Kvalitet analgezije nakon hirurškog vađenja donjih umnjaka: randomizovana, duplo slepa studija efikasnosti levobupivakaina, bupivakaina i lidokaina sa adrenalinom
Sažetak
Uvod/Cilj. Hirurško vađenje donjih impaktiranih umnjaka praćeno je bolom umerenog do jakog intenziteta, sa maksimalnim intenzitetom tokom prvih 12 sati, koji ima značajan uticaj na kvalitet života pacijenata u postoperativnom periodu. Upotreba dugodelujućih lokalnih anestetika predstavlja obećavajuću strategiju za poboljšanje postoperativne analgezije. Cilj ove studije bio je da se ispitaju analgetički parametri i zadovoljstvo pacijenata postignutom analgezijom u postoperativnom periodu nakon primene 0,5% levobupivakaina (Lbup), 0,5% bupivakaina (Bup) i 2% lidokaina sa epinefrinom (1: 80,000) (Lid + Epi) za sprovodnu anesteziju donjeg alveolarnog nerva prilikom hirurškog vađenja donjih umnjaka. Metode. Ukupno 102 pacijenta (ASA I) bila su podeljena u tri grupe u zavisnosti od primljenog anestetika: 3 mL Lbup, 3 mL Bup ili 3 mL Lid + Epi. Intenzitet postoperativne analgezije registrovan je primenom verbalne rangirajuće skale (VRS). Zabeležena je ukupna količina primenjenih analgetika nakon prvog i sedmog postoperativnog dana. Zadovoljstvo pacijenata ocenjivano je na osnovu modifikovanih verbalnih skala. Rezultati. Značajno jači intenzitet postoperativnog bola zabeležen je u grupi Lid + Epi, u poređenju sa grupama Lbup i Bup. Značajno smanjenje potrebe za analgeticima u postoperativnom periodu zabeleženo u grupama Lbup i Bup (50%) u poređenju sa grupom Lid + Epi (80%) nakon 24 časa. Značajno smanjenje potrebe za postoperativnim analgeticima u grupama Lbup i Bup zabeleženo je i nakon 7 dana. Potpuno zadovoljstvo pacijenata postignutom analgezijom bilo je značajno slabije u grupi Lid + Epi (10%) u poređenju sa grupama Lbup (56%) i Bup (52%). Zaključak. Upotreba novog dugodelujućeg lokalnog anestetika 0,5% levobupivakaina klinički je relevantna i efikasna za sprovodnu anesteziju donjeg alveolarnog nerva i kontrolu postoperativnog bola nakon hirurškog vađenja donjih umnjaka. U našoj studiji Lbup i Bup bili su efikasniji u kontroli postoperativnog bola nakon hirurškog vađenja donjih umnjaka u poređenju sa Lid + Epi.
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