Histeroskopi Girişimlerinde Remifentanil Infüzyonu Ile Paraservikal Blok Kombinasyonunda Premedikasyonun Etkisi: Erken Dönem Sonuçlarinin Deǧerlendirilmesi

Hysteroscopy is a short procedure with predictable pain that has to be relieved. In the present study, we aimed to investigate the efficacy of intravenous remifentanil infusion with paracervical block (PCB) and the contribution of meperidine premedication on this technique in patients undergoing hysteroscopy. Twenty-five, ASA I-II patients scheduled for hysteroscopy were divided into two groups as premedicated with im 50 mg meperidine (Group I, n=13) or unpremedicated (Group II, n=12). After the intravenous remifentanil infusion of 0.25 μg kg^-1 min^-1, when the patient complained from dizziness, 2 mL of 1% lidocaine to the 12 o'clock and 10 mL to the 3 and 9 o'clock positions of the cervix were administered for PCB. Respiratory and cardiovascular functions including heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO₂), end tidal carbon dioxide (ETCO₂) were recorded preoperatively and intraoperatively at specific time points up to 30 minutes post-operative. The degree of sedation and pain intensity were determined. Intra- and post-operative side effects and the amount of remifentanil used were noted. HR recorded at the time of PCB and MAP at the onset of hysteroscopy and the post-operative 30th minute increased significantly in Group II (p<0.05). In Group II, SpO₂ significantly decreased at the onset of remifentanil infusion, dizziness, and at the beginning of the hysteroscopy with respect to Group I, but they remained within normal clinical limits. ETCO₂ values of Group II were significantly higher than those of Group I at certain time points (PCB, hysteroscopy onset, resection, end of hysteroscopy, postoperative 10th and 20th min). Median sedation scores and VAS were comparable in both groups. There were no significant differences in the incidence of intra- and post-operative side effects between the groups. The combination of PCB with remifentanil infusion with or without meperidine premedication provided sufficient analgesia for hysteroscopy without any major side effects and with high rates of patient and surgeon satisfaction.