Bel fıtığı mikrodiskektomi ameliyatlarında spinal, epidural ve genel anestezi yöntemlerinin karşılaştırılması
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Dosyalar
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda elektif lomber disk cerrahisi uygulanacak hastalarda epidural anestezi, spinal anestezi ve genel anestezinin etkinliğini karşılaştırıp, hemodinamik parametreler, yan etkiler, hasta konforu, postoperatif derlenme, analjezik ihtiyacı üzerine etkilerini göstermeyi amaçladık. ASA I-II risk grubundan toplam 60 hasta rastgele üç gruba ayrıldı. Epidural anestezi grubundaki hastalara oturur pozisyonunda 18G Touhy iğne ile epidural aralığa toplam 20-25 ml %0,5 bupivakain verildi. Spinal anestezi grubundaki hastalara da oturur pozisyonda 25 G iğne ile %0,5 heavy bupivakain verildi. Genel anestezi grubundaki hastalara anestezi indüksiyonu 2-3mg/kg propofol, 0,6 mg/kg roküronyum, 1µg/kg fentanyl ile yapıldı. Anestezi idamesi için %50 oksijen, %50 kuru hava toplam 4 lt/dk ve 1-1,5 MAC sevofluran kullanıldı. Her üç grupta da pron pozisyon verilerek cerrahi başlatıldı. Tüm hastaların kan basınçları, KTA, SpO2, operasyon süresi, VAS skorları, postoperatif analjezi, yan etkiler ve komplikasyonlar izlenerek kaydedildi. Gruplar arasında, yaş, cinsiyet, ağırlık, boy, VKİ, ASA skoru, bazal VAS skorları, kan basınçları, KTA, SpO2 değerleri benzerlik bulundu. Her üç grupta da cerrahi boyunca ve uyandırma odası SAB değerleri bazal değerlerine göre anlamlı olarak düşük bulundu (p<0,05). Üç grupta SAB değerinde bazale göre artış sadece genel anestezi grubunda entübasyon sonrası gözlendi. Gruplara göre bradikardi, taşikardi, hipotansiyon, bronkospazm, kanama oranlarında anlamlı fark saptanmadı. İntraoperatif atropin ve efedrin kullanımı açısından anlamlı fark bulunmadı. Genel anestezi grubunda hipertansiyonu varolan bireylerin oranı anlamlı düzeyde yüksek bulundu. Epidural ve spinal anestezi uygulanan her hastada yeterli blok seviyesi sağlandı. İntraoperatif opioid kullanımı açısından fark saptanmazken, VAS cerrahi bitiş, VAS uyandırma giriş, VAS uyandırma çıkış değerleri açısından epidural anestezide anlamlı olarak daha düşük değerler bulundu (p<0,05).Hasta konforu skalasıile değerlendirildiğinde gruplar arasında anlamlı fark saptanmadı. Anestezi süresi, cerrahi süre ve uyandırma odası kalış süresi değerleri açısından gruplar arasında anlamlı fark saptanmadı. Postoperatif dönemde bulantı, kusma, idrar retansiyonu, ek opioid analjezik kullanımı, mobilizasyon süreleri ve taburculuk süreleri değerlendirildi, anlamlı fark bulunmadı. Epidural anestezi uygulanan bir hastada lokal anestezik santral toksisitesi gelişti. Sonuç olarak; lomber disk cerrahisinde epidural, spinal ve genel anestezide hemodinaminin benzer olması, rejyonel anestezi yöntemlerinin hasta konforu ve memnuniyeti açısından etkin, güvenilir ve genel anesteziye alternatif bir yöntem olduğunu düşündürmektedir. Spinal anestezi ve epidural anestezi çoğu merkezde birçok operasyon için güvenle kullanılırken lomber disk cerrahisinde de kullanımı yaygınlaştırılmalıdır.
