Posterior Füzyon Cerrahisi Sonrası Preemptif Segmental Epidural Levobupivakain Uygulaması ve Yara Yeri İnfiltrasyonu: Vaka Serisi (original) (raw)
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SDÜ Tıp Fakültesi Dergisi, 2021
Amaç Çalışmanın amacı varikosel cerrahisinde kullanılan farklı anestezik tekniklerin postoperatif ağrı kesici ihtiyacı ve hasta yatış süreleri üzerine etkisini değerlendirmektir. Gereç ve Yöntem Bu çalışmaya 2014-2018 yılları arasında varikosel cerrahisi uygulanmış 299 hasta dahil edildi. Hastalar uygulanan anestezik yönteme göre genel anestezi+lokal anestezi ile (20 mL prilocaine (%2)) cilt infiltrasyonu yapılan hastalar [genel anestezi grubu (grup 1, n=50)], sadece spinal anestezi uygulanan hastalar [spinal anestezi grubu (grup 2, n=142)], Spinal anes-tezi+Tap blok uygulanan hastalar [Spinal+Tap blok grubu (grup 3, n=52)] ve spinal anestezi ve intratekal morfin uygulanan hastalar [Spinal+ITM grubu (grup 4, n=55)] olarak gruplandırıldı. Bulgular Genel anestezi grubunda analjezik kullanım oranlarının spinal anestezi grubu karşılaştırıldığında aralarındaki farkı anlamlı olmadığı (p>0.05) Spinal+Tap blok grubu ve spinal+ITM grubu ile karşılaştırıldığında aralarında anlamlı fark olduğu görüldü (tüm p<0.05). Genel anestezi grubunda ilk analjezik kullanım zamanının diğer gruplarla karşılaştırıldığında anlamlı oranda kısa olduğu görüldü (p=0.001). Sonuç Varikosel cerrahisinde spinal anestezi+TAP blok uygulaması diğer yöntemlerle kıyasla, daha düşük analjezik ihtiyacı ve daha kısa hastanede kalış süresi ile etkin ve güvenilir bir yöntemdir.
Turkiye Klinikleri Journal of Medical Sciences, 2011
Epidural anesthesia can be used successfully for lumbar disc surgery. Levobupivacaine,the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. The aim of this study was to compare the clinical efficacy and safety of epidural anesthesia with levobupivacaine + fentanyl and bupivacaine + fentanyl in equivalent concentration and doses for elective lumbar laminectomy and discectomy. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Eighty ASA I-III cases undergoing lumbar laminectomy and discectomy were randomly divided into two groups. In the first group (Grup LF n=40) epidural block was achieved with 0.5% levobupivacaine (15 mL, 75 mg) + fentanyl 100 μg + 3 ml 0.9% NaCl solution, and in the second group (Grup BF n=40) 0.5% bupivacaine (15 mL, 75 mg) + fentanyl 100 μg + 3 ml 0.9% NaCl solution was used for epidural block. Surgery was started when sensory block reached to dermatomal level of T8. The onset time, and quality of sensory and motor block were evaluated. Blood pressure, heart rate, side effects and time to need for analgesic supplement (time to reach VAS 4) were recorded. R Re es su ul lt ts s: : Demographically both groups were similar. Onset of adequate sensory block (T8 dermatome) was similar in two groups (14.4 ± 5.9 min for Group LF, 11.4 ± 4.3 min for Group BF, respectively). Mean maximum block height was T5 in both groups (groupLF T2-T6 , group BF T4-T6). Complete regression of sensory block was significantly longer in group LF (296.7 ± 53.4 min) than Group BF (232.7 ± 37 min) (p<0.05). Motor block was evaluated by using modified Bromage scale. Degree of motor block in group LF was significantly lower than in group BF (p<0.05). The heart rate and mean arterial pressure values decreased in both groups but the decrease in group BF was significant between 30-60 min (p<0,05).The frequency of bradycardia and hypotension was higher in Group BF. C Co on nc cl lu us si io on n: : In conclusion, 0.375% levobupivacaine with fentanyl and 0.375% bupivacaine with fentanyl are suitable anesthetics for use in lumbar spine surgery but levobupivacaine provides less motor block and beter hemodynamic stability in comparison to bupivacaine.
