Alt ekstremite kemik cerrahisinde hasta kontrollü analjezide ondansetronun tramadol ve morfin tüketimine etkisi
Çalışmamızda, alt ekstremite cerrahisinde postoperatif analjezi amaçlı hasta kontrollü analjezi yöntemiyle morfin ve tramadol uygulanan hastalara, antiemetik proflaksisi amacıyla ondansetron uygulanmasının analjezik tüketimi üzerine etkisini araştırmayı planlandık. Etik kurul onayı alındıktan sonra alt ekstremite cerrahisi planlanan ASA I-II grubu 100 hasta çalışma kapsamına alındı. Hastalar anestezi indüksiyonundan sonra rastgele dört gruba ayrıldı. Grup I’ e operasyon bitiminden bir saat önce 1.5 mg kg-1 tramadol yükleme dozu uygulandıktan sonra HKA pompası set doz 0.3 mg kg-1, kilitli kalma süresi 10 dakika olacak şekilde analjezi sağlandı. Grup II’de ek olarak anestezi indüksiyonundan sonra 0.1 mg kg-1 ondansetron uygulandı. Grup III’e operasyon bitiminden 30 dakika önce 0.15 mg kg-1morfin yükleme dozu uygulandıktan sonra HKA pompasıyla HKA set doz 0.03 mg kg-1, kilitli kalma süresi 10 dakika olacak şekilde analjezi sağlandı.Grup IV’e ek olarak anestezi indüksiyonundan sonra 0.1 mg kg-1 ondansetron uygulandı. Tüm gruplarda; ağrı skorları (VAS), bulantı, kusma ve sedasyon skorları, analjezik tüketimleri ve olası yan etkiler postoperatif 5., 15., 30., 45. dakikalar, 4., 8., 12. ve 24. saatlerde değerlendirildi. Hastaların postoperatif VAS, bulantı, kusma ve sedasyon skorları arasında istatistiksel olarak anlamlı bir fark saptanmadı. Analjezik tüketimi Grup I ve II karşılaştırıldığında ilk 45 dakikada istatistiksel olarak anlamlı değil iken 4., 8., 12. ve 24. saatlerde grup II’de anlamlı derecede yüksek olduğu saptandı. Grup III ve IV karşılaştırıldığında tüm zamanlarda analjezik tüketiminde istatistiksel olarak anlamlı bir fark saptanmadı. Sonuç olarak, HKA yöntemiyle tramadol ve morfin uygulanan hastalarda ondansetronun tramadol tüketimini artırırken morfin tüketimini etkilemediği kanısına varılmıştır.
Anahtar Kelimeler:
Analjezi, hasta kontrollü, Morfin, Tramadol, Ondansetron
Effect of ondansetron in lower extremity bone surgery on morphine and tramadol consumption using patient controlled analgesia
In this study, we aimed to assess the effect of administration of ondansetron in patient undergoing morphine and tramadol using patient controlled analgesia procedure for postoperative analgesia on analgesic consumption. After approval by the ethic committee, 120 patient planned to receive lower extremity surgery with ASA status I or II were included in the study. Patients were randomly divided into 4 groups following the induction. Group I received tramadol as PCA with an infusion of 0.3 mg/kg following a loading dose of 1.5 mg/kg administered 1 hour before the end of surgery. Group II received ondansetron 0.1 mg/kg following induction of anesthesia, additionally. Group III received morphine as PCA with an infusion following a loading dose of 0.15 mg/kg administered 30 minutes before the end of surgery. Group IV received ondansetron 0.1 mg/kg following induction of anesthesia, additionally. Pain scores(VAS), nausea, vomitting and sedation scores, analgesic consumptions and adverse effects were recorded at 5th, 15th, 30th, 45th minutes and 4th, 8th, 12th and 24th hours postoperatively. Postoperative VAS, nausea, vomitting and sedation scores were similar among the groups. The analgesic consumption was found significantly higher at 4th, 8th, 12th and 24th hours in group II. No statistical significant difference was found in analgesic