Postperatif ağrı tedavisinde, hasta kontrollü analjezi yöntemi ile kullanılan tramadol, tramadol-metamizol, tramadol-lornoksikamın karşılaştırılması
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Tarih
2006
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Majör cerrahi girişim geçiren hastalarda, erken postoperatif dönemde tek başına NSAİİ ve antipiretik ajanların kullanımı yetersiz kalmaktadır. Ancak opioid analjeziklerle de solunum depresyonu başta olmak üzere istenmeyen komplikasyon riski fazladır. Bu nedenle, istenmeyen yan etkileri azaltarak etkin bir analjezi sağlamak için çeşitli analjezik ilaç kombinasyonları kullanılmaktadır. Bu çalışmada, alt abdominal cerrahi girişimlerde, intravenöz. HKA yöntemi ile uygulanan tramadol ile tramadol-metamizol ve tramadol-lornoksikam kombinasyonlarının postoperatif analjezik etki ve yan etkilerinin karşılaştırılması amaçlandı. Etik kurul onayı ile çalışmaya dahil edilen, ASA I-II grubu, 20-60 yaşları arasında, 60 hasta. randomize olarak 3 gruba ayrıldı. Grup I (n=20): 50 ml izotonik içinde 500 mg tramadol (10 mg/ml tramadol) Grup II (n=20): 50 ml izotonik içinde 250 mg tramadol+3000 mg metamizol (5 mg/ml tramadol+60 mg/ml metamizol) Grup III (n=20): 50 ml izotonik içinde 250 mg tramadol+20 mg lornoksikam (5 mg/ml tramadol+0,4 mg/ml lornoksikam ) bulunan solüsyonlar hazırlandı. Yükleme dozu operasyon bitiminden 40 dakika önce 10 ml olarak uygulanan, tüm gruplarda; bolus doz 2 ml, kilitlenme süresi 15 dakika ve 24 saatlik maksimum ilaç volümü 40 ml olarak programlandı. HKA cihazı, ilk ağrı yakınmasında intravenöz olarak takıldı. Postoperatif ilk saatte, 15 dakika aralıklarla, daha sonra 2., 4., 8., 12., 18., 24. saatlerde vizüel analog skala (VAS) ve verbal ağrı skoru (VRS) ile ağrı takibi yapıldı. Eş zamanlı olarak, bulantı-kusma, sedasyon-memnuniyet skorları, vital bulgular ve yan etkiler ile toplam analjezik tüketimleri kaydedildi. İstatistiksel incelemede tek yönlü vi varyans analizi (One Way Anova) ve Post Hoc Bonferroni ile Kruskal Wallis testleri kullanıldı. P < 0,05 anlamlı kabul edildi. Bu çalışmada, postoperatif ağrı skorları, ilk analjezik gereksinim zamanları, periferik oksijen saturasyonları ve kalp atım hızları bakımından, gruplar arasında anlamlı bir farklılık yoktu. Toplam tramadol tüketimi, uyanma dönemindeki postoperatif bulantı ve kusma sıklığı ile antiemetik gereksinimi, Grup I'de diğer gruplara göre anlamlı derecede yüksek bulundu (p< 0,05). Sonuç olarak; postoperatif ağrı kontrolünde, intravenöz HKA yöntemi ile uygulanan tramadol-metamizol ve tramadol-lornoksikam kombinasyonlarının, tramadol gereksinimini azaltarak, daha az yan etki ile etkin bir analjezi sağladığı kanaatine varıldı. Anahtar kelimeler: Tramadol, metamizol, lornoksikam, hasta kontrollü analjezi (HKA), postoperatif ağrı
For patients who has undergone major surgery, NSAIDs and antipyretic agents alone are insufficient in early postoperative period. However, with opiod analgesics, there is a high risk of complications such as respiratory depression as the leading one. Thereof, various analgesic drug combinations are used to diminish the undesired side effects and establish an efficient analgesia. In this study, our aim was to compare the analgesic and side effects of tramadol and combinations of tramadol-metamizol and tramadol-lornoxicam, all of which were administered by intravenous PCA method, in lower abdominal surgeries. 