AND TOTAL INTRAVENOUS ANESTHESIA ON POSTOPERATIVE ANALGESIA PROPERTIES

Abstract

Aim: We planned the present study to reveal the effects of different adjuvant agents added to hyperbaric bupivacaine on post-operative analgesia and the post-operative analgesic differences between spinal anesthesia and total intravenous anesthesia TIVA . Materials and Methods: 100 cases were randomly divided into 5 groups of 20 cases. 15 mg 0.5%hyperbaric bupivacaine and 0.5 mL saline were used in Group SF; in other groups, Group HB, Group F and Group S, 2.5 mg hyperbaric bupivacaine, 25 μg fentanyl and 2.5 μg sufentanyl were added respectively to hyperbaric bupivacaine instead of saline. TIVA was administered in Group T, with propofol and remifentanyl. Total spinal drug volume was 3.5 mL. Post-operative analgesia duration, VRS scores at the end of post-operative analgesia duration, the amount of tramadol consumed in the 2nd hour after the post-operative analgesia and the amount of tramadol consumed at the 24th hour after the administration of analgesia were recorded. Results: The duration of post-operative analgesia in Group F and Group S was statistically significantly longer compared with other groups. The VRS scores at the end of post-operative analgesia duration in Group F and Group S was statistically significantly lower compared with other groups. The amount of tramadol consumed in the 2nd hour after post-operative analgesia and the amount of tramadol consumed at the 24th hour after the administration of anesthesia were statistically significantly lower in Group F and Group S. Conclusion: Fentanyl and sufentanyl prolong postoperative analgesia duration, lower the VRS scores at the end of post-operative analgesia duration and reduce the need of post-operative pain killers by creating intrathecal multimodal analgesia. Post-operative analgesia duration in spinal anesthesia is longer compared with TIVA and post-operative pain killer need is statistically significantly lower compared with TIVA

Keywords

spinal anesthesia,total intravenous anesthesia,intrathecal multimodal analgesia,fentanyl,sufentani

İntratekal Hiperbarik Bupivakaine Eklenen Farklı Adjuvan Ajanların ve Total İntravenöz Anestezinin, Postoperatif Analjezik Özellikler Üzerine Etkileri

Öz

Amaç: Biz bu çalışmayı, spinal anestezi uygulanan olgularda, hiperbarik bupivakaine eklenen farklı adjuvan ajanların, postoperatif analjezi üzerine etkilerini ve spinal anestezi ile total intravenöz anestezi TİVA arasındaki postoperatif analjezik farklılıkları ortaya koymak amacı ile planlandık.Gereç ve yöntemler: 100 olgu rastgele 20 olguluk 5 gruba ayrıldı. Grup SF 15 mg %0,5 hiperbarik bupivakain ve 0,5 mL serum fizyolojik , diğer gruplarda serum fizyolojik yerine: Grup HB 2,5 mg hiperbarik bupivakain , grup F 25 μg fentanil , Grup S 2,5 μg sufentanil hiperbarik bupivakaine eklendi. Grup T de propofol ve remifentanil ile TİVA uygulandı. Total spinal ilaç volümü 3,5 mL idi. Postoperatif analjezi süresi, postoperatif analjezi süresi sonundaki VRS puanları, postoperatif analjezi süresi sonrasında 2. saatte tüketilen tramadol miktarı ve anestezi verilmesinden sonraki 24. Saatte tüketilen tramadol miktarı kaydedildi.Bulgular: Postoperatif analjezi süresi Grup F ve Grup S de diğer gruplara göre istatistiksel olarak anlamlı uzundu. Postoperatif analjezi süresi sonundaki VRS skorları Grup F ve Grup S de diğer gruplara göre anlamlı düşüktü. Postoperatif analjezi süresi sonrasında ki 2. saatte tüketilen tramadol miktarı ve anestezi verildikten sonraki 24. saatte tüketilen tramadol miktarı Grup F ve Grup S de istatistiksel olarak anlamlı düşüktü. Spinal anestezi yapılan tüm gruplarda postoperatif anestezi süresi Grup T’ye göre daha uzundu.Sonuç: Fentanil ve sufentanil intratekal multimodal analjezi oluşturarak postoperatif analjezi süresini uzatır, postoperatif analjezi süresi sonunda ki VRS skorlarını düşürür, postoperatif ağrı kesici ihtiyacını azaltır. Spinal anestezide postoperatif analjezi süresi Grup T’ye göre daha uzundur, postoperatif ağrı kesici ihtiyacı Grup T’ye göre istatistiksel olarak anlamlı düşüktür

Anahtar Kelimeler

spinal anestezi,total intravenöz anestezi,intratekal multimodal analjezi,fentanil,sufentanil

