Kraniyotomilerde çivili başlık ve insizyona hemodinamik yanıtın önlenmesinde ve postoperatif analjezide bupivakain ve levobupivakain ile yapılan skalp bloğun etkinliğinin araştırılması
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Date
2009
Authors
Can, Banu Otlar
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Kraniyotomi olgularında % 0.5 bupivakain ve levobupivakain ile yapılan skalp bloğunun çivili başlık ve insizyona bağlı hemodinamik yanıtın önlenmesindeki etkinliğini, postoperatif analjeziye ve analjezik ihtiyacına etkisini araştırmayı amaçladık.Randomize, plasebo kontrollü, çift kör planlanan çalışmaya, etik kurul onamı sonrası elektif kraniyotomi geçirecek ASA I-II, 18-85 yaş arası 90 olgu; Grup B: (20 ml %0.5 bupivakain, n=30), Grup L: (20 ml %0.5 levobupivakain, n=30) ve Grup K: (20 mL 0.9 normal salin, n=30) olacak şekilde rastgele gruplandırıldı. Anestezi indüksiyonu sonrası çivili başlık yerleştirilmesinden 5 dk. önce skalp bloğu gerçekleştirildi. Sistolik (SAB), diastolik (DAB), ortalama arteriyel basıncı (OAB), kalp atım hızı (KAH), periferik oksijen saturasyonu (SpO2) ve soluk sonu karbondioksit (ETCO2) değerleri kontrol (Z1), indüksiyondan 1dk (Z2) ve 5 dk sonra (Z3), blok sırasında (Z4) ve 1 dk sonra (Z5), çivili başlık yerleştirilmesi sırasında (Z6) ve 1 dk sonra (Z7), insizyon öncesi (Z8) ve 1 dk sonra (Z9), cilt kapatılması (Z10) ve 1 dk sonra (Z11) kaydedildi. Postoperatif ayılma ünitesinde gözlenen komplikasyonlar (bradikardi, hipotansiyon, ilaç alerjisi, bulantı, kusma) kaydedildi. Postoperatif bilinci açık hastalarda 2, 4, 8, 12, 16 ve 24. saatlerde 10 cm'lik vizüel analog skala (0 hiç ağrı yok, 10 olası en kötü ağrı) ile ağrı değerlendirilerek; postoperatif dönemde VAS 2'nin üzerinde ise analjezi için diklofenak i.m 75 mg ve VAS 5'in üzerinde ise dolantin 100 mg i.m yapılması planlandı. İstatiksel analiz; grup içi karşılaştırmada Wilcoxon testi ve eşleştirilmiş t test, gruplarası karşılaştırmada Mann-Whitney U ve Kruskal Wallis testi ile yapıldı.Çivili başlık takılması ve insizyon sırasında OAB ve KAH değerleri Grup K'da B ve L'ye göre anlamlı olarak yüksekti (p<0.05). Postoperatif dönemde 2. saatte VAS skoru Grup K'da B ve L'ye göre anlamlı olarak yüksekti (p<0.05), Grup B ve L arasında OAB, KAH ve 2.st'teki VAS skoru açısından anlamlı fark saptanmadı. Grup K'da peroperatif hipertansiyon ve taşikardi nedeniyle ek ilaç uygulanması Grup B ve L'ye göre anlamlı olarak yüksekti (p=0.001). Postoperatif analjezik ihtiyacı ve komplikasyonlar açısından anlamlı bir farklılık saptanmadı.Sonuç olarak skalp bloğu kraniyotomilerde intraoperatif dönemde sempatik cevabı azaltarak hemodinamik yanıtların stabilizasyonunu sağlar ve erken postoperatif dönemde ağrıyı azaltmaya yardımcıdır Bupivakain ve levobupivakainin klinik etkinliklerinin benzer olması ve postoperatif analjezik etkileri açısından da anlamlı bir farklılıklarının olmamasından dolayı daha az toksik etkiye sahip olan levobupivakainin skalp bloğunda etkin bir şekilde kullanılabileceğini düşünmekteyiz.
