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Alt ekstremite cerrahilerinde sürekli spinal ve kombine spinal-epidural anestezisinin karşılaştırılması

Yıl 2011, Cilt: 33 Sayı: 3, 324 - 332, 15.04.2011

Hasan Özal Sinan Gürsoy , İclal Kol , Kenan Kaygusuz , Cevdet Düger , Hayati Öztürk Caner Mimaroğlu

Öz

Özet

Amaç. Bu çalışmada alt ekstremite cerrahisi yapılacak olan hastalarda %0,5 bupivakain + morfin kombinasyonu kullanarak, sürekli spinal anestezi ve kombine spinal epidural anestezi yöntemlerinin peroperatif dönemde anestezi kalitesi, hemodinamik stabilite, blok seviyesi, komplikasyonlar ve postoperatif dönemde analjezi kalitesi üzerine olan etkilerinin karşılaştırılması amaçlandı. Yöntem. Çalışmaya ASA I-III grubu 54 hasta dahil edildi ve hastalar rastgele iki gruba ayrıldı. I. Gruba; (n=27) spinal kateter intratekal aralıkta 2-3 cm sefale olacak şekilde yerleştirildi ve kateterden intratekal aralığa 10 mg (2 mL) %0,5’lik bupivakain + 0,1 mg morfin / 2,5 mL volümde uygulandı. II. Gruba; (n=27) kombine spinal-epidural anestezi için intratekal aralığa 5 mg %0,5 bupivakain + 0,05 mg morfin / 2,5 mL volümde uygulandı. Tüm hastaların sistolik ve diastolik arter basınçları, kalp atım hızları, periferik oksijen saturasyon değerleri, bromage, duyusal blok seviyesi, vizüel analog skala, verbal point skala değerleri, memnuniyet, ek doz gereksinimi ve dozlar kaydedildi. Bulgular. Gruplar arasında demografik özellikler, yöntemin uygulanma ve ameliyat süreleri yönünden fark saptanmadı. Hemodinamik parametreler, motor ve duyusal blok seviyeleri ve hasta memnuniyeti yönünden fark görülmezken, total ilaç tüketimi kombine spinal epidural anestezi grubunda daha yüksekti (P<0,05). Postoperatif dönemde her iki yöntemin analjezik etkileri benzer bulunurken, ek doz ihtiyacı ve kaşıntı insidansı kombine spinal epidural grubunda daha yüksekti (P<0,05). Sonuç. Sonuç olarak, bir yöntemin diğerine intraoperatif ve postoperatif dönemde bir üstünlüğü olmadığı kanaatine vardık.

Anahtar sözcükler: Sürekli spinal anestezi, kombine spinal epidural anestezi, bupivakain, morfin

 

Abstract

Aim. In this study, it was aimed to compare the effects of the continuous spinal anesthesia and the combined spinal-epidural anesthesia by using 0.5 % bupivacaine + morphine on peroperative analgesia quality, hemodynamic stability, block level, complications and postoperative analgesia quality in surgery of the lower extremity. Method. Fifty-four, ASA I-III patients included the study and divided into the two groups randomly. In the first group (n=27), a spinal catheter was placed into the intrathecal space and 10 mg 0.5 % bupivacaine + 0.1 mg morphine/2.5 mL were administered. In the second group (n=27), 5 mg 0.5% bupivacaine + 0.05 mg morphine/2.5 mL were administered intrathecal space and 30 mg 0.5% bupivacaine + 2 mg morphine/10 mL were administered into the epidural space. The time of the both procedures, systolic blood pressure, diastolic blood pressure, heart rate, bromage, sensorial block level, visual analog scale, verbal point scale values, patient’s satisfaction, additional dose necessity and overall doses were recorded for all patients. Results. There was no significant difference between the groups in point of application time of the method and operation time. While there was no difference between the groups in point of hemodynamic parameters, level of motor block, level of the sensorial block and patient’s satisfaction, the drugs consumption was higher in the combined spinal epidural anesthesia group (P<0.05) in the intraoperative period. In the postoperative period, while the analgesic effects of the both groups were similar, necessity of the additional dose and the itch incidence were higher in the combined spinal epidural anesthesia group (P<0.05). Conclusion. In conclusion, we decided that one method has not superiority over the other method in the intraoperative and postoperative periods.

