182. Efficacy of intrathecal neostigmineand fentanyl for the relief of pain intransurethral resection of prostate
Email: [email protected] of Anaesthesiology and ReanimationTeaching and Research Hospital, Istanbul. korkadi sk.turizm sitesi 4.blok No:13 ulus/ istanbul Turkey
Introduction: We evaluated the analgesic efficancy and safety ofintrathecal (IT) neostigmine and IT fentanyl for the relief of painand postoperative nausea and vomiting (PONV) in transurethralresection of prostate (TURP).
Methods: Our study was performed in 45 patients of ASA I- IIIundergoing transurethral procedures were randomly assigned tothree equal groups which received IT %5 hyperbaric bupivacaine10mg with either normal saline 1ml, neositigmine 25�g, or fenta-nyl 50�g The onset of anaesthesia, duration of analgesia, time touse of first rescue analgesics, the overall 24h VAS pain scores andthe incidance of side effects were recorded for 24h postdrug ad-ministrtion.
Results: There were no statistically significant difference in onset ofanesthesia, maximal level of sensory block among the three groups.The duration of analgesia in the fentanyl and neostigmine groupswere prolonged to the saline group. Compered with the salinegroup, the fentanyl and neostigmine groups also showed a lateronset of postsurgical pain, lower overall 24h VAS pain score andprolonged time to first rescue analgesic, and first rescue analgesic inthe fentanyl group prolonged relative to the neostigmine group.The incidence of treatment for PONV was greater in patients re-ceiving neositigmine (44%) than receiving saline (2%) and fenta-nyl (15%)(p� 0.05).
Conclusion: we conclude that neostigmine 25�g, and fentanyl50�g with bupivacain produced an effective spinal analgesia forTURP. However, IT neostigmine increased incidence of nausea orvomiting was limited for clinical use.
183. Comparison of volume preloadingwith lactated Ringer’s versus differenttypes of hydroxyethylstarch before spinalanaesthesia
Sivrikaya G, Dobrucali H, T. kilinc L, K. erol M, Hanci A,Burgutoglu BEmail: [email protected] Etfal Education and Research Hospital, Departmentof 2.Anaesthesiology and Reanimation Istanbul TURKEY
Introduction: Hypotension is a frequent problem following spinalanaesthesia. One of the techniques to prevent hypotension is,intravascular volume expansion using intravenous fluid (“pre-load”) before spinal anaesthesia. The aim of this study was todetermine if there was a difference between crystaloid and differentcolloid solutions on the effectiveness of prevention.
Methods: The study was approved by the Medical Ethics Commit-tee of the hospital and informed patient consent was obtained. 60patients were allocated randomly to three groups to receive either;10 ml.kg-1 lactated Ringer’s solution in Group I or 10 ml.kg-1 6%hydroxyethylstarch 200/0.5 in Group II or 10 ml.kg-1 6% hy-droxyethylstarch 130/0.4 in Group III before spinal anaesthesia.Systolic and diastolic blood pressure, heart rate were recorded at 10minutes intervals pre and peroperatively and then every 15 min-utes for 2 hours postoperatively. Hypotension was defined as adecrease of 30% or more below baseline values or �90 mmHg(systolic blood pressure) and was treated by intravenous ephedrinebolus doses. The incidence of hypotension, number of patientsrequired a vasopressor and doses of ephedrine required to restoreblood pressure were recorded. Nausea and vomiting were observedas adverse effects. Repeated measures of ANOVA, chi square testswere used for the statistical analyses. p�0.05 considered as signif-icant.
Results: The incidence of hypotension was significantly higher inGroup I when compared with Group II and III. It was lower inGroup III than Group II but the difference was not significant.Bradycardia was more frequent in Group I than Group II and III.Number of patients and doses of ephedrine required was signifi-cantly higher in Group I than Group II and III. These data werelower in Group III than Group II, but the difference was notsignificant. The incidence of nausea and vomiting was similar in allthree groups.
Conclusion: Fluid preloading considered to be a safe and effectivemethod of reducing the incidence hypotension induced by spinalanaesthesia. The results of our study showed that colloid solutionsare more effective on prevention of hypotension than crystaloidsolution in spinal anaesthesia and 6% hydroxyethylstarch 130/0.4appears to be superior to 6% hydroxyethylstarch 200/0.5 in thisindication.
54 Posters • Central Nerve Blocks
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