References

Goodwin SA. A review of preemptive analgesia. J Perianesth Nurs 1998; 13: 109-14.
Casey FW, Rise LJ, Hannallah RS, Broadman L, Norden JM, Guzzetta P. A comparasion between bupivacaine installation versus ilioinguinal hernioraphy in children. Anesthesiology 1990; 72: 637-9.
Staats SP, Dougherty MP. Practical management of pain. P Prithvi Raj. Spinal Analgesics: Present and future. 3st ed. St Louis, Missouri. Mosby, inc. 2000; 513-28.
Woolf CJ. Somatic pain-pathogenesis and prevention. Br. J Anesth 1995; 75: 169-76.
differences in pressure pain threshold in healthy humans. Pain 2003; 101: 259-66.
De cosmo G, Congedo E, Lai C. Preoperative Physhologic and Demographic Predictorsof pain perception and Tramadol consumption using intravenous Patient-Controlled Analgesia. Clin J Pain 2008; 24: 399-405.
Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg 2003; 97: 1464-8.
Mamie C, Bernstein M, Morabia A, Klopfenstein CE, Sloutskis D, Forster A. Are there reliable predictors of postoperative pain? Acta Anesthesiol Scand 2004; 48: 234-42.

Chia YY, Chow LH, Hung CC, Liu K, Ger LP, Wang PN. Gender and pain upon movement are associated with the requirements for postoperative patient-controlled IV analgesia Can J Anaesth 2002; 49: 249-55.
Lynch EP, Marissa A, Lazor MA, Orav J, Goldman L, Marcantonio ER. Patient experience of pain after elective noncardiac surgery. Anesth Analg 1997; 85: 117-23.
Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain 1996; 64: 357-64.
Gagliese L, Gauthier LR, Macpherson AK, Jovellanos M, Chan VW. Correlates of postoperative pain and intravenous patient-controlled analgesia use in younger and older surgical patients. Pain Med 2008; 3: 299-314.
Kain ZN, Sevarino F, Pincus S et al. Attenuation of the preoperative stres response with midazolam: Effects on postoperative outcomes. Anesthesiology 2000; 93: 141-7.
Ip HY, Abrishami A, Peng PW Wong J, Chung F. Predictors of postoperative pain and analgesic consumption a qualitative systematic review. Anesthesiology 2009; 111: 657-77.
Kehlet H, Dahl JB. The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg 1993; 77: 1048-56.
Özyalçın S. Preemptif analjezi. Ağrı 1995; 7: 5-10.
Kang H, Ha YC, Kim JY, Woo YC, Lee JS, Jang EC. Effectiveness of Multimodal Pain Management After Bipolar Hemiarthroplasty for Hip Fracture: A Randomized, Controlled Study. J Bone Joint Surg Am. 2013; 95: 291-6.
Fader JP, Cleary RK, Lampman RM, Winter S, Singal BM, Plona AE. Does intrathecal morphine sulfate provide preemptive analgesia for patients undergoing stapled hemorrhoidopexy. Pain Med 2011; 12: 322-7.
Yukawa Y, Kato F, Ito K et al. A case- control study of preemptive analgesia for postoperative pain in patients undergoing posterior lumbar interbody fusion: Continuous subcutaneous morphine alone and combined with intrathecal injection. J Spinal Disortd tech 2010; 23 : 333-7.
Gasanova I, Grant E, Way M, Rosero EB, Joshi GP. Ultrasound-guided Transversus abdominal plane block with multimodal analgesia for pain management after total abdominal hysterectomy. Arch Gynecol Obstet. 2013; 288: 105-11.
Tverscoy M, Cozacov C, Ayache M, et al. Postoperative pain after inguinal herniorraphy with different type of anesthesia. Anesth Analg 1990; 70: 29-35.
Munglani R, Jones JG, Hunt S. Preemptive analgesia use of immediate early genes expression as markers of neuronal stimulation. Br J Anaesth 1993; 71 : 458.
Tverskoy M, Oz Y, Isakson A et al. Preemptive effect of fentanyl and ketamine on postoperative pain and wound hyperalgesia. Anesth Analg 1994; 78 : 205-9.
Cohen SM. Extended pain relief trial utilizing infiltration of Exparel(®), a long-acting multivesicular liposome formulation of bupivacaine: a Phase IV health economic trial in adult patients undergoing open colectomy. J Pain Res 2012; 5: 567-72.
Cho CH, Song KS, Min BW, Jung GH, Lee YK, Shin HK. Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2012 Oct 30
Rawall N. Postoperatif ağrı tedavisi. Ağrı. Serdar Erdine. Nobel tıp kitabevi. İstanbul. 2000: p: 124-41.
Keskinbora K, Aydınlı I. An atypical opioid analgesic: tramadol. Ağrı 2006; 18: 5-19.

Details

Primary Language

Turkish

Subjects

-

Journal Section

-

Authors

Abdulkadir Yektaş

Enver Belli

Publication Date

June 1, 2014

Submission Date

-

Acceptance Date

-

Published in Issue

Year 1970 Number: 2

IZ

https://izlik.org/JA66PP56HS

Cite

RIS / Bibtex

EndNote

Yektaş A, Belli E (June 1, 2014) İntratekal Hiperbarik Bupivakaine Eklenen Farklı Adjuvan Ajanların ve Total İntravenöz Anestezinin, Postoperatif Analjezik Özellikler Üzerine Etkileri. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2 113–120.