O bjective: To compare effects and side effects or complications of epidural versus intramuscularly administered morphine for relieve of postoperative pain. Patients and methods: In the first group (epidural) analgesia is achieved by application of morphine through epidural catheter. To the amount of morphine is added physiological solution until 10 ml of total volume of the mixture is achieved. This mixture is given to 150 patients, by epidural route before the exit from the operation room. Epidural catheter is removed after 48 hours. Second group (intramuscular) analgesia is realized by application of 10 mg of morphine by intramuscular route. Morphine is injected at the end of surgery. Pain is assessed with combination of verbal categorical scale and visual analog scale. Verbal categorical scale used is 8 points scale and contains words of Tursky: 0 no pain, 1 very low pain , 2 week pain, 3 mild pain , 4 moderate pain , 5 strong pain, 6 severe pain, 7 untolerated pain. Awareness i...
Safety and efficacy of postoperative epidural analgesia
British Journal of Anaesthesia, 2001
Effective analgesia for postoperative pain relief after major surgery has been a practical proposition with epidural administration of local anaesthetic (LA) and opioid drugs since the early 1980s. Although epidural administration is perceived by 80% of UK anaesthetists as the ideal analgesic technique for upper abdominal surgery, 34 there are many patients undergoing major surgery who do not receive this form of analgesia. In a recent survey of UK practice, only 15% of patients undergoing abdominal surgery had epidural analgesia in the 12 hospitals sampled. 31 The main factor which has limited the use of epidural analgesia has been the dif®culty in making a reasonable risk/bene®t analysis about the technique, which has resulted in clinicians constantly asking whether epidurals are effective for postoperative pain relief and whether the technique is safe.
Middle East journal of anaesthesiology, 2010
Epidural analgesia is one of the commonly used methods of postoperative pain control despite its associated complications. Early recognition and intervention is required to minimize the effect of these complications. Present audit was conducted to find out the incidence of complications and type of interventions required to change the outcome. The record of all the patients who had epidural catheter placed for postoperative pain management reviewed from the departmental acute pain management register. Parameters included level of insertion, drugs used, number of days infusion continued and complications like nausea, vomiting, motor block, sedation, dural tap, catheter pull out, hypotension and itching. In addition, the intervention done to manage these complications was also recorded. Total 1706 entries of epidurals were recorded in study period 2001 to 2007. The overall incidence of the complication was 26.6%. The common complications were motor block (13.4%), dural tap (1.2%), ine...
İstanbul Tıp Fakültesi Dergisi, 2017
Objective: Despite various developments in the treatment of post-operative caesarean pain, there are still difficulties in satisfying patients due to individual differences. Ketamine is used as a potent anaesthetic and an effective analgesic since 1960's. The purpose of our study is to observe the effects of low-dose ketamine applied following spinal anaesthesia for postoperative analgesia and nausea & vomiting in pregnant patients. Materıal and Method: We examined the Visual Analogue Scales values of 120 patients at the 1 st , 2 nd , 4 th , 12 th , 24 th , and 48 th hours and evaluated nausea & vomiting. We also recorded the first additional analgesic demands and ketamine associated adverse events. Results: We detected significant differences between the visual analogue scale values of ketamine and control group in the 2 nd , 4 th and 12 th hours. Significant differences were also seen in the first analgesic demand periods. We found a significant decrease in nausea and vomiting and insignificant elevation of psychodysleptic findings in ketamine group. Conclusion: We believe that low-dose ketamine can be effectively used to sustain analgesia in pregnant patients who received spinal anaesthesia. We further believe that the effect of ketamine in decreasing nausea and vomiting, in exchange of low levels of neuropsychiatric symptoms, is a remarkable subject.
