www.medenosrce.net/arhimed   arhimed(a-t>medenosrce.net   [22/04/2026 01:33:26] http://www.medenosrce.net/arhimed/poglej.asp?id=161 PRIMERJAVA DVEH POOPERATIVNIH PROTIBOLECINSKIH SHEM PO SUBARAHNOIDNEM BLOKU ZARADI POŠKODBE SPODNJIH OKONCIN Avtor: Vesna Gorup Mentor: prof. dr. Aleksander Manohin Somentor: asist. mag. Dušan Vlahovic IZHODIŠCE: Za oskrbo poškodb spodnjih udov se pogosto odlocamo za podrocno anestezijo s subarahnoidnim blokom. Po koncanem operativnem posegu ostane operirani ud še nekaj ur omrtvicen in nebolec. Ko zacne blok popušcati, se pojavijo znaki popušcanja bloka (mravljincenje, obcutek toplote ipd.), brez analgezije pa bi se postopoma razvila bolecina. S casovno pravilnim uvajanjem analgeticne mešanice tramadola in metamizola želimo bolecino izniciti ali jo omiliti do povsem znosne mere. NAMEN: Namen naloge je bilo ugotoviti, ali je s stališca zaznavanja bolecine smiselno uvajati pooperativno analgezijo takoj po operaciji ali takrat, ko se pokažejo prvi znaki popušcanja subarahnoidnega bloka, a se bolecina še ni razvila. HIPOTEZA: Pooperativno analgezijo je smiselno uvajati ob prvih znakih popušcanja subarahnoidnega bloka (preden se razvije bolecina) in ne rutinsko že ob koncu operacije. V raziskavi smo izhajali iz nicelne predpostavke, da med obema shemama ni razlike. METODE: V prospektivno, randomizirano, dvojno slepo klinicno študijo smo vkljucili 40 bolnikov s poškodbami spodnjih okoncin, pri katerih je bil opravljen operativni poseg v podrocni anesteziji (subarahnoidni blok) ter so pisno privolili na sodelovanje v študiji. Bolnike smo nakljucno razdelili v preiskovano in kontrolno skupino. Preiskovana skupina je dobila intravensko analgeticno mešanico tramadola in analgina ob prvih znakih popušcanja bloka, kontrolna skupina pa ob koncu operacije. Opazovali smo pojavnost in jakost bolecine ob zacetku popušcanja bloka, najhujšo bolecino v dnevu po operaciji in pojavnost in jakost bolecine 24 ur po operaciji. Beležili smo tudi potrebo po rešilnem analgetiku. Rezultate pojavnosti smo statisticno obdelali s testom ocenjevanja proporca populacije hi-kvadrat, jakosti pa z analizo variance in z dvosmernim Studentovim testom t. REZULTATI: Pojavnost in jakost bolecine ob zacetku popušcanja bloka pri preiskovani in kontrolni skupini se ne razlikujeta statisticno signifikantno. Ravno tako ni signifikantne razlike med jakostjo najhujše bolecine v dnevu po operaciji, ki so jo izkusili preiskovanci preiskovane in kontrolne skupine. Tudi pojavnost in jakost bolecine pri preiskovancih obeh skupin 24 ur po operaciji se ne razlikuje statisticno signifikantno. Potreba po rešilnem analgetiku je bila v obeh skupinah enako pogosta. ZAKLJUCEK: Iz opravljenega raziskovalnega dela zakljucujemo, da sta ocenjevani shemi uvajanja pooperativne analgezije po operaciji spodnjih okoncin v subarahnoidnem bloku enakovredni. S stališca ocenjevanja bolecine je nepomembno, ali dobi operiranec analgeticno mešanico takoj po operaciji ali šele ko zacne blok popušcati, vendar pred pojavom bolecine. Menimo, da je zaradi manjšega izpostavljanja operiranca neželenim ucinkom in zaradi ekonomskih vidikov primernejše uvajati pooperativno analgezijo ob zacetku popušcanja subarahnoidnega bloka. «» [Abstract / English version] PRIMERJAVA DVEH POOPERATIVNIH PROTIBOLECINSKIH SHEM PO SUBARAHNOIDNEM BLOKU ZARADI POŠKODBE SPODNJIH OKONCIN Author: Vesna Gorup Mentor: prof. dr. Aleksander Manohin Co-mentor: asist. mag. Dušan Vlahovic BACKGROUND: Regional anesthesia with subarachnoid block is a technique commonly applied for the operation of lower limbs trauma. After the procedure the limb remains numb and painless for some hours. When the block abates, patients experience tingling and warmth in both limbs and without analgesia, pain would gradually evolve. With the appropriate induction analgesia (drug combination of metamizol and tramadol) we wish to obtain a pain-free postoperative period or to keep it on an acceptable level. AIM: The aim of this work was to determine, whether it is more reasonable to induce analgesia immediately at the end of the operation or by the first signs of the block abatement before pain evolves. HYPOTHESIS: The postoperative analgesia should be induced by the first signs of the block abatement (before the pain evolves) and not routinely at the end of operation. The zero-hypothesis we adopted was that there is no difference between the two induction schemes. METHODS: 40 patients with lower limb injury have been included in a prospective, randomized, double blind study. All patients involved in the study have been operated in a regional anesthesia (subarachnoid block) and have given an informed consent. The patients have been randomly devided in two groups. By the patients in the studied group the intravenous analgetic combination of tramadol and metamizol was given at the first signs of the block abatement, while by the control group the same analgesia was given at the end of the operation. The incidence and intensity of pain has been evaluated at the first signs of the block abatement and 24 hours after the procedure. Maximum pain intensity in 24 hours and the incidence of need of rescue analgesia have also been recorded. The incidence data have been statistically analyzed by population proportion hi-square test and the intensity of pain by variance analysis Student's t-test. RESULTS: Pain incidence and intensity at the first signs of the block abatement have not shown statistically significant difference in the studied and control group. There is also no significant difference between the intensity of maximum pain in the day after the procedure in the compared groups. Furthermore, no significant difference has been found with regards to the pain incidence and intensity 24 hours after the procedure. The need of rescue analgesia was of the same frequency. CONCLUSIONS: The evaluated schemes of postoperative analgesia after the lower limbs operation in subarachnoid block can be concluded equal. Taken pain incidence and intensity in consideration, there is no significant difference whether the analgesia is induced immediately after the operation or when the block starts to abate, as long as it is given before pain evolves. It is however our opinion, that it is more suitable to induce analgetic treatment at the first signs of the block abatement. In this way patient is exposed to the side effects of the drugs for a shorter amount of time and form the economic point of view this scheme is also favorable.