The purpose of our study was to compare and to state the effects of epidural, spinal and general anesthesia on perioperative hemodynamic parameters, side effects, patient convenience, discharge criteria and analgesic requirement in patients undergoing elective lumbar discectomy. 60 ASA class I-II patients were randomly assigned in 3 groups. Epidural anesthesia was performed in sitting position using 18 G Tuohy needle and 20-25 ml of bupivacaine 0,5 %. Spinal anesthesia was performed in sitting position using 25 G needle and heavy bupivacaine 0,5 %. General anesthesia was inducted with propofol 2-3 mg/kg, rocuronium 0,6 mg/kg and fentanyl 1 mcg/kg and maintained with 50% oxygen and 50% medical air of 4 l/min total flow rate and sevoflurane of 1-1,5 MAC. Intraoperative all patients were in prone position. Blood pressure, heart rate, SpO2, duration of surgery, VAS scores, postoperative analgesic procedure, side effects and complications were recorded. Age, gender, weight, height, BMI, ASA class, basal VAS scores, blood pressures, heart rates and SpO2 values were similar between 3 groups. Systolic pressure values measured intraoperatively and postoperatively in PACU were significantly lower than basal values (p<0,05). There was no significant difference in occurence of bradycardia, tachycardia, hypotension, bronchospasm, hemorrhagia between groups. Intraoperative atropine and ephedrine demands showed no significant difference. The number of hypertensive patients in general anesthesia group was significantly higher than other two groups. In all patients in spinal and epidural groups were occupied a satisfying block level. There was no difference in intraoperative opioid demand but VAS scores on the end of surgery and on in- and outgoing PACU were significantly lower in epidural anesthesia group (p<0,05). In patient convenience there was no significant difference between groups. There was no significant difference in duration of anesthesia, duration of surgery and duration of stay in PACU between groups. Concurrently there was no significant difference between groups in postoperative nausea, vomiting, urinary retention, additional opioid demand, mobilisation time and discharge time. Central nervous system toxicity of local anesthetic occurred in one patient in epidural anesthesia group. We concluded that regional anesthesia technics are effective and safe alternatives to general anesthesia in lumbar disc operations as hemodynamic parameters, patient convenience and satisfaction are similar between epidural, spinal and general anesthesia groups. We recommend more extensively performance of spinal and epidural anesthesia in lumbar disc surgery as in many other operations.
The purpose of our study was to compare and to state the effects of epidural, spinal and general anesthesia on perioperative hemodynamic parameters, side effects, patient convenience, discharge criteria and analgesic requirement in patients undergoing elective lumbar discectomy. 60 ASA class I-II patients were randomly assigned in 3 groups. Epidural anesthesia was performed in sitting position using 18 G Tuohy needle and 20-25 ml of bupivacaine 0,5 %. Spinal anesthesia was performed in sitting position using 25 G needle and heavy bupivacaine 0,5 %. General anesthesia was inducted with propofol 2-3 mg/kg, rocuronium 0,6 mg/kg and fentanyl 1 mcg/kg and maintained with 50% oxygen and 50% medical air of 4 l/min total flow rate and sevoflurane of 1-1,5 MAC. Intraoperative all patients were in prone position. Blood pressure, heart rate, SpO2, duration of surgery, VAS scores, postoperative analgesic procedure, side effects and complications were recorded. Age, gender, weight, height, BMI, ASA class, basal VAS scores, blood pressures, heart rates and SpO2 values were similar between 3 groups. Systolic pressure values measured intraoperatively and postoperatively in PACU were significantly lower than basal values (p<0,05). There was no significant difference in occurence of bradycardia, tachycardia, hypotension, bronchospasm, hemorrhagia between groups. Intraoperative atropine and ephedrine demands showed no significant difference. The number of hypertensive patients in general anesthesia group was significantly higher than other two groups. In all patients in spinal and epidural groups were occupied a satisfying block level. There was no difference in intraoperative opioid demand but VAS scores on the end of surgery and on in- and outgoing PACU were significantly lower in epidural anesthesia group (p<0,05). In patient convenience there was no significant difference between groups. There was no significant difference in duration of anesthesia, duration of surgery and duration of stay in PACU between groups. Concurrently there was no significant difference between groups in postoperative nausea, vomiting, urinary retention, additional opioid demand, mobilisation time and discharge time. Central nervous system toxicity of local anesthetic occurred in one patient in epidural anesthesia group. We concluded that regional anesthesia technics are effective and safe alternatives to general anesthesia in lumbar disc operations as hemodynamic parameters, patient convenience and satisfaction are similar between epidural, spinal and general anesthesia groups. We recommend more extensively performance of spinal and epidural anesthesia in lumbar disc surgery as in many other operations.
Açıklama
YÖK Tez No: 507875
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation, Anestezi, Anesthesia, Anestezi-epidural, Anesthesia-epidural, Anestezi-genel, Anesthesia-general, Anestezi-spinal, Anesthesia-spinal, Bel ağrısı, Back pain, Cerrahi, Surgery, Diskektomi, Diskectomy, Lomber vertebra, Lumbar vertebrae, İntervertebral disk, Intervertebral disc