60 patients, in ASA I-II group (age 20-60 years) who were included in the study by approval of ethic commitee, were randomly divided into three groups. The solutions were prepared containing 500 mg tramadol in 50 ml saline (10 mg/ml tramadol) for Group I (n=20), 250 mg tramadol+3000 mg metamizol in 50 ml saline (5 mg/ml tramadol+60 mg/ml metamizol) for Group II (n=20) and 250 mg tramadol+20 mg lornoxicam in 50 ml saline (5 mg/ml tramadol+0.4 mg/ml lornoxicam) for Group III (n=20). In all groups the loading dose (10 ml) was administered 40 minute before the end of operation; bolus dose, lockout period and 24 hour maximum drug volume were programmed as 2 ml, 15 mins and 40 ml, respectively. PCA device was placed intravenously at the first complaint of pain. Pain follow-up was done by visual analog scale (VAS) and verbal rating scale (VRS) in every 15 minute intervals at the first hour and later at 2nd, 4th, 8th, 12th, 18th and 24th hours of postoperative period. Simultaneously, nausea-vomiting, sedation-contentment scores, vital statistics, side-effects and total analgesic viii consumptions were recorded. One way variance analysis (One Way Anova), Post Hoc Bonferroni and Kruskal Wallis tests were used for statistical analysis. p<0.05 was accepted as statistically significant. In this study, there were no significant differences between groups in terms of time of the first analgesic need, periferic oxygen saturations and heart rates. Total tramadol consumption, postoperative nausea and vomiting rate and antiemetic needs during postoperative recovery period were significantly higher in group I than the others (p<0.05). Consequently, it was concluded that the combinations of tramadol-metamizol and tramadol-lornoxicam which were administered by intravenous PCA method provides effecient analgesia and less side effects by reducing the need of tramadol. Keywords : Tramadol, metamizol, lornoxicam, Patient Controlled Analgesia (PCA), postoperative pain
For patients who has undergone major surgery, NSAIDs and antipyretic agents alone are insufficient in early postoperative period. However, with opiod analgesics, there is a high risk of complications such as respiratory depression as the leading one. Thereof, various analgesic drug combinations are used to diminish the undesired side effects and establish an efficient analgesia. In this study, our aim was to compare the analgesic and side effects of tramadol and combinations of tramadol-metamizol and tramadol-lornoxicam, all of which were administered by intravenous PCA method, in lower abdominal surgeries. 60 patients, in ASA I-II group (age 20-60 years) who were included in the study by approval of ethic commitee, were randomly divided into three groups. The solutions were prepared containing 500 mg tramadol in 50 ml saline (10 mg/ml tramadol) for Group I (n=20), 250 mg tramadol+3000 mg metamizol in 50 ml saline (5 mg/ml tramadol+60 mg/ml metamizol) for Group II (n=20) and 250 mg tramadol+20 mg lornoxicam in 50 ml saline (5 mg/ml tramadol+0.4 mg/ml lornoxicam) for Group III (n=20). In all groups the loading dose (10 ml) was administered 40 minute before the end of operation; bolus dose, lockout period and 24 hour maximum drug volume were programmed as 2 ml, 15 mins and 40 ml, respectively. PCA device was placed intravenously at the first complaint of pain. Pain follow-up was done by visual analog scale (VAS) and verbal rating scale (VRS) in every 15 minute intervals at the first hour and later at 2nd, 4th, 8th, 12th, 18th and 24th hours of postoperative period. Simultaneously, nausea-vomiting, sedation-contentment scores, vital statistics, side-effects and total analgesic viii consumptions were recorded. One way variance analysis (One Way Anova), Post Hoc Bonferroni and Kruskal Wallis tests were used for statistical analysis. p<0.05 was accepted as statistically significant. In this study, there were no significant differences between groups in terms of time of the first analgesic need, periferic oxygen saturations and heart rates. Total tramadol consumption, postoperative nausea and vomiting rate and antiemetic needs during postoperative recovery period were significantly higher in group I than the others (p<0.05). Consequently, it was concluded that the combinations of tramadol-metamizol and tramadol-lornoxicam which were administered by intravenous PCA method provides effecient analgesia and less side effects by reducing the need of tramadol. Keywords : Tramadol, metamizol, lornoxicam, Patient Controlled Analgesia (PCA), postoperative pain
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