In our study we aim to investigate the effects of scalp block with 0.5% bupivacaine and levobupivacaine on the hemodynamic response to head pinning and incision during craniotomy and to evaluate efficacy on postoperative analgesia and analgesic requirement.After ethics committee approval 90 ASA status I-II patients, aged 18 to 85 years who planned elective craniotomy were allocated to randomized, placebo controlled double-blind study and patients were randomly divided into three groups to receive either 0.5% bupivacaine 20 ml Group B (n=30), 0.5% levobupivacaine 20 ml Group L (n=30) and saline as placebo Group K (n=30). After the anaesthesia induction, 5 minutes before the head pinning scalp block was performed. Systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2) and end-tidal carbon dioxide (ETCO2) were recorded at basal (Z1) , 1 (Z2) and 5 min after the induction of anaesthesia (Z3), during (Z4) and 1 min after scalp block (Z5), during (Z6) and 1 min after head pinning (Z7), during (Z8) and 1 min after incision (Z9), during (Z10) and1 min after closure of skin (Z11). Also complications (bradycardia, hypotension, drug allergy, nause, vomiting) in postoperative care unit were recorded. Patients who were awake postoperative pain was evaluated at 2.,4.,8.,16. and 24. hours with 10 cm visual analog scale (where 0 is defined as no pain at all and 10 is the worst possible pain) and in postoperative period planned to give diclophenac 75 mg im if VAS score was more than 2 and to give meperidine 100 mg im if VAS score was more than 5. Statistical analyses were performed with Wilcoxon and paired t test per group and Mann-Whithey U and Kruskal Wallis between the groups.During head pinning and incision MAP and HR were significantly higher in Group K than Group B and Group L (p<0.05). At second of postoperative period VAS score was significantly higher in Group K than Group B and Group L (p<0.05). There was no significant difference between Group B and Group L regarding MAP, HR and VAS score. Additional drug administration for controlling hypertension and tachycardia in peroperative period is significantly higher in Group K than Group B and Group L. Also there was no difference between the groups regarding postoperative analgesic requirement and complications in postoperative care unit.As a conclusion; scalp block is effective to control hemodynamic response as blunting the sympathic activity intraoperatively during craniotomy and decreases the severity of pain in early postoperative period. Because the clinical effects of bupivacaine and levobupivacaine were similar, and there was no significant difference between the effects of postoperative analgesia and levobupivacaine has less toxicity than bupivacaine therefore levobupivacaine can be used safely and effectively for scalp block.
In our study we aim to investigate the effects of scalp block with 0.5% bupivacaine and levobupivacaine on the hemodynamic response to head pinning and incision during craniotomy and to evaluate efficacy on postoperative analgesia and analgesic requirement.After ethics committee approval 90 ASA status I-II patients, aged 18 to 85 years who planned elective craniotomy were allocated to randomized, placebo controlled double-blind study and patients were randomly divided into three groups to receive either 0.5% bupivacaine 20 ml Group B (n=30), 0.5% levobupivacaine 20 ml Group L (n=30) and saline as placebo Group K (n=30). After the anaesthesia induction, 5 minutes before the head pinning scalp block was performed. Systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2) and end-tidal carbon dioxide (ETCO2) were recorded at basal (Z1) , 1 (Z2) and 5 min after the induction of anaesthesia (Z3), during (Z4) and 1 min after scalp block (Z5), during (Z6) and 1 min after head pinning (Z7), during (Z8) and 1 min after incision (Z9), during (Z10) and1 min after closure of skin (Z11). Also complications (bradycardia, hypotension, drug allergy, nause, vomiting) in postoperative care unit were recorded. Patients who were awake postoperative pain was evaluated at 2.,4.,8.,16. and 24. hours with 10 cm visual analog scale (where 0 is defined as no pain at all and 10 is the worst possible pain) and in postoperative period planned to give diclophenac 75 mg im if VAS score was more than 2 and to give meperidine 100 mg im if VAS score was more than 5. Statistical analyses were performed with Wilcoxon and paired t test per group and Mann-Whithey U and Kruskal Wallis between the groups.During head pinning and incision MAP and HR were significantly higher in Group K than Group B and Group L (p<0.05). At second of postoperative period VAS score was significantly higher in Group K than Group B and Group L (p<0.05). There was no significant difference between Group B and Group L regarding MAP, HR and VAS score. Additional drug administration for controlling hypertension and tachycardia in peroperative period is significantly higher in Group K than Group B and Group L. Also there was no difference between the groups regarding postoperative analgesic requirement and complications in postoperative care unit.As a conclusion; scalp block is effective to control hemodynamic response as blunting the sympathic activity intraoperatively during craniotomy and decreases the severity of pain in early postoperative period. Because the clinical effects of bupivacaine and levobupivacaine were similar, and there was no significant difference between the effects of postoperative analgesia and levobupivacaine has less toxicity than bupivacaine therefore levobupivacaine can be used safely and effectively for scalp block.
Description
Keywords
Skalp bloğu, Çivili başlık, Bupivakain, Levobupivakain, Scalp block, Pin holder, Bupivacaine, Levobupivacain
Citation
Can, B. O. (2009). Kraniyotomilerde çivili başlık ve insizyona hemodinamik yanıtın önlenmesinde ve postoperatif analjezide bupivakain ve levobupivakain ile yapılan skalp bloğun etkinliğinin araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.