İskemik Kolon Anastomoz İyileşmesinde Tramadol Hidroklorür Etkisi
[ X ]
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
In patients who are operated under emergency or elective conditions after reasons such as ileus, bleeding, colorectal malignancy or trauma, anastomosis can be performed together with segmental bowel resection, and separation or separation of this anastomosis in the postoperative period is one of the important complications with high mortality and morbidity. The minimal level of ischemia / reperfusion damage occurring in the postoperative period will have a positive effect on the healing process of the anastomosis. Studies on factors contributing to wound healing have increased in order to prevent complications that we may encounter in the postoperative period in colon anastomoses. Tramadol hydrochloride is considered a weak opioid analgesic and has serotonin and noradrenaline reuptake inhibition. It is a drug used to treat moderate to severe pain, usually in the postoperative period. Our aim in this study is to show the effect of tramadol hydrochloride, an opioid analgesic drug, on inflammation and colon anastomosis healing in a reperfused rat model after distant ischemia / reperfusion injury. Method: 24 Winstar Albino rats will be included in the study, and the rats will be divided into two groups. Group 1: Intraperitoneal normal saline will be administered daily for 5 days postoperatively. Group 2: Tramadol hydrochloride 30 mg/kg will be administered intraperitoneally every day for 5 days postoperatively. In our study, according to the experimental model plan prepared according to the experimental model used in the study Effects of montelukast on the healing of ischemic colon anastomoses, Atilla Celik, American Journal of Surgery, 2013 Oct;206(4):502-8, 24 rats with the same characteristics were swam from the 14th day before the study. From the beginning to the end of the work, it will be subjected to a 12-hour day-night cycle at 21±3º C room temperature, 60% ideal humidity. After completing the feeding under the specified conditions for 14 days, two groups of 12 will be formed from the rats, with an equal number of controls and experiments (the group to which Tramadol hydrochloride will be administered) by simple random sampling method. Intramuscular dissociative anesthesia will be created with 50 mg/kg ketamine hydrochloride for all rats. After shaving the skin of the rats in the supine position, antisepsis will be provided with 10% povidone iodine. Sterility conditions will be ensured throughout the surgery and spontaneous respiration of the rats will be allowed. All rats will be subjected to a 5 cm midline incision by laparotomy and the superior mesenteric artery and collateral vessels will be clamped from the distal aorta with the help of a microvascular clamp for 45 minutes, then the clamps will be released and 45 minutes will be allowed for reperfusion. After reperfusion, a full-thickness incision will be made in the left colon segment 3 cm proximal to the peritoneal reflection of all animals and anastomosis will be made one by one with 6/0 monofilament propylene sutures. In the postoperative period after left colon anastomosis, rats in the first group will receive 1 cc intraperitoneal saline once a day, and 30 mg/kg 1 cc intraperitoneal Tramadol hydrochloride will be administered to the rats in the second group once a day for 5 days. The anastomosis line in the left colon segment will be resected together with the proximal and distal regions of two centimeters each, by entering the abdomen through the incision on the 6th postoperative day before. All rats will be sacrificed by intracardiac blood puncture. Burst pressures will be measured to determine clinical recovery from the removed anastomosis intestinal segment. After the fecal content in the left colon intestinal segment lumen is washed with physiological saline, the distal end of the anastomosis will be tied, the proximal part will be integrated into the catheter tip, infusion pump, pressure manometer, monitor system and burst pressures will be recorded. As a biochemical examination from blood samples taken by intracardiac puncture during the sacrification of rats according to the experimental model plan; catalase, nitric oxide, glutathione, reductase, Superoxide Dismutase, TNFα, IL-6, AST, ALT, Hydroxyproline, Myeloperoxidase, Malondialdehyde, Caspase-3 will be checked and their effectiveness will be measured. In the statistical evaluation, the data obtained after the study will be used using the SPSS 21.0 (SPSS Inc., Chicago, IL, USA) package program and the mean, median, standard deviation, minimum, maximum, percentage values of all data will be calculated. Normality tests of the subjects' data will be done with the Kolmogorov-Smirnov test, and Mann Whitney U test will be used to evaluate the difference between the groups of non-parametric data of the subjects (p<0.05). Parametric data will be analyzed with Independent Samples t test (p<0.05).
