학술논문
Efficacy Evaluation of Two Different Doses of Morphine used in Spinal Anesthesia/Spinal Anestezide, Kullanilan Iki Farkli Morfin Dozunun Etkinlik Degerlendirmesi
RESEARCH ARTICLE/ARASTIRMA MAKALESI: SURGICAL MEDICAL SCIENCES/CERRAHI TIP BILIMLERI
RESEARCH ARTICLE/ARASTIRMA MAKALESI: SURGICAL MEDICAL SCIENCES/CERRAHI TIP BILIMLERI
Document Type
Clinical report
Source
Journal of Ankara University Faculty of Medicine. September 2023, Vol. 76 Issue 3, p258, 7 p.
Subject
Language
English
Abstract
Giris Spinal anestezi, sezaryen operasyonlarinda en sik kullanilan anestezi teknigidir. Spinal anestezi ile gerceklestirilen sezaryen operasyonlarindan sonra agri kontrolu icin siklikla intratekal opioidler kullanilmaktadir (1). Postoperatif agri kontrolu acisindan opioidlerin [...]
Objectives: Spinal anesthesia is the most commonly used anesthesia technique in cesarean sections and intrathecal opioids are frequently used for pain control. Intrathecal morphine provides effective and long-term pain control in the postoperative period. The aim of our study was to compare the intrathecal two different morphine doses in terms of additional analgesic need, patient satisfaction, and side effects. Materials and Methods: A total of 165 American Society of Anesthesiologists (ASA) l-ll patients who will undergo elective cesarean section at Ankara University Faculty of Medicine, Gynecology and Obstetrics Hospital were included in the study. The study was designed as prospective, randomized and double-blind. The pregnant women were randomly alloceted into three groups to receive either 50 or 100 ng intrathecal morphine and the control group. All patients were anesthetized with 10 mg hyperbaric bupivacaine. Pain levels of the patients were determined by visual analogue scale (VAS) at 24 hours postoperatively and additional analgesic needs were determined. Morphine- related side effects such as nausea-vomiting, pruritus and respiratory depression were evaluated. Results: In the postoperative period, VAS scores and additional analgesic needs were found to be significantly lower in the morphine-administered groups compared to the control group. There was no significant difference between Groups II and III in terms of these parameters. Itching and nausea-vomiting were found to be significantly higher in Group III compared to Group II. Conclusion: We found that intrathecal 50 ng morphine dose had the same analgesic efficacy as the 100 ng dose for cesarean section operations. We think that 50 ng intrathecal morphine dose is an effective analgesic dose for pain control after cesarean section, due to the lower incidence of postoperative side effects. Key Words: Caesarean, Intrathecal Morphine, Postoperative Analgesia Amac: Spinal anestezi sezaryen operasyonlarinda en sik kullanilan anestezi teknigidir. Spinal anestezi ile gerceklestirilen sezaryen operasyonlarindan sonra agri kontrolu icin siklikla intratekal opioidler kullanilmaktadir. Intratekal morfin, postoperatif donemde etkin ve uzun sureli bir agri kontrolu saglamaktadir. Calismamizin amaci sezaryen operasyonu geciren gebelerde iki fakli dozda uygulanan intratekal morfin dozunu etkinlik, ek aneljezik ihtiyac, hasta memnuniyeti ve yan etkiler acisindan karsilastirmaktir. Gerec ve Yontem: Ankara Universitesi Tip Fakultesi Kadin Hastaliklari ve Dogum Hastanesi'nde elektif sezaryen operasyonuna alinacak American Society of Anesthesiologists (ASA) l-ll toplam 165 hasta calismaya dahil edildi. Calisma prospektif, randomize ve cift kor olarak tasarlandi. Gebeler intratekal 50 mikrogram (fjg) (Grup II), 100 ng (Grup III) morfin uygulanan ve morfin uygulanmayan kontrol grubu (Grup I) olarak randomize edildi. Tum gruplara 10 mg hyperbaric bupivacaine intratekal olarak uygulandi. Hastalarin postoperatif 24 saat gorsel analog skalasi (VAS) ile agri duzeyleri saptandi, ek analjezik ihtiyaclari belirlendi. Morfine bagli bulanti-kusma, kasinti ve solunum depresyonu gibi yan etkiler degerlendirildi. Bulgular: Postoperatif donemde morfin uygulanan gruplarda VAS skorlari ve ek aneljezik ihtiyaclari kontrol grubuna gore anlamli olarak dusuk saptandi. Grup II ve III arasinda bu parametreler acisindan anlamli fark saptanmadi. Kasinti ve bulanti-kusma Grup IN'te Grup ll'ye oranla anlamli olarak yuksek saptandi. Sonuc: Sezaryen operasyonlari icin intratekal 50 ng morfin dozunun 100 ng dozla ayni analjezik etkinlikte oldugunu saptadik. Postoperatif yan etki sikliginin daha az olmasi nedeniyle 50 ng intratekal morfin dozunun sezaryen sonrasi agri kontrolunde etkin analjezik doz oldugunu dusunmekteyiz. Anahtar Kelimeler: Sezaryen, Intratekal Morfin, Postoperatif Analjezi