Epidural Doğum Analjezisinde Sufentanil Eklenen İki Farklı Bupivakain Dozunun Karşılaştırılması
Turkiye Klinikleri Journal of Medical Sciences, 2013
Ob bj je ec ct ti iv ve e: : Addition of opioids to local anesthetics for epidural obstetric analgesia provides effective analgesia with decreased side effects. We compared the analgesic quality of 0,0625% bupivacaine and 0,1% bupivacaine with 0.5 μg/mL sufentanil. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Study participants were 18-45-year-old, primiparous 30 parturients. An epidural catheter was placed, 8-10 mL of 0.0625% bupivacaine with 0.5 μg/mL sufentanil and 0.1% bupivacaine with 0.5 μg/mL sufentanil were given to Group I and Group II, respectively. Hemodynamic parameters, obstetric examination findings, pain grades, time to reach visual analog scale (VAS)<4 and the first dose interval were recorded. Satisfaction levels, motor and sensorial blocks, oxytocin and valetamate bromide consumption, side effects were assessed. Total and additional drug use, duration of second stage of the delivery, mean delivery times, instrumental delivery, Apgar scores, fetal heart rates and uterine contraction pressures were recorded. The percentage of participation of the parturients to the delivery was assessed. R Re es su ul lt ts s: : Median VAS values were significantly lower in Group II. Median VAS values were lower than 4 in both groups after 15 th minute. The time to the second analgesic dose was longer in Group II. Systolic, diastolic and mean arterial blood pressures were measured lower in Group II. Satisfaction scores were significantly higher in Group II. C Co on nc cl lu us si io on n: : In the present study, satisfactory analgesia was produced in both groups. Although median VAS scores were lower in Group II, VAS<4 could be reached in Group I. We concluded that 0.0625% bupivacaine+0.5 μg/mL sufentanil combination, as providing VAS<4, could be a preferable alternative to 0.1% bupivacaine+0.5 μg/mL sufentanil. K Ke ey y W Wo or rd ds s: : Analgesia, obstetrical; analgesia, epidural Ö ÖZ ZE ET T A Am ma aç ç: : Epidural obstetrik analjezi için lokal anesteziklere opioidlerin eklenmesi daha efektif bir analjezi sağlar ve yan etkileri azaltır. Biz bu çalışmada %0,0625 bupivakain ve %0,1 bupivakaine 0,5 mikrog/mL sufentanil ekleyerek analjezi kalitesini karşılaştırdık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya, 18-45 yaşları arasında, 30 primipar gebe dahil edildi. Epidural kateter yerleştirildikten sonra %0,0625 bupivakain ile 0,5 mikrog/mL sufentanil veya %0,1 bupivakain ile 0,5 mikrog/mL sufentanil sırasıyla Grup I ve Grup II olarak belirlendi ve 8-10 mL uygulandı. Hemodinamik parametreler, obstetrik muayene bulguları, ağrı düzeyleri, vizuel analo skala (VAS)<4 olma zamanı ve ilk analjezik gereksinim zamanı kayıt edildi. Memnuniyet dereceleri, motor ve duyusal blok, oksitosin ve valetamat bromür kullanımı ve yan etkiler değerlendirildi. Toplam ve ek ilaç kullanımı, doğumun 2. evresinin süresi, doğumun toplam süresi, doğumda yardımcı alet kullanımı, Apgar skorları, fetal kalp hızı ve uterin kontraksiyon basınçları kayıt edildi. Gebelerin doğuma katılım yüzdeleri değerlendirildi. B Bu ul lg gu ul la ar r: : Median VAS değerleri Grup II'de anlamlı şekilde düşük bulundu. İlk 15 dakikadan sonra her iki grupta da VAS değerleri 4'ün altında devam etti. İkinci dozun yapılma zamanı Grup II'de daha uzundu. Sistolik, diyastolik ve ortalama arter basınç değerleri Grup II'de daha düşük bulundu. Memnuniyet düzeyleri Grup II'de anlamlı şekilde yüksekti. S So on nu uç ç: : Bu çalışma, her iki grupta da analjezi memnuniyeti sağlandı. Median VAS değerleri Grup II'de daha düşük bulundu ve fakat Grup I'de de VAS<4 düzeyinde oldu. Sonuç olarak, %0,0625 bupivakain+0,5 mikrog/mL sufentanil kombinasyonu VAS<4 düzeylerini sağlayabildiğinden, %0,1 bupivakain+0,5 mikrog/mL sufentanile iyi bir alternatiftir.
DergiPark (Istanbul University), 2023
Spinal anestezi çok çeşitli cerrahilerde kullanılabilen, oldukça sık tercih edilen bir nöroaksiyel anestezi yöntemidir. Fakat nadir de olsa kardiyak arreste (KA) kadar ilerleyebilen komplikasyonlarla karşılaşılmaktadır. Bu vaka raporunda, regüle hipertansiyon dışında sistemik hastalığı bulunmayan hastamızın hemoroid cerrahisi sonrası ayılma ünitesinde bradikardi ile başlayan kardiyak arrest gelişimi ve müdahelesi anlatılmış, başta deksmedetomidin olmak üzere zemin hazırlayan etkenlerin tartışılması amaçlanmıştır. Vakamızdan yola çıkarak spinal anestezinin kardiyovasküler sistem üzerindeki etkilerini de düşündüğümüzde uygulama sırasında oluşabilen sempatik blokajın şiddetini arttırabilecek, özellikle vagal tonus artışı olan, bazal kalp atım hızı (KH) 60 dk-1 altındaki ASA I genç bireylerde ve özellikle kardiyak hastalığı bulunan hastalarda deksmedetomidin oldukça dikkatli kullanılmalı ve spinal anestezi sırasında ortaya çıkabilecek komplikasyonlar unutulmamalıdır.