Assessment of epidural analgesia and recovery after major spinal surgery: Comparison of bupivacaine-fentanyl and bupivacaine-fentanyl-methylprednisolone acetate combinations Major spinal cerrahide epidural analjezi ve derlenmenin deǧerlendirilmesi: Bupivakain-fentanil ve bupivakain-fentanil-steroid kombinasyonunun karşilaştirilmasi

Şahinkaya H. H., Özgencil E., ATTAR A., Yörükoǧlu D., Keçir Y.

Anestezi Dergisi, cilt.25, sa.3, ss.131-137, 2017 (Scopus) identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 25 Sayı: 3
  • Basım Tarihi: 2017
  • Dergi Adı: Anestezi Dergisi
  • Derginin Tarandığı İndeksler: Scopus, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.131-137
  • Anahtar Kelimeler: Bupivacaine, Major spinal surgery, Methylprednisolone acetate, Patient controlled epidural analgesia, Postoperative pain
  • Ankara Üniversitesi Adresli: Evet

Özet

Objective: We compared bupivacaine-fentanyl and bupivacaine-fentanyl-methylprednisolone acetate combinations in order to evaluate epidural analgesia and emergence after major spinal surgery. Method: Twenty-four patients, aged between 18-70 years, ASA I-II status, undergoing posterior fusion surgery of lumbar and/or lower thoracic regions of the spine were enrolled in the study. Patients were randomly allocated into two groups via sealed envelope technique. After the patients were anesthetized, epidural catheter was introduced through two segments above the surgical site and pulled out subcutaneously. Both groups recieved epidural bupivacaine-fentanyl solution intraoperatively. Group II recieved additional 80 mg methylprednisolone acetate before the initiation of the surgery. Postoperative pain was managed via patient-controlled epidural analgesia for 48 hours. Pain parameters were assessed by visual analog scale (VAS) and verbal rating scale (VRS). Rescue medication of 1 gr metamizole intramuscular was delivered when VAS>4. Demand, delivery, total volume of epidural infusion and additional analgesic requirement, side effects were noted. Patient satisfaction about the analgesic technique were noted. Results: Demographic data, hemodynamic parameters, blood loss, number of transfusion were similiar among groups. Extubation time and emergence time were also similar between the two groups. There was no difference in the postoperative hemodynamic parameters. Although there was no difference in VAS data between the groups, VAS at 24th hour in Group II was significantly lower (p=0.004). Delivery data for PCA settings were analogous among groups but demand was lower in Group II compared to Group I. Although side effects were similar nausea was seen in Group I higher than in Group II. 87.5% of the patients were satisfied about the pain management. Conclusion: We conclude that patient controlled epidural analgesia is a reliable and effective technique for postoperative pain management. Epidural administration of steroids reduce PCA demand, but has no significant effect on VAS parameters.