Keywords: Continuous spinal anesthesia, combined spinal epidural anesthesia, bupivacaine, morphine

Anahtar Kelimeler

-

Kaynakça

  • Uyar M, Eriş O, Ayanoğlu HÖ, Yegül İ. Alt ekstremite cerrahisinde sürekli spinal ve sürekli epidural anestezinin karşılaştırılması. Ağrı Dergisi 1996; 8: 31-6.
  • Valentin N, Lomholt B, Jensen JS, Hejgaard N, Kreiner S. Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients. Br J Anaesth 1986; 58: 284-91.
  • Reisli R, Horasanlı E, Demirbilek S, Dikmen B, Yiğitbaşı B, Göğüş N. Tek doz ve sürekli spinal anestezinin hemodinamik ve anestezik etkilerinin karşılaştırılması. Türk Anest Rean Cem Mecmuası 1999; 27: 21-7.
  • Denny NM, Selander DE. Continuous spinal anaesthesia. Br J Anaesth 1998; 81: 590-7.
  • Favarel-Garrigues JF, Sztark F, Petitjean ME, Thicoipe M, Lassie P, Dabadie P. Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter. Anesth Analg 1996; 82: 312-6.
  • Erdine S. Sinir Blokları. Emre Matbaacılık, İstanbul 1993; 1-176.
  • Rawal N, Holmstrom B, Crowhurst JA, Van Zundert A. The combined spinal-331 Cumhuriyet Tıp Dergisi Cumhuriyet Tıp Derg 2011; 33: 324-332 Cumhuriyet Medical Journal Cumhuriyet Med J 2011; 33: 324-332 epidural technique anesthesiology. Anesthesiol Clin North America 2000; 18: 267-95.
  • Collis RE, Baxandall ML, Srikantharajah ID, Edge G, Kadim MY, Morgan BM. Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers. Int J Obstet Anesth 1994; 3: 75-81.
  • Imbelloni LE, Carneiro ANG. Combined spinal-epidural anesthesia fororthopedic surgery: Needle-through needle technique or two needle in diferent interspaces. Rev Bras Anestesiol 1998; 48: 177-83.
  • Gurlit S, Reinhardt S, Möllmann M. Continuous spinal analgesia or opioid-added continuous epidural analgesia for postoperative pain control after hip replacement. Eur J Anaesthesiol 2004; 21: 708-14.
  • Rawal N, Van Zundert A, Holmstrom B, Crowhurst JA. The combined spinalepidural technique. Reg Anesth 1997; 22: 406-23.
  • Cousins MJ, Veering BT. Epidural neural blockade. In: Cousins MJ, Brindenbaugh PO, eds. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Philadelphia: Lippincott-Raven, Philedelphia 1998; 97-983.
  • Rawal N. Epidural and spinal agents for postoperative analgesia. Surg Clin North Am 1999; 79: 313-44.
  • DeAndres J, Valia JC, Olivares A, Bellyer J. Continuous spinal anaesthesia; a comparative study of standard microcatheter and spinocath. Reg Anesth Pain Med 1999; 24: 110-6.
  • Wilhelm S, Standl T. Continuous spinal anaesthesia vs combined spinal-epidural anaesthesia in emergency surgery: the combined spinal-epidural anaesthesia technique does not offer an advantage of spinal anaesthesia with a microcatheter. Anaesthesist 1997; 46: 938-42.
  • Hallworth SP, Fernando R, Bell R, Parry MG, Lim GH. Comparison of intrathecal and epidural diamorphine for elective caesarean section using a combined spinal-epidural technique. Br J Anaesth 1999; 82: 228-32.
  • Morgan GE, Mikhail MS. Clinical Anesthesiology. Appleton&Lange, Connecticu 1996;pp; 1-244.
  • Imbelloni LE, Beato L. Comparison between spinal, combined spinal-epidural and continuous spinal anesthesias for hip surgeries in elderly patients: a retrospective study. Rev Bras Anestesiol 2002; 52: 316-25.
  • Imbelloni LE, Gouveia MA, Cordeiro JA. Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study. Sao Paulo Med J 2009; 127: 7-11.
  • Pitkanen M, Rosenberg P, Silvanto M, Tuominen M. Haemodynamic changes during spinal anaesthesia with slow continuous infusion or single dose of plain bupivacaine. Acta Anaesthesiol Scand 1992; 36: 526-9.
  • Labaille T, Benhamou D, Westermann J. Hemodynamic effects of continuous spinal anaesthesia; a comparative study between low and high doses of bupivacaine. Reg Anesth 1992; 17: 193-6.
  • Biboulet P, Deschodt J, Aubas P, Vacher E, Chauvet P, D’Athis F. Continuous spinal anaesthesia; does low-dose plain bupivacaine or hyperbaric bupivacaine allow the performance of hip surgery in the elderly? Reg Anesth 1993; 18: 170-5.
  • Wilhelm S, Standl T, Burmeister M, Kessler G, Schulte am Esch J. Comparison of continuous spinal and combined spinal-epidural anaesthesia using plain bupivacaine %0.5 in trauma patients. Anest Anesth Analg 1997; 85: 69-74.
  • Niemi L, Pitkanen M, Tuominen M, Rosenberg PH. Technical problems and side effects associated with continuous intratechal or epidural post-operative analgesia in patients undergoing hip arthroplasty. Eur J Anaesthesiol 1994; 11: 469-74.
  • Vercauteren MP, Geernaert K, Hoffmann VLH, Dohmen D, Adriaensen HA. Postoperative intrathecal patient-controlletd analgesia with bupivacaine, sufentanyl or a mixture of both. Anaesthesia 1998; 53: 1022-7.
  • Mollmann M, Cord S, Holst D, Auf der Landwehr U. Continuous spinal 332 Cumhuriyet Tıp Dergisi Cumhuriyet Tıp Derg 2011; 33: 324-332 Cumhuriyet Medical Journal Cumhuriyet Med J 2011; 33: 324-332 anaesthesia or continuous epidural anaesthesia for postoperative pain control after hip replacement? Eur J Anaesthesiol 1999; 16: 454-61.
  • Gurlit S, Reinhardt S, Mollmann M. Continuous spinal analgesia or opioid-added continuous epidural analgesia for postoperative pain control after hip replacement. Eur J Anaesthesiol 2004; 21: 708-14.
  • Petros AJ, Barnard M, Smith D, Ronzoni G, Carli F. Continuous spinal anaesthesia: dose requirements and characteristics of the block. Reg Anesth 1993;18: 52-4.
  • Weber EW, Slappendel R, Gielen MJ, Dirksen R. Intrathecal addition of morphine to bupivacaine is not the cause of postoperative nause and vomiting. Reg Anesth Pain Med 1998; 23: 81-6.
  • Slappendel R, Weber EWG, Dirksen R, Gielen MJ, Van Limbeek J. Optimization of the dose of inrathecal morphine in total hip surgery: a dose finding study. Anesth Analg 1999; 88: 822-6.
  • Brunschwiler M, VanGessel E, Forster A, Bruce A, Gamulin Z. Comparison of clonidine, morphine or placebo mixed with bupivacaine during continuous spinal anaesthesia. Can J Anaesth 1998; 45: 735-40.
  • Scott NB, James K, Murphy M, Kehlet H. Continuous thoracic epidural analgesia versus combined spinal/thoracic epidural analgesia on pain, pulmonary function and the metabolic response following colonic resection. Acta Anaesthesiol Scand 1996; 40: 691-6.
  • Cole PJ, Craske DA, Wheatley RG. Efficacy and respiratory effects of low-dose spinal morphine for postoperative analgesia following knee arthroplasty. Br J Anaesth 2000; 85:233-7.