Objectives: Spinal anesthesia is the most commonly used anesthesia technique in cesarean sections and intrathecal opioids are frequently used for pain control. Intrathecal morphine provides effective and long-term pain control in the postoperative period. The aim of our study was to compare the intrathecal two different morphine doses in terms of additional analgesic need, patient satisfaction, and side effects. Materials and Methods: A total of 165 American Society of Anesthesiologists (ASA) l-ll patients who will undergo elective cesarean section at Ankara University Faculty of Medicine, Gynecology and Obstetrics Hospital were included in the study. The study was designed as prospective, randomized and double-blind. The pregnant women were randomly alloceted into three groups to receive either 50 or 100 ng intrathecal morphine and the control group. All patients were anesthetized with 10 mg hyperbaric bupivacaine. Pain levels of the patients were determined by visual analogue scale (VAS) at 24 hours postoperatively and additional analgesic needs were determined. Morphine- related side effects such as nausea-vomiting, pruritus and respiratory depression were evaluated. Results: In the postoperative period, VAS scores and additional analgesic needs were found to be significantly lower in the morphine-administered groups compared to the control group. There was no significant difference between Groups II and III in terms of these parameters. Itching and nausea-vomiting were found to be significantly higher in Group III compared to Group II. Conclusion: We found that intrathecal 50 ng morphine dose had the same analgesic efficacy as the 100 ng dose for cesarean section operations. We think that 50 ng intrathecal morphine dose is an effective analgesic dose for pain control after cesarean section, due to the lower incidence of postoperative side effects. Key Words: Caesarean, Intrathecal Morphine, Postoperative Analgesia Amac: Spinal anestezi sezaryen operasyonlarinda en sik kullanilan anestezi teknigidir. Spinal anestezi ile gerceklestirilen sezaryen operasyonlarindan sonra agri kontrolu icin siklikla intratekal opioidler kullanilmaktadir. Intratekal morfin, postoperatif donemde etkin ve uzun sureli bir agri kontrolu saglamaktadir. Calismamizin amaci sezaryen operasyonu geciren gebelerde iki fakli dozda uygulanan intratekal morfin dozunu etkinlik, ek aneljezik ihtiyac, hasta memnuniyeti ve yan etkiler acisindan karsilastirmaktir. Gerec ve Yontem: Ankara Universitesi Tip Fakultesi Kadin Hastaliklari ve Dogum Hastanesi'nde elektif sezaryen operasyonuna alinacak American Society of Anesthesiologists (ASA) l-ll toplam 165 hasta calismaya dahil edildi. Calisma prospektif, randomize ve cift kor olarak tasarlandi. Gebeler intratekal 50 mikrogram (fjg) (Grup II), 100 ng (Grup III) morfin uygulanan ve morfin uygulanmayan kontrol grubu (Grup I) olarak randomize edildi. Tum gruplara 10 mg hyperbaric bupivacaine intratekal olarak uygulandi. Hastalarin postoperatif 24 saat gorsel analog skalasi (VAS) ile agri duzeyleri saptandi, ek analjezik ihtiyaclari belirlendi. Morfine bagli bulanti-kusma, kasinti ve solunum depresyonu gibi yan etkiler degerlendirildi. Bulgular: Postoperatif donemde morfin uygulanan gruplarda VAS skorlari ve ek aneljezik ihtiyaclari kontrol grubuna gore anlamli olarak dusuk saptandi. Grup II ve III arasinda bu parametreler acisindan anlamli fark saptanmadi. Kasinti ve bulanti-kusma Grup IN'te Grup ll'ye oranla anlamli olarak yuksek saptandi. Sonuc: Sezaryen operasyonlari icin intratekal 50 ng morfin dozunun 100 ng dozla ayni analjezik etkinlikte oldugunu saptadik. Postoperatif yan etki sikliginin daha az olmasi nedeniyle 50 ng intratekal morfin dozunun sezaryen sonrasi agri kontrolunde etkin analjezik doz oldugunu dusunmekteyiz. Anahtar Kelimeler: Sezaryen, Intratekal Morfin, Postoperatif Analjezi