Pinar SAYİN, Hale DOBRUCALİ, Hacer TURK, Tolga TOTOZ, Canan ISİL, Ayse HANCİ

Artroskopik diz cerrahisinde intraartiküler uygulanan levobupivakain, fentanil-levobupivakain ve tramadol-levobupivakain’in postoperatif ağrı kontrolüne etkileri

Amaç: Bu çalışmanın amacı diz cerrahisinde levobupivakain, levobupivakain-fentanil ve levobupivakain-tramadol eklem içi enjeksiyonlarının postoperatif ağrı kontrolündeki etkinliğini karşılaştırmaktır.Çalışma planı: Elektif diz artroskopisi için başvuran 80 hasta çalışmaya dahil edildi. Hastalar 20’şerli gruplara ayrıldı. Grup 1’deki hastalara eklem içi serum fizyolojik verildi ve kontrol grubu olarak planlandı. Grup 2’deki hastalara levobupivakain 2,5 mg/ml, Grup 3’teki hastalara levobupivakain 2.5 mg/ml içine 50 mg tramadol ve Grup 4’teki hastalara levobupivakain 2.5 mg/ml içine 50 mcg fentanil kombinasyonu verildi. Tüm hastalar genel anestezi altında opere edildi ve total 20 ml çalışma solüsyonu enjekte edildi; bu dozun 7 ml’si cerrahi öncesi cilde, 13 ml’si ameliyat sonrası eklem içi enjekte edildi. Postoperatif ağrı için cerrahi sonrası Vizuel analog skala (VAS) 1., 2., 4., 8., 12. ve 24. saatlerde uygulandı. VAS skoru 5’ten fazla olan hastalara diklofenak sodyum verildi ve analjezik ihtiyaçları not edildi.Bulgular: Postoperatif 1., 2., 4., 8., 12. ve 24. saatlerde Grup 3 ve Grup 4 postoperatif ağrı açısından istatistiksel anlamlı düşük VAS skorlarına sahipti. Postoperatif analjezik ihtiyaçları da gruplar arasında anlamlılık gösterdi. Postoperatif 1. saatte analjezik ihtiyaçları Grup 3 ve Grup 4’te istatistiksel olarak anlamlı derecede düşüktü (p<0.01). Postoperatif iki ve dördüncü saatte analjezik ihtiyaçları Grup 3’te diğer gruplara göre istatistiksel olarak anlamlı derecede düşüktü (p<0.01). Postoperatif sekizinci saatte analjezik ihtiyaçları Grup 3 ve Grup 4’te istatistiksel olarak anlamlı derecede düşüktü (p<0.01). Postoperatif 12. ve 24. saatte analjezik ihtiyaçları arasında anlamlı farklılık yoktu (p>0.05).Çıkarımlar: Bu bulgular levobupivakain’in fentanil veya tramadol ile kombinasyonunun tek başına kullanımına göre ağrı kontrolünde daha etkin olduğu, operasyon sonrası ağrı skorlarını ve analjezik ihtiyaçlarını azalttığının göstermektedir. DOI: 10.3944/AOTT.2015.14.0107Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Anahtar Kelimeler:

Analjezik ihtiyacı; fentanil; eklem içi; diz cerrahisi; levobupivakain; postoperatif ağrı; tramadol

Effects of intra-articular levobupivacaine, fentanyllevobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery

Objective: The aim of this study was to compare the postoperative analgesic efficacy of intra-articularly injected levobupivacaine, levobupivacaine-fentanyl, and levobupivacaine-tramadol combinations.Methods: Eighty patients scheduled for elective knee arthroscopy were divided randomly into 4 groups of 20 patients each. Group 1 (the control group) received intra-articular saline, Group 2 received levobupivacaine 2.5 mg/ml, Group 3 received levobupivacaine 2.5 mg/ml + tramadol 50 mg, and Group 4 received levobupivacaine 2.5 mg/ml + fentanyl l50 mcg. All patients were operated on under general anesthesia, and a total of 20 ml study solution was injected: 7 ml subcutaneously before surgery and 13 ml intra-articularly upon completion of surgery. For postoperative, pain visual analogue scale (VAS) was assessed at the 1st, 2nd, 4th, 8th, 12th, and 24th hours postoperatively. Patients with a VAS score over 5 received diclofenac sodium, and the need for rescue analgesics was recorded.Results: At the 1st, 2nd, 4th, 8th, 12th, and 24th postoperative hours, Group 3 and Group 4 had statistically significant lower VAS scores of pain (p<0.01). Postoperative rescue analgesic requirements were different among the groups. The postoperative 1st hour analgesic requirement was statistically significantly lower in Group 3 and Group 4 when compared to the other groups (p<0.01). At the postoperative 2nd and 4th hours, analgesic requirements were statistically significantly lower in Group 3 than in the other groups (p<0.01). Analgesic requirements were statistically significantly lower in Group 3 and Group 4 than in the other groups (p<0.01). Analgesic requirements at the 12th and 24th postoperative hours did not show any statistically significant difference (p>0.05).Conclusion: The results indicated that levobupivacaine combined with either fentanyl or tramadol decreased rescue analgesic requirements when compared to levobupivacaine alone.

Keywords:

Analgesic need, fentanyl, intra-articular, knee surgery, levobupivacaine, postoperative pain tramadol,

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