Kombine spino-epidural anestezi yöntemiyle sezaryen operasyonlarında düşük doz izobarik, hiperbarik bupivakain ile izobarik levobupivakain'e ilave edilen fentanil'in hemodinamik ve motor blok etkilerinin karşılaştırılması

MUHAMMET KARACA

Kombine spino-epidural anestezi yöntemiyle sezaryen operasyonlarında düşük doz izobarik, hiperbarik bupivakain ile izobarik levobupivakain'e ilave edilen fentanil'in hemodinamik ve motor blok etkilerinin karşılaştırılması

Thesis Type: Expertise In Medicine

Institution Of The Thesis: Ataturk University, Tıp Fakültesi, Cerrahi Tıp Bilimleri, Turkey

Approval Date: 2013

Thesis Language: Turkish

Student: MUHAMMET KARACA

Supervisor: Canan Atalay

Open Archive Collection: AVESIS Open Access Collection

Abstract:

We aimed to compare the hemodynamic and motor block effects of fentanyl, which is added low doses of isobaric and hyperbaric bupivacaine and isobaric levobupivacaine in caesarean operations with Combined Spinal-Epidural Anesthesia (CSEA) method. 160 pregnant women, who were planned to have elective caesarean birth with CSEA, are included in the study. Patients were randomly separated into four groups (n=40). All groups were applied a total of 1.8 ml: Group A(n=40) had 9 mg % 0.5 isobaric bupivacaine (1.8ml), Group B(n=40) had 5 mg % 0.5 (1ml) isobaric bupivacaine and 40 µg fentanyl (0.8ml), Group C(n=40) had 5mg % 0.5 isobaric levobupivacaine (1ml) and 40 µg fentanyl (0.8ml), Group D(n=40) had 5mg % 0.5 hyperbaric bupivacaine (1ml) and 40 µg fentanyl (0.8ml) mixture. When spinal injection was completed, epidural catheter is placed, and the patient is taken into supine position; once in every 2 minutes at the first 10 minutes, once in every 3 minutes until 30th minute, then once in every 5 minutes until end of the incident, and post-op at 1st and 2nd hours, sense level, motor block level, blood pressure and heart rate were recorded. When sense block reached T4, surgery was permitted. None of the cases required epidural additional medicines. All groups achieved T4 sensorial block. No significant differences were found within and between groups in terms of hemodynamic parameters and sensorial block levels. Time to reach T4 sensorial block level was 6 ± 1 minutes in Group A, 4 ± 1 minutes in Group B and C, and 7.5 ± 2.5 minutes in Group D. In Group B and C, time to reach T4 sensorial block level was significantly short (p=0,045). Bromage scores: Grup A, B, D motor block regressions are respectively 110.50 ± 10.07, 90.10 ± 11.12, 85.12± 10.23 minutes. Grup C had no motor block improvement, only 9 cases had Bromage 1 and these cases regressed to Bromage 0 within the first 35-40 minutes. First analgesic requirement was determined according to Verbal Rating Scale (VAS). VAS 3 was deemed as pain start and epidural post-op analgesic fluid was applied. Post-op pain, i.e. VAS 3; statistically and significantly started earlier in Group A, according to other groups (p=0,000). No statistically significant difference has been found in the other three groups (p=1,000). As a result; in the KSEA technique applied in caesarean cases, sufficient anesthesia were achieved with 40 µg fentanyl, which was added a low dose of 5 mg isobaric and hyperbaric bupivacaine and isobaric levobupivacaine. However, it was determined that there was no difference between groups in terms of hemodynamic parameters, that in terms of Bromage score, motor block regression, and patient satisfaction there were significant differences according to Group A in fentanyl groups, and significant differences in Group C with all groups.