South Clin Ist Euras. 2013; 24(2): 73-81 | DOI: 10.5505/jkartaltr.2013.90377

Spinal anestezi uygulanan sezaryen seksiyolarda levobupivakaine ilave edilen fentanil ve morfinin etkileri

Müjge Hatun¹, Gülten Arslan², Feriha Temizel², Hakan Erkal², Hüsnü Süslü³, Yaman Özyurt⁴, Tamer Kuzucuoðlu², Zuhal Arýkan^5
1Sivas Devlet Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Sivas
²Dr. Lütfi Kýrdar Kartal Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Ýstanbul
³Maltepe Üniversitesi Týp Fakültesi, Anesteziyoloji ve Reanimasyon Kliniði, Ýstanbul
⁴Özel Umut Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Ýstanbul
⁵(Emekli) Dr. Lütfi Kýrdar Kartal Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Ýstanbul

AMAÇ: Çalýþmamýzýn amacý spinal anestezi altýnda sezaryen ameliyatý geçirecek olgularda 10 mg levobupivakaine 10 mcg fentanil, 0.01 mg morfin veya salin eklenmesinin etkilerini
karþýlaþtýrmaktýr.
YÖNTEMLER: Spinal anestezi altýnda elektif sezaryen ameliyatý uygulanacak ASA I-II grubundaki 90 hasta rastgele olarak takip eden üç gruba ayrýldý. Grup L: 10 mg levobupivakain ve salin, Grup LF: 10 mg levobupivakain ve 10 mcg fentanil, Grup LM: 10 mg levobupivakain ve 0.01 mg morfin. Sensoryel ve motor blok baþlama, geri dönüþüm zamanlarý, sensoryel blok seviyesi, sensoryel bloðun en yüksek seviyesi ve ulaþma zamaný, motor blok derecesi, çalýþma ilaçlarýnýn spinal enjeksiyonundan sonra 1., 5., 10., 15., 20., 25., 30., 35., 40. dk’larda hemodinamik parametreler, görsel analog skala, ilk analjezik gereksinim zamaný, ilk 24 saatteki total analjezik gereksinimi, anestezi kalitesi, yan etkiler, umblikal arter kan gazlarý, APGAR skorlarý kaydedildi.
BULGULAR: Gruplar arasýnda demografik özellikler, APGAR skorlarý, umblikal arter kan gazlarý açýsýndan farklýlýk bulunmadý. Sistolik arter basýncý ve görsel analog skala deðerleri grup LF’de daha fazla azalmýþ idi (p<0.05).
SONUÇ: Levobupivakaine eklenen fentanil ve morfinin kýsaltýlmýþ duyusal ve motor blok baþlangýç zamaný, geliþtirilmiþ analjezi kalitesi oluþturmasý nedeniyle, sezaryen ameliyatý gibi kýsa süreli giriþimlerde spinal anestezi için daha iyi bir seçenek olabileceði kanýsýna varýldý.

Anahtar Kelimeler: Fentanil, levobupivakain, morfin, seksiyo sezaryen, spinal anestezi

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The effects of addition of fentanyl or morphine to levobupivacaine in spinal anesthesia for cesarean section

Müjge Hatun¹, Gülten Arslan², Feriha Temizel², Hakan Erkal², Hüsnü Süslü³, Yaman Özyurt⁴, Tamer Kuzucuoðlu², Zuhal Arýkan^5
1Sivas State Hospital, Department of Anesthesiology and Reanimation, Sivas, Turkey
²Dr. Lütfi Kýrdar Kartal Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
³Maltepe University Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey
⁴Private Umut Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
⁵(Retired) Dr. Lütfi Kýrdar Kartal Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey

OBJECTIVE: The purpose of the study was to compare the effects of adding 0.01 mg of morphine, 10 mcg of fentanyl or saline to 10 mg of levobupivacaine in patients undergoing cesarean section under spinal anesthesia.
METHODS: Ninety American Society of Anesthesiologists (ASA) I-II patients undergoing elective cesarean section under spinal anesthesia were randomized into the following three groups:
Group L: 10 mg levobupivacaine and saline, Group LF: 10 mg levobupivacaine and 10 mcg fentanyl, and Group LM: 10 mg levobupivacaine and 0.01 mg morphine. Sensorial and motor block onset and recovery times, the level of sensory block, time to highest sensory block, highest sensory block level, the degree of motor block, hemodynamic parameters at 1, 5, 10, 15, 20, 25, 30, 35, and 40 minutes after spinal injection of the study drugs, visual
analogue scale, first analgesic requirement time, total analgesic requirement in the first 24 hours, anesthesia quality, side effects, umbilical artery blood gases, and APGAR scores were recorded.
RESULTS: There was no difference between groups in demographics, APGAR scores, or umbilical artery blood gases. Systolic arterial pressure and visual analog scale values were decreased in Group LF (p<0.05).
CONCLUSION: Due to the shortened sensorial and motor block onset times, for improved quality of anesthesia, we believe that addition of fentanyl or morphine to levobupivacaine may be a better choice for spinal anesthesia for short procedures such as cesarean section.

Keywords: Fentanyl, levobupivacaine, morphine, cesarean section, spinal anesthesia

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