Epidural Anestezide Uygulanan İzobarik Bupivakain ile Hiperbarik Bupivakainin Etkilerinin Değerlendirlmesi
Abstract
Öz:Bu çalışmada lokal anesteziklerin barisitesinin tek taraflı epidural
anestezi uygulamasına olan etkisini araştırılması amaçlandı. Çalışma, ESOGÜ Tıp Fakültesi
Hastanesi, Anesteziyoloji ve Reanimasyon Bölümünde 23/09/2011 tarih ve 15 sayılı etik kurul izni
ve bilgilendirilmiş hasta oluru alındıktan sonra elektif
tek taraflı diz artroskopisi planlanan rastgele seçilmiş yaşları 18-55 olan ASA
I-II hastalarda yapıldı. Grup H (hiperbarik
bupivakain) ve grup İ (izobarik bupivakain) hastalarına orta hattan
uygun seviyeden (L3-L4, L4-L5) antisepsi kurallarına uyularak kataterin ucu
sefale doğru 2-4 cm yönlendirilerek epidural katater takıldı. Grup İ
hastalarına 14-18 cc izobarik bupivakain, grup H hastalarına 14-18 cc
hiperbarik bupivakain verildi. Takibinde hastalara 20 dakika boyunca operasyon
tarafına doğru 30 derecelik tilt uygulandı. Hastaların ilk 30 dakika 5 dakikada
bir sonrasında 60 dakikada aynı taraf ve karşı taraf duysal blok seviyeleri,
Bromage skoruna göre motor blok seviyeleri ve hemodinamik verileri kaydedildi. Veriler değerlendirilirken tanımlayıcı istatistiksel
metotların yanı sıra demografik özellikler ve ölçüm zamanlarına göre gruplar
arası karşılaştırmada bağımsız iki örneklem t testi yapılmıştır. Normallik
varsayımının sağlanmadığı veriler için gruplar arası karşılaştırma yapılırken
Mann-Whitney U testi ve Fisher’s kesinlik testi kullanılmıştır. Karşılaştırmada hiperbarik bupivakain ve izobarik bupivakain
arasında tek taraflı motor ve duysal blok oluşturmada fark olmadığı görüldü.
(p>0,05) Hemodinamik verilerin karşılaştırılmasında hiperbarik bupivakainin
daha az hemodinamik instabiliteye neden olduğu görüldü. (p< 0,05) Elde
edilen veriler neticesinde barisitenin tek başına izole tek taraflı motor blok
oluşturmaya yetmeyeceği ve pozisyon ile birleştirildiğinde daha az hemodinamik
instabiliteye neden olan ve tek tarafta daha yoğun duysal blok oluşturabileceği sonucuna
varıldı.
Keywords
References
- Kayhan Z. Klinik Anestezi. 2. Baskı. İstanbul: Logos Yayıncılık; 2004.
- Casatti A, Fanelli G. Unilateral spinal anesthesia: state of art. Minerva Anestesiol 2001; 67:855-62
- Borghi B, Angoletti V, Ricci A. A prospective, randomized evaluation of the effects of epidural needle rotation on the distribution of epidural block. Anesth Analg. 2004; 98: 1473-8
- Hogan Q. Distribution of Solution in the Epidural Space: Examination by Cryomicrotome Section. Reg Anesth Pain Med 2002;27:150‐156
- Hocking G, Wildsmith J. Intrathecal drug spread. Br. J. Anaesth. 2004;93:568-78
- Raj PP: Textbook of Regional Anesthesia. 2. Ed. New York: Churchill-Livingstone; 2003.
- Urban BJ. Clinical observations suggesting a changing site of action during induction and recession of epidural blok; Anesthesiology. 1973; 39: 5
- Bonica JJ, Kennedy WF, Morikawa K. Circulatory affects of peridural block: effect of levels of analgesia and dose of lidocain. Anesthesiology 1970; 33: 619.
- Bromage PR. Spinal-epidural analgesia. Edinburgh & London: S. Living-Storer Ltd.; 1954.
