Bora BİLAL, Özgür YAĞAN, Mahinur Demet ALBAYRAK, Belgin AKAN TUNÇTÜRK, Nermin GÖĞÜŞ

Transüretral Cerrahide Spinal Anestezide Ropivakain ve Levobupivakainin Karşılaştırılması

Amaç: Çalışmamızda prostatın transüretral rezeksiyon (TUR-P) cerrahisinde spinal anestezide kullanılan levobupivakain ve ropivakainin etkinliklerinin karşılaştırılması amaçlandı.Gereç ve Yöntemler: Prospektif, randomize çift kör olarak ASA I-III risk grubunda 40 hasta çalışmaya dahil edildi. I. Grupta (n=20) intratekal aralığa % 0.75’lik levobupivakain 7.5mg, ikinci grupta % 0.75 ‘lik ropivakain 7,5 mg verilerek spinal anestezi uygulandı. Bulgular: Gruplar arasında duyusal bloğun T10’a ulaşma süreleri, maksimum blok seviyesi, maksimum bloğa ulaşma süreleri, operasyon sonu motor blok seviyesi bakımından istatistiksel olarak anlamlı fark yoktu. İki segment regresyon süresi, grup I’de 73,25 ± 15,50 dk, Grup II’de 53,75 ± 10,75 dk, T12’ye regresyon süresi grup I’de 88,00 ± 20,42 dk, grup II’de 70,25±17,05 dk, motor blok süresi ise grup I’de 92,00±26,03 dk, grup II’de 60,75±36,93 dk. bulundu. Hemodinamik veriler ve yan etkiler bakımından istatistiksel olarak anlamlı fark saptanmadı. Sonuç: Çalışmamızda; düşük doz levobupivakain veya ropivakain ile yapılan spinal anestezide TUR için yeterli duyusal ve motor blok sağlandı. Ropivakain grubunda motor blok süresi anlamlı olarak kısa bulundu. Sonuç olarak transüretral cerrahide kullanılan düşük doz ropivakain ve levobupivakain’in birbirine benzer etkilerinin olduğu, yeterli seviyede ve güvenilir anestezi sağladığı, ancak motor blok süresinin kısa olması nedeniyle ropivakain kullanılmasının bir avantaj olduğu kanısına varıldı.

Anahtar Kelimeler:

Spinal anestezi, Prostat Transüretral Rezeksiyon (TUR-P), Ropivakain, Levobupivakain

The Comparison of Spinal Ropivacaıne and Levobupivacaine for Transurethral Surgery

Objective. It was aimed to compare the efficacy of levobupivacaine and ropivacaine during transurethral resection of the prostate under spinal anesthesia.Material and Methods: In this prospective, randomized, double-blind trial, 40 patients undergoing elective transurethral resection of the prostate under spinal anesthesia were randomized into two groups. 0.75% levobupivacaine 7.5mg (Group I) and 0.75% ropivacaine 7.5mg (Group II) were used intrathecally.Results: There were no differences the time for sensorial block to reach T10, maximum sensorial block level, the time to reach maximum block level, motor block level at the end of surgery between the groups. The two-segment regression time was 53.75 ± 10.75 minutes in Group I and 73.25 ± 15.50 minutes in Group II (p<0.000), the regression time to reach T12 was 70.25±17.05 minutes in Group I and 88.00 ± 20.42 in Group II (p<0.005), the duration of the motor block was 60.75±36.93 minutes in Group I and 92.00±26.03 minutes in Group II (p<0.004). There was not any significant difference between groups with regard to hemodynamic data and side effects. Conclusions: This study showed that, low-dose levobupivacaine and ropivacaine used in transurethral surgery have similar effects and delivers sufficient and reliable anesthesia. Use of ropivacaine constitutes an advantage since the motor blockage level is shorter with it. As a result, it was concluded that low-dose ropivacaine and levobupivacaine used in transurethral surgery had similar effects, provided adequate and reliable anesthesia, but ropivacaine was an advantage because of the short duration of motor block.

Keywords:

Spinal anaesthesia, Transurethral resection of the prostate, Ropivacaine, Levobupivacaine,

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1. Dobson PM, Caldicott LD, Gerrish SP, et al: Changes in hemodynamic variables during transurethral resection of the prostate: Comparison of general and spinal anesthesia. Br J Anesth 1994;72:2672.
2. Gravenstein D: Transurethral resection of the prostate (TURP) syndrome: A review of the patophysiology and management. Anesth Analg 1997;84:438
3. McLure HA, Rubin AP: Review of local anaesthetic agents. Minerva Anesthesiol. 2005; 71: 59-74.
4. McClellan KJ, Faulds D: Ropivacaine: an update of its use in regional anaesthesia. Drugs 2000;60: 1065-1093.
5. Foster RH, Markham A. Levobupivacaine: A Review of its Pharmacology and Use as a Local Anaesthetic. Drugs 2000 Mar; 59 (3): 551-579.
6. Wahedi W, Nolte H, Klein P: Ropivacaine for spinal anesthesia. A dose –finding study. Anaesthesist. 1996 Aug; 45(8):737-44.
7. Sell A, Olkkola K T, Jalonen J, Aantaa R. Minimum effective local anaesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery. Br J of Anaest.2005; 94 (2): 239–42
12. Chung CC, Choi SR, Yeo KW, Park HS: Hyperbaric Spinal Ropivacaine for Cesarean Delivery: A Comparison to Hyperbaric Bupivacaine. Anesth Analg. 2001;93:157–61
9. Cappelleri G, Aldegher G, Danelli G, Marchetti C: Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: A prospective, randomized, double-blind study. Anesth Analg. 2005; 101: 77–82
10. Casati A, Moizo E, Marchetti C, Vinciguerra F, A prospective randomize, double-blind comporison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine or levobupivacaine for inguinal herniorrhaphy.Anaesth Analg 2004; 99: 1387-1392
11. Heef JW, Veering BT, Anton GL. Spinal Anesthesia with Ropivacaine: A Double-Blind Study on the Efficacy and Safety of 0.5% and 0.75% Solutions in Patients Undergoing Minor Lower Limb Surgery. Anesth Analg 1994;78: 1125-30
13. McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafson U. Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml(-1) with bupivacaine 5 mg ml (-1) for major orthopaedic suegery. Br J Anaesth 2002;89:702-6
14. Glasser C, Marhofer P, Zimpfer G, et al: Levopupivacaine versus racemic Bupivacaine for spinal anaesthesia. Anaesth Anal 2002; 94: 194-198
15. Lee YY, Muchhal K, Chan CK: Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intensive Care. 2003; 31(6): 637-641