Orijinal araştırma-Original research

Yıl 2011, Cilt: 33 Sayı: 3, 324 - 332, 15.04.2011

Hasan Özal Sinan Gürsoy , İclal Kol , Kenan Kaygusuz , Cevdet Düger , Hayati Öztürk Caner Mimaroğlu

Öz

Amaç. Bu çalışmada alt ekstremite cerrahisi yapılacak olan hastalarda %0,5 bupivakain + morfin kombinasyonu kullanarak, sürekli spinal anestezi ve kombine spinal epidural anestezi yöntemlerinin peroperatif dönemde anestezi kalitesi, hemodinamik stabilite, blok seviyesi, komplikasyonlar ve postoperatif dönemde analjezi kalitesi üzerine olan etkilerinin karşılaştırılması amaçlandı. Yöntem. Çalışmaya ASA I-III grubu 54 hasta dahil edildi ve hastalar rastgele iki gruba ayrıldı. I. Gruba; (n=27) spinal kateter intratekal aralıkta 2-3 cm sefale olacak şekilde yerleştirildi ve kateterden intratekal aralığa 10 mg (2 mL) %0,5’lik bupivakain + 0,1 mg morfin / 2,5 mL volümde uygulandı. II. Gruba; (n=27) kombine spinal-epidural anestezi için intratekal aralığa 5 mg %0,5 bupivakain + 0,05 mg morfin / 2,5 mL volümde uygulandı. Tüm hastaların sistolik ve diastolik arter basınçları, kalp atım hızları, periferik oksijen saturasyon değerleri, bromage, duyusal blok seviyesi, vizüel analog skala, verbal point skala değerleri, memnuniyet, ek doz gereksinimi ve dozlar kaydedildi. Bulgular. Gruplar arasında demografik özellikler, yöntemin uygulanma ve ameliyat süreleri yönünden fark saptanmadı. Hemodinamik parametreler, motor ve duyusal blok seviyeleri ve hasta memnuniyeti yönünden fark görülmezken, total ilaç tüketimi kombine spinal epidural anestezi grubunda daha yüksekti (P