- Cusick JF, Myklebust JB, Abram SE. Differential neural effects of epidural anesthetics. Anesthesiology. 1980; 53:299-30
- Choi DH, Lee SM, Cho HS. Relationship between the bevel of the Tuohy needle and catheter direction in thoracic epidural anesthesia. Reg Anesth Pain Med. 2006; 31(2):105-12
- Beck H. The effect of the Tuohy cannula on the positioning of an epidural catheter. A radiologic analysis of the location of 175 epidural catheters. Reg Anaesth. 1975; 13(2):42-5
- Boyacı BT, Arı DE,Peker TT, Baykal B. Comprasion of intraoperative and postoperative effects oflateral epidural and midline epidural anaesthesia in patients undergoing unilateral lower extremity operation.Turk J Anesesth Reanim 2015;43:162-8
- Şen Ö, Dönmez NF, Örnek D, Kalaycı D. Effects of epidural needle rotation and differen speeds of injection on the distribution of epidural block. Rev Bras Anestesiol. 2012;62:6:852-862
- Nishumura N, Ogura S. The effect of the posture in the spread of the epidural anesthesia. Masui 1994; 43(1)1:2-6
- Grundy EM, Rao LN, Winnie AP. Epidural anesthesia and the lateral position. Anesth Analg. 1978; 57: 95-97
- Apostolou GA, Zarmakoupis PK, Mastrokostopoulos GT. Spread of epidural anesthesia and the lateral position. Anesth Analg. 1981; 60:584-6
- Park WY, Poon KC, Massengale MD. Direction of the needle bevel and the epidural anesthetic spread. Anesthesiology. 1982; 57: 327-8
- Hogan Q. Epidural catheter tip position and distribution of injectate evaluated by computed tomography. Anesthesiology. 1999; 90:964-70
Abstract
Abstract:
This study aimed to investigate
effect of baricity of local anesthetics on unilateral epidural anesthesia. After
the univercity ethic committee’s approval and patients informant consent taken study
was conducted on randomly selected ASA I-II patients aged between 18-55 years
who were scheduled for elective unilateral knee arthroscopy. Both group H
(hyperbaric bupivacain) and group I (isobaric bupivacain) patients received
epidural catheters. These catheters were placed at appropriate intervertebral
(L3-L4, L4-L5) levels. Tip of the catheter was directed 2-4 cm towards
cephalade direction. Group I patients received 14-18 cc isobaric bupivacain,
whereas group H patients received 14-18 cc hyperbaric bupivacain. Consequently,
30 degree tilt was performed towards operation site for 20 minutes.
Hemodynamical findings, motor block levels according to Bromage score and
sensorial block levels of same side and contralateral side were all recorded at
every 5 minutes for the first 30 minutes, and every 60 minutes thereafter. The
statistical comparisons revealed that there was no significant difference
between isobaric bupivacain and hyperbaric bupivacain in terms of unilateral
motor and sensorial block (p<0,05). Comparison of hemodynamical data
revealed that hyperbaric bupivacain caused less hemodynamical instability
(p<0,05). In the light of these data, it was concluded that baricity solely
is not sufficient to establish isolated unilateral motor block however in
combination with suitable position, it causes less hemodynamical instability
and more intense sensorial block unilaterally.
Keywords
References
- Kayhan Z. Klinik Anestezi. 2. Baskı. İstanbul: Logos Yayıncılık; 2004.
- Casatti A, Fanelli G. Unilateral spinal anesthesia: state of art. Minerva Anestesiol 2001; 67:855-62
- Borghi B, Angoletti V, Ricci A. A prospective, randomized evaluation of the effects of epidural needle rotation on the distribution of epidural block. Anesth Analg. 2004; 98: 1473-8
- Hogan Q. Distribution of Solution in the Epidural Space: Examination by Cryomicrotome Section. Reg Anesth Pain Med 2002;27:150‐156
- Hocking G, Wildsmith J. Intrathecal drug spread. Br. J. Anaesth. 2004;93:568-78
- Raj PP: Textbook of Regional Anesthesia. 2. Ed. New York: Churchill-Livingstone; 2003.
- Urban BJ. Clinical observations suggesting a changing site of action during induction and recession of epidural blok; Anesthesiology. 1973; 39: 5
- Bonica JJ, Kennedy WF, Morikawa K. Circulatory affects of peridural block: effect of levels of analgesia and dose of lidocain. Anesthesiology 1970; 33: 619.
- Bromage PR. Spinal-epidural analgesia. Edinburgh & London: S. Living-Storer Ltd.; 1954.
- Cusick JF, Myklebust JB, Abram SE. Differential neural effects of epidural anesthetics. Anesthesiology. 1980; 53:299-30
- Choi DH, Lee SM, Cho HS. Relationship between the bevel of the Tuohy needle and catheter direction in thoracic epidural anesthesia. Reg Anesth Pain Med. 2006; 31(2):105-12
- Beck H. The effect of the Tuohy cannula on the positioning of an epidural catheter. A radiologic analysis of the location of 175 epidural catheters. Reg Anaesth. 1975; 13(2):42-5
- Boyacı BT, Arı DE,Peker TT, Baykal B. Comprasion of intraoperative and postoperative effects oflateral epidural and midline epidural anaesthesia in patients undergoing unilateral lower extremity operation.Turk J Anesesth Reanim 2015;43:162-8
- Şen Ö, Dönmez NF, Örnek D, Kalaycı D. Effects of epidural needle rotation and differen speeds of injection on the distribution of epidural block. Rev Bras Anestesiol. 2012;62:6:852-862
- Nishumura N, Ogura S. The effect of the posture in the spread of the epidural anesthesia. Masui 1994; 43(1)1:2-6
- Grundy EM, Rao LN, Winnie AP. Epidural anesthesia and the lateral position. Anesth Analg. 1978; 57: 95-97
- Apostolou GA, Zarmakoupis PK, Mastrokostopoulos GT. Spread of epidural anesthesia and the lateral position. Anesth Analg. 1981; 60:584-6
- Park WY, Poon KC, Massengale MD. Direction of the needle bevel and the epidural anesthetic spread. Anesthesiology. 1982; 57: 327-8
- Hogan Q. Epidural catheter tip position and distribution of injectate evaluated by computed tomography. Anesthesiology. 1999; 90:964-70
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | ORİJİNAL MAKALE |
| Authors | |
| Publication Date | January 31, 2018 |
| Published in Issue | Year 2018 Volume: 40 Issue: 1 |