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.

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.

Kaynakça

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