Anahtar Kelimeler

Sürekli spinal anestezi kombine spinal epidural anestezi bupivakain morfin

Kaynakça

  • Uyar M, Eriş O, Ayanoğlu HÖ, Yegül İ. Alt ekstremite cerrahisinde sürekli spinal ve sürekli epidural anestezinin karşılaştırılması. Ağrı Dergisi 1996; 8: 31-6.
  • Valentin N, Lomholt B, Jensen JS, Hejgaard N, Kreiner S. Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients. Br J Anaesth 1986; 58: 284-91.
  • Reisli R, Horasanlı E, Demirbilek S, Dikmen B, Yiğitbaşı B, Göğüş N. Tek doz ve sürekli spinal anestezinin hemodinamik ve anestezik etkilerinin karşılaştırılması. Türk Anest Rean Cem Mecmuası 1999; 27: 21-7.
  • Denny NM, Selander DE. Continuous spinal anaesthesia. Br J Anaesth 1998; 81: 590-7.
  • Favarel-Garrigues JF, Sztark F, Petitjean ME, Thicoipe M, Lassie P, Dabadie P. Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter. Anesth Analg 1996; 82: 312-6.
  • Erdine S. Sinir Blokları. Emre Matbaacılık, İstanbul 1993; 1-176.
  • Rawal N, Holmstrom B, Crowhurst JA, Van Zundert A. The combined spinal-331 Cumhuriyet Tıp Dergisi Cumhuriyet Tıp Derg 2011; 33: 324-332 Cumhuriyet Medical Journal Cumhuriyet Med J 2011; 33: 324-332 epidural technique anesthesiology. Anesthesiol Clin North America 2000; 18: 267-95.
  • Collis RE, Baxandall ML, Srikantharajah ID, Edge G, Kadim MY, Morgan BM. Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers. Int J Obstet Anesth 1994; 3: 75-81.
  • Imbelloni LE, Carneiro ANG. Combined spinal-epidural anesthesia fororthopedic surgery: Needle-through needle technique or two needle in diferent interspaces. Rev Bras Anestesiol 1998; 48: 177-83.
  • Gurlit S, Reinhardt S, Möllmann M. Continuous spinal analgesia or opioid-added continuous epidural analgesia for postoperative pain control after hip replacement. Eur J Anaesthesiol 2004; 21: 708-14.
  • Rawal N, Van Zundert A, Holmstrom B, Crowhurst JA. The combined spinalepidural technique. Reg Anesth 1997; 22: 406-23.
  • Cousins MJ, Veering BT. Epidural neural blockade. In: Cousins MJ, Brindenbaugh PO, eds. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Philadelphia: Lippincott-Raven, Philedelphia 1998; 97-983.
  • Rawal N. Epidural and spinal agents for postoperative analgesia. Surg Clin North Am 1999; 79: 313-44.
  • DeAndres J, Valia JC, Olivares A, Bellyer J. Continuous spinal anaesthesia; a comparative study of standard microcatheter and spinocath. Reg Anesth Pain Med 1999; 24: 110-6.
  • Wilhelm S, Standl T. Continuous spinal anaesthesia vs combined spinal-epidural anaesthesia in emergency surgery: the combined spinal-epidural anaesthesia technique does not offer an advantage of spinal anaesthesia with a microcatheter. Anaesthesist 1997; 46: 938-42.
  • Hallworth SP, Fernando R, Bell R, Parry MG, Lim GH. Comparison of intrathecal and epidural diamorphine for elective caesarean section using a combined spinal-epidural technique. Br J Anaesth 1999; 82: 228-32.
  • Morgan GE, Mikhail MS. Clinical Anesthesiology. Appleton&Lange, Connecticu 1996;pp; 1-244.
  • Imbelloni LE, Beato L. Comparison between spinal, combined spinal-epidural and continuous spinal anesthesias for hip surgeries in elderly patients: a retrospective study. Rev Bras Anestesiol 2002; 52: 316-25.
  • Imbelloni LE, Gouveia MA, Cordeiro JA. Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study. Sao Paulo Med J 2009; 127: 7-11.
