Artroskopik diz cerrahisinde intraartiküler levobupivakain ve bupivakain kullanımının postoperatif analjeziye etkisinin karşılaştırılması
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Date
2010
Authors
Özdemir, Nurdan
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızda artroskopik diz cerrahisi geçiren olgularda intraartiküler enjeksiyonda morfin ve adrenalin karışımına eklenen, bupivakain ve levobupivakainin postoperatif analjezi ve fonksiyonel derlenme üzerine etkilerini karşılaştırmayı amaçladık. Etik Kurul onayı ve yazılı bilgilendirme sonrası, artroskopik diz cerrahisi planlanan, 60 ASA I-II olgu çalışmaya alındı. Olgular randomize üç eşit gruba ayrıldı (n=20 her grupta): Grup B’ye 30 ml izobarik %0.5 bupivakain+2 mg morfin+100 μg adrenalin; Grup L’ye 30 ml %0.5 levobupivakain+2 mg morfin+100 μg adrenalin; Grup K’ya 30 ml serum fizyolojik operasyon bitiminde cerrahi ekip tarafından intraartiküler uygulandı. Morfin kullanımı 2., 4., 6., 8., 12. ve 24. saatlerde kaydedildi. Ağrı skorları aynı dönemlerde değerlendirildi. İlk analjezik gereksinim zamanı ve morfin kullanım süresi kaydedildi. İlk mobilizasyon, düz bacak kaldırma testine pozitif yanıt verme, 30-50˚ diz fleksiyonuna tolerans ve kuadriseps refleksinin dönüş zamanları değerlendirildi. Olgu ve cerrah memnuniyeti, taburculuk zamanı ve olgunun benzer cerrahi uygulama için aynı anestezi yöntemini tercih edip etmeyeceği sorgulandı. Ağrı skorları postoperatif 2., 4., 6., 8., 12. ve 24. saatlerde Grup B ve Grup L’de Grup K’dan daha düşüktü (tüm dönemler için p<0.001). B ve L gruplarında, ilk analjezik gereksinim zamanı uzun (p<0.01), morfin tüketimi az (p<0.001) ve analjezik kullanım süresi kısa (p<0.001), hasta ve cerrah memnuniyeti yüksek (p<0.01, p<0.01) bulundu. Düz bacak kaldırma testine pozitif yanıt verme, 30-50˚ diz fleksiyonuna tolerans ve ilk mobilizasyon zamanları Grup B ve Grup L’de kısa bulundu (tüm değişkenler için p<0.001). Artroskopik diz cerrahisinde, intraartiküler uygulanan morfin ve adrenalin karışımına, levobupivakain eklenmesi bupivakain eklenmesine benzer şekilde postoperatif analjezik gereksinimini ve kullanım süresini azaltmakta, mobilizasyona olan toleransı arttırmaktadır.
The aim of our study was to compare the efficacy of intraarticularly injected bupivacaine and levobupivacaine which added to morphine and adrenaline combination for postoperative pain control and functional recovery at knee surgery. After obtaining Ethics Committee’s approval and written informed consents, 60 patients of ASA I-II undergoing arthroscopic knee surgery under spinal anesthesia were enroled in this study. Patients were randomized into three groups (n=20 in each group): in Group B 30 ml of isobaric %0.5 bupivacaine+2 mg morphine+100 μg adrenaline, in Group L 30 ml of %0.5 levobupivacaine+2 mg morphine+100 μg adrenaline, in Group K 30 ml serum physiologic was given intraarticularly by surgical team at the end of the operation. Morphine usage was recorded at 2., 4., 6., 8., 12. ve 24 hours. Pain scores are evaluated at the same period. Time to first analgesic request and the duration of usage of morphine were recorded. Times of the first mobilization of patients, positive response to straight leg raising test, tolerance to 30-50 degrees of knee flexion, recovery of quadriceps reflexes were evaluated. Patient and surgeon satisfaction, discharge time, the patient’s preference about the same anesthesic method for similar kind of surgical procedure were recorded. The VAS values were lower in Groups B and L than in Group K at 2., 4., 6., 8., 12. and 24 hours postoperatively (p<0.001 for all terms). In Groups B and L, the time for first analgesic request was longer (p<0.01), morphine consumption was lower (p<0.001) and the duration of morphine usage was shorter (p<0.001), and patient and surgeon satisfaction was higher (p<0.01, p<0.01). Times of positive response to straight leg raising test, tolerence to 30-50 degrees of knee flexion and the first mobilization were found to be shorter in Group B and Group L (p<0.001 for all variables). At arthroscopic knee surgery, intraarticular levobupivacaine which added to morphine-adrenaline combination decreases the postoperative requirement for analgesic drugs, shortens the duration of analgesic usage and increases the tolerance for mobilization like bupivacaine does.
The aim of our study was to compare the efficacy of intraarticularly injected bupivacaine and levobupivacaine which added to morphine and adrenaline combination for postoperative pain control and functional recovery at knee surgery. After obtaining Ethics Committee’s approval and written informed consents, 60 patients of ASA I-II undergoing arthroscopic knee surgery under spinal anesthesia were enroled in this study. Patients were randomized into three groups (n=20 in each group): in Group B 30 ml of isobaric %0.5 bupivacaine+2 mg morphine+100 μg adrenaline, in Group L 30 ml of %0.5 levobupivacaine+2 mg morphine+100 μg adrenaline, in Group K 30 ml serum physiologic was given intraarticularly by surgical team at the end of the operation. Morphine usage was recorded at 2., 4., 6., 8., 12. ve 24 hours. Pain scores are evaluated at the same period. Time to first analgesic request and the duration of usage of morphine were recorded. Times of the first mobilization of patients, positive response to straight leg raising test, tolerance to 30-50 degrees of knee flexion, recovery of quadriceps reflexes were evaluated. Patient and surgeon satisfaction, discharge time, the patient’s preference about the same anesthesic method for similar kind of surgical procedure were recorded. The VAS values were lower in Groups B and L than in Group K at 2., 4., 6., 8., 12. and 24 hours postoperatively (p<0.001 for all terms). In Groups B and L, the time for first analgesic request was longer (p<0.01), morphine consumption was lower (p<0.001) and the duration of morphine usage was shorter (p<0.001), and patient and surgeon satisfaction was higher (p<0.01, p<0.01). Times of positive response to straight leg raising test, tolerence to 30-50 degrees of knee flexion and the first mobilization were found to be shorter in Group B and Group L (p<0.001 for all variables). At arthroscopic knee surgery, intraarticular levobupivacaine which added to morphine-adrenaline combination decreases the postoperative requirement for analgesic drugs, shortens the duration of analgesic usage and increases the tolerance for mobilization like bupivacaine does.
Description
Keywords
İntraartiküler enjeksiyon, Bupivakain, Levobupivakain, Postoperatif ağrı, Artroskopik cerrahi, Intraarticular injection, Bupivacaine, Levobupivacaine, Postoperative pain, Arthroscopic surgery
Citation
Özdemir, N. (2010). Artroskopik diz cerrahisinde intraartiküler levobupivakain ve bupivakain kullanımının postoperatif analjeziye etkisinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.