Pre-emptif uygulanan intravenöz, spinal ve epidural morfinin erken postoperatif analjezi ve stres yanıt üzerine etkileri

Hakan Ayvaz; Cevdet Düger; Filiz Bulut; Sinan Gürsoy; Kenan Kaygusuz; Ahmet İsbir; İclal Özdemir Kol; Bilge Gürelik; Caner Mimaroğlu

EN TR

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Abstract

In this study, it was aimed to determine the effects of preemptive intravenous, spinal and epidural morphine on analgesic consumption, and stress response in the early postoperative period. Sixty ASA I-II patients who were undergoing lower abdominal surgery were randomly divided into three groups. Group I patients were admisnistered 5 mg iv morphine 5 minutes before induction, Grup II patients were administered 0.5 mg of intrathecal morphine 5 minutes before induction, Group III patients were administered 5 mg epidural morphine 30 min before induction of anesthesia. Induction of anesthesia, was performed with 0.1 mg kg fentanyl and 4-7 mg kgthiopental sodium. For muscle relaxation 0.1 mg kg vecuronium were given. Anaesthesia was maintained with 1-2% sevoflurane and 50% NO. Pre and postoperative hemodynamic parameters, VAS (Visual Analog Pain Scale) scores, time to first analgesic requirement, total analgesic consumption were recorded. In addition, to evaluate the stress response blood samples were taken three times before the administration of preoperative medications, preoperative 30th minute, and postoperative and 2nd hour. In our study, postoperative VAS scores between groups was significantly different at all times for the iv group and the spinal group and iv group and epidural group (P<0.05). In terms of time to first analgesic requirement, total analgesic consumption of group iv and iv with a group of spinal epidural group and the difference between groups was significant (P<0.05). Operative in terms of prolactin and ACTH between groups was significantly different at all times for the iv group and the spinal group and iv group and epidural group (P<0.05). Cortisol, glucose, and insulin levels postoperatively for 2. hour intravenous group and the spinal epidural group and iv group and the difference between groups was significant (P<0.05). As a result of preemptive spinal and epidural morphine in relieving postoperative pain and suppress the stress response was found to be effective in group iv.

Keywords

Preemptive analgesia, morphine, spinal analgesia, epidural analgesia, intravenous analgesia, stress response

Pre-emptif uygulanan intravenöz, spinal ve epidural morfinin erken postoperatif analjezi ve stres yanıt üzerine etkileri

Öz

Bu çalışmada, preemptif uygulanan iv, spinal ve epidural morfinin erken postoperatif dönemdeki analjezik tüketimi ve stres yanıt üzerine etkilerini belirlemek amaçlandı. Alt batın operasyonu uygulanacak ASA I-II grubuna giren 60 hasta rasgele üç gruba ayrıldı. Grup I’e indüksiyondan 5 dk. önce 5 mg iv morfin, Grup II’ye indüksiyondan 5 dk önce 0,5 mg intratekal morfin, Grup III’e indüksiyondan 30dk önce 5mg epidural morfin uygulandı. Anestezi indüksiyonu 0,1 µg kg-1 fentanil ve 4-7 mg kg-1 tiopental sodyum ile sağlandı. Kas gevşemesi ise 0,1mg/kg vekuronyum ile sağlandı. İdamede %1-2 sevofluran ve %50 N2O kullanıldı. Pre ve postoperatif dönemde hastaların hemodinamik parametreleri ve postoperatif dönemde hemodinamik parametreler, VAS (Visual Analog Ağrı Skala) değerleri, ilk analjezik ihtiyaç zamanları ve total analjezik tüketimi kaydedildi. Ayrıca stres yanıtı değerlendirmek için preoperatif dönemde ilaçlar uygulanmadan önce, peroperatif 30’uncu dakika ve postoperatif 2’nci saatte olmak üzere üç kan örneği alındı. Çalışmamızda VAS değerleri açısından postoperatif tüm zamanlarda iv grup ile spinal grup ve iv grup ile epidural grup arasındaki farklılık anlamlı (P < 0.05). İlk analjezik ihtiyaç zamanı ve total analjezik tüketimi açısından iv grup ile spinal grup ve iv grup ile epidural grup arasındaki farklılık anlamlı bulundu (P < 0.05). Prolaktin ve ACTH değerleri açısından perop. 30 dk. ve postop. 2’nci saatte iv grup ile spinal grup ve iv grup ile epidural grup arasındaki farklılık anlamlı bulundu (P < 0.05). Kortizol, glukoz ve insülin değerleri açısından postop; 2’nci saatte iv grup ile spinal grup ve iv grup ile epidural grup arasındaki farklılık anlamlı bulundu (P < 0.05). Sonuç olarak preemptif uygulanan spinal ve epidural morfinin postoperatif ağrıyı gidermede ve stres yanıtı baskılamada iv gruba göre etkili oldukları tesbit edildi.

Anahtar Kelimeler

Preemptif analjezi, morfin, spinal analjezi, epidural analjezi, iv analjezi, stres yanıt

Kaynakça

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Ayrıntılar

Birincil Dil

Türkçe

Konular

-

Bölüm

-

Yazarlar

Hakan Ayvaz

Filiz Bulut

Ahmet İsbir

Bilge Gürelik

Yayımlanma Tarihi

27 Mart 2013

Gönderilme Tarihi

27 Mart 2013

Kabul Tarihi

-

Yayımlandığı Sayı

Yıl 2013 Cilt: 35 Sayı: 3

IZ

https://izlik.org/JA48GH68GP

Kaynak Göster

RIS / Bibtex

AMA

1.Ayvaz H, Düger C, Bulut F, vd. Pre-emptif uygulanan intravenöz, spinal ve epidural morfinin erken postoperatif analjezi ve stres yanıt üzerine etkileri. CMJ. 2013;35(3):363-372. https://izlik.org/JA48GH68GP