  • Pitkanen M, Rosenberg P, Silvanto M, Tuominen M. Haemodynamic changes during spinal anaesthesia with slow continuous infusion or single dose of plain bupivacaine. Acta Anaesthesiol Scand 1992; 36: 526-9.
  • Labaille T, Benhamou D, Westermann J. Hemodynamic effects of continuous spinal anaesthesia; a comparative study between low and high doses of bupivacaine. Reg Anesth 1992; 17: 193-6.
  • Biboulet P, Deschodt J, Aubas P, Vacher E, Chauvet P, D’Athis F. Continuous spinal anaesthesia; does low-dose plain bupivacaine or hyperbaric bupivacaine allow the performance of hip surgery in the elderly? Reg Anesth 1993; 18: 170-5.
  • Wilhelm S, Standl T, Burmeister M, Kessler G, Schulte am Esch J. Comparison of continuous spinal and combined spinal-epidural anaesthesia using plain bupivacaine %0.5 in trauma patients. Anest Anesth Analg 1997; 85: 69-74.
  • Niemi L, Pitkanen M, Tuominen M, Rosenberg PH. Technical problems and side effects associated with continuous intratechal or epidural post-operative analgesia in patients undergoing hip arthroplasty. Eur J Anaesthesiol 1994; 11: 469-74.
  • Vercauteren MP, Geernaert K, Hoffmann VLH, Dohmen D, Adriaensen HA. Postoperative intrathecal patient-controlletd analgesia with bupivacaine, sufentanyl or a mixture of both. Anaesthesia 1998; 53: 1022-7.
  • Mollmann M, Cord S, Holst D, Auf der Landwehr U. Continuous spinal 332 Cumhuriyet Tıp Dergisi Cumhuriyet Tıp Derg 2011; 33: 324-332 Cumhuriyet Medical Journal Cumhuriyet Med J 2011; 33: 324-332 anaesthesia or continuous epidural anaesthesia for postoperative pain control after hip replacement? Eur J Anaesthesiol 1999; 16: 454-61.
  • Gurlit S, Reinhardt S, Mollmann M. Continuous spinal analgesia or opioid-added continuous epidural analgesia for postoperative pain control after hip replacement. Eur J Anaesthesiol 2004; 21: 708-14.
  • Petros AJ, Barnard M, Smith D, Ronzoni G, Carli F. Continuous spinal anaesthesia: dose requirements and characteristics of the block. Reg Anesth 1993;18: 52-4.
  • Weber EW, Slappendel R, Gielen MJ, Dirksen R. Intrathecal addition of morphine to bupivacaine is not the cause of postoperative nause and vomiting. Reg Anesth Pain Med 1998; 23: 81-6.
  • Slappendel R, Weber EWG, Dirksen R, Gielen MJ, Van Limbeek J. Optimization of the dose of inrathecal morphine in total hip surgery: a dose finding study. Anesth Analg 1999; 88: 822-6.
  • Brunschwiler M, VanGessel E, Forster A, Bruce A, Gamulin Z. Comparison of clonidine, morphine or placebo mixed with bupivacaine during continuous spinal anaesthesia. Can J Anaesth 1998; 45: 735-40.
  • Scott NB, James K, Murphy M, Kehlet H. Continuous thoracic epidural analgesia versus combined spinal/thoracic epidural analgesia on pain, pulmonary function and the metabolic response following colonic resection. Acta Anaesthesiol Scand 1996; 40: 691-6.
  • Cole PJ, Craske DA, Wheatley RG. Efficacy and respiratory effects of low-dose spinal morphine for postoperative analgesia following knee arthroplasty. Br J Anaesth 2000; 85:233-7.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Cerrahi Tıp Bilimleri Araştırma Yazıları
Yazarlar

Hasan Özal

Sinan Gürsoy

İclal Kol

Kenan Kaygusuz

Cevdet Düger

Hayati Öztürk

Caner Mimaroğlu

Yayımlanma Tarihi 15 Nisan 2011
Yayımlandığı Sayı Yıl 2011Cilt: 33 Sayı: 3

Kaynak Göster

AMA Özal H, Gürsoy S, Kol İ, Kaygusuz K, Düger C, Öztürk H, Mimaroğlu C. Alt ekstremite cerrahilerinde sürekli spinal ve kombine spinal-epidural anestezisinin karşılaştırılması. CMJ. Eylül 2011;33(3):324-332.