Suna Akın TAKMAZ, ÇETİN KAYMAK, Başak Şare PEHLİVAN, Beyazıt DİKMEN

Açık kolesistektomi cerrahisinde preoperatif tek doz oral 900 ve 1200 mg gabapentinin postoperatif ağrı ve tramadol tüketimi üzerine etkisi

Bu çalışmada, elektif açık kolesistektomi cerrahisinde, preoperatif tek doz 900 ve 1200 mg gabapentin dozunun, postoperatif ağrı ve tramadol tüketimi üzerine olan etkisi araştırılmıştır. Elektif açık kolesistektomi yapılacak ASA I-II grubundan 45 hasta rastgele 3 gruba ayrıldı. I.gruptaki hastalar kontrol grubu kabul edilirken II ve III.gruptaki hastalara operasyondan 1 saat önce sırasıyla 900mg veya 1200mg gabapentin verildi. Ameliyatın sonunda tüm hastalara hasta kontrollü analjezi (HKA) cihazı ile iv-tramadol verildi. Postoperatif ağrı uyanma odasında (0),1,2,3,4,6,8,12 ve 24. saatlerde VAS skalası ile istirahatte ve harekette değerlendirildi. Total tramadol tüketimi, ilave meperidin ihtiyacı, yan etkiler ve hasta memnuniyeti kaydedildi. III.gruptaki hastaların uyanma odası VAS istirahat skorlarında I ve II.gruba göre 3 kat (1,4±0.6’ya karşın 4,9±1.0 ve 4.4±1.1), VAS hareket skorlarında ise 2 kat (3.4±1.0’e karşın 6.8±1.8 ve 6.1±1.6) azalma tesbit edildi. Ortalama yükleme dozu III.grupta (28.3 ±8.7) I. (66.6±20.4) ve II. (61.6±20.8) gruba göre belirgin olarak azdı. VAS istirahat skorları ilk 6 saat, VAS hareket skorları ise ilk 8 saat III.grupta, I. ve II.gruba göre belirgin olarak düşüktü. Total tramadol tüketimi III.grupta (240.4±31.0), I. (456.0±35.5) ve II. (438.7±35.0) gruba göre daha düşüktü. III.grupta hiçbir hastada ilave meperidin ihtiyacı olmazken, I ve II.gruptan 2’şer hastada gerekli oldu. III.grupta daha yüksek hasta memnuniyet skorları elde edildi. Yan etki sıklığı I ve II.grupta III. gruba göre daha fazlaydı. Sonuç olarak, açık kolesistektomi sonrası analjezi kalitesini arttırmak üzere kullanılacak preoperatif tek doz oral gabapentinin en az 1200 mg dozunda kullanılması gerektiği kanaatine varıldı.

Anahtar Kelimeler:

Tramadol, Ağrı, ameliyat sonrası, Kolesistektomi

Effect of preoperative 900 and 1200 mg single oral dose of gabapentin on postoperative pain relief and tramadol consumption in open cholecystectomy surgery

In this study, the effects of preoperative 900 and 1200mg single dose of gabapentin on postoperative pain relief and tramadol consumption in elective open cholecystectomies were investigated. Fourtyfive ASAI-II patients were randomly divided into three groups. GroupI was control group and patients in groupII and III received 900mg or 1200mg gabapentin 1 hour before the operations respectively. All patients received intravenous tramadol at the end of surgery via a PCA device. Pain scores were evaluated at the recovery room(0),1,2,3,4,6,8,12 and 24h postoperatively at rest and movement, using a 10cm VAS. In the recovery room, VAS scores at rest were three times less (1,4±0.6 versus 4,9±1.0 and 4.4±1.1), and VAS scores at movement were two times less (3.4±1.0 versus 6.8±1.8 ve 6.1±1.6) in groupIII when compared to groupI and II respectively. Mean loading doses were significantly lower in groupIII (28.3±8.7) than groupI (66.6±20.4) and II (61.6±20.8). VAS scores at rest during the postoperative first 6h and at movement during the postoperative first 8h were significantly lower in groupIII than groupI and II. Total tramadol consumption was lower in groupIII (240.4±31.0), than groupI (456.0±35.5) and groupII (438.7±35.0). Additional meperidine was necessary for two patients both in groupsI and II, although none of the patients needed in groupIII. Higher patient satisfaction scores were obtained in group III. Adverse effect incidences were higher in groupI and II than in groupIII. As a result, we believe that to improve analgesic quality after open cholecystectomy, preoperative single dose of gabapentin should at least be 1200 mg.

Keywords:

Tramadol, Pain, Postoperative, Cholecystectomy,

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Backonja M, Beydoun A, Edwards KR, Schwartz SL, Fonseca V, Hes M et all: Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998; 280: 1831-1836.
Bone M, Critchley P, Buggy DJ: Gabapentin in postamputation phantom limb pain: a randomised, double-blind, placebocontrolled, cross-over study. Reg Anesth Pain Med 2002; 27: 481-486
Brennan TJ. Frontiers in translational research: the etiology of incisional and postoperative pain. Anesthesiology 2002; 97: 535-537.
Carr DB, Goudas LC: Acute pain. Lancet 1999; 353: 2051-2058.
Dierking G, Duedahl TH, Rasmussen ML, Fomsgaard JS, Moniche S, Romsing J, Dahl JB: Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy:Arandomized, double-blind trial. Acta Anaesthesiol Scand 2004;48: 322-327.
Dirks J, Petersen KL, Rowbotham MC, Dahl JB: Gabapentin supresses cutaneous hyperalgesia following heat-capsaicin sensitization. Anesthesiology 2002; 97: 102-107.
Fassoulaki A, Patrik K, Sarantopoulos C, Hogan O: The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg 2002; 95: 4: 985-991.
Gee NS, Brown JP, Dissanayake VU, Offord J, Thurlow R, Woodruff GN: The novel anticonvulsant drug, gabapentin (Neurontin) binds to the alpha2delta subunitof a calcium channel. J Biol Chem 1996; 271: 5768-5776.
Gilron I, Biederman J, Jhamandas K, Hong M: Gabapentin blocks and reverses antinociceptive morphine tolerance in the rat pawpressure and tail flick tests. Anesthesiology 2003; 98: 1288-1292.
Gilron I, Orr E, Tu D, O’neill JP, Zamora JE, Bell Allan C: A placebocontrolled randomized clinical trial of perioperative administration of gabapentin, rofecoxib and their combination for spontaneous and movement-evoked pain after abdominal hysterectomy. Pain 2005; 113: 191-200.
Gregg AK, Francis S, Sharpe P, Rowbotham DJ: Analgesic effect of gabapentin premedication in laparoscopic cholecystectomy:a randomized double-blind placebo-controlled trial. Br J Anaesth 2001; 87: 174
Guttuso Jr Th, Roscoe J, Griggs J. Effect of gabapentin on nausea induced by chemotherapy in patients with breast cancer. Lancet 2003; 361: 1703-1705.
Luo ZD, Chaplan SR, Higuera ES, et al: Upregulation of dorsal root ganglion (alpha)2(delta) calcium channel subunit and its correlation with allodynia in spinal nevre-injured rats. J Neurosci 2001;21:1868-1875.
Menigaux C, Adam F, Gulgnard B, Sessier DI, Chauvin M: Preoperative gabapentin decreases anxiety and improves early functionalrecovery from knee surgery. Anesth Analg 2005;100:5:1394-1399.
Pandey CK, Sahay S, Gupta D, Ambesh SP, Singh RB, Raza M, Singh U, Singh PK: Preemptive gabapentin decreases postoperative pain after lumbar discoidectomy. Can J Anaesth 2004a;51:986-989.
Pandey CK, Priye S, Singh S, Singh U, Singh RB, Singh PK: Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirements in laparoscopic cholecystectomy. Can J Anaesth 2004b;51:358-363.
Pandey CK, Navkar DV, Giri PJ, Raza M, Behari S, Singh RB, Singh U, Singh PK: Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy: A randomized, double blind, placebo-controlled study. J Neurosurg Anesthesiol 2005;17:65-68.
Rice AS, Maton S: Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain 2001;94:215-224
Rorarius MG, Mennander S, Suominen P, Rintala S, Puura A, Pirhonen R, Salmelin R, Haanpaa M, Kujansuu E, Yli-Hankala A: Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain 2004;110:175-181.
Rose MS, Kam PC: Gabapentin:pharmacology and its use in pain management. Anaesthesia 2002;57:451-462.
Schmid RL, Sandler AL, Katz J: Use and efficacy of low-dose ketamine in the management of acute postoperative: a review of current techniques and outcomes. Pain 1999;82:111-125.
Serpell MG, neuropathic pain study group: Gabapentin in neuropathic pain syndromes: a randomised, double-blind, placebo-controlled, trial. Pain 2002; 99: 557-566
Shimoyama M, Shimoyama N, Hori Y: Gabapentin affects glutamatergic excitatory neurotransmission in the rat dorsal horn. Pain 2000; 85: 405-414.
Taylor CP, Gee NS, Su TZ, Kocsis JD, Welty DF, Brown JP et al: A summary of mechanistic hypotheses of gabapentine pharmacology. Epilepsy Res 1998; 29: 233-249.
Turan A, Karamanlıoğlu B, Memiş D, Hamamcıoğlu MK, Tükenmez B, Pamukçu Z, Kurt i: Analgesic effects of gabapentin after spinal surgery. Anesthesiology 2004a; 100: 935-938.
Turan A, Karamanlıoğlu B, Memiş D, Usar P, Pamukçu Z, Türe M: The analgesic effects of gabapentin after total abdominal hysterechtomy. Anesth Analg; 2004b; 98: 1370-1373.
Turan A, Memiş D, Karamanlıoğlu B, Yağız R, Pamukçu Z, Yavuz E: The analgesic effects of gabapentin in monitored anesthesia care for ear-nose-throat surgery. Anesth Analg 2004c; 99: 375-378.
Tverskoy M, Oren M, Dahkovsky I, Kisin I: Alfentanil dose-response relationships for relief of postoperative pain. Anest Analg 1996; 83: 387-393.
Wadhwa A, Clarke D, Goodchild CS, Young D: Large-dose oral dextromethorphan as an adjunt to patient controlled analgesia with morphine after knee surgery. Anesth Analg 2001; 92: 448-454.
WalderB, Schafer M, Henzi I, Tramer MR: Efficacy and safety of patient controlled opioid analgesia for acute postoperative pain. A quantitative systematic review. Acta Anaesthesiol Scand 2001;45: 795-804.
Woolf CJ, Chong MS: Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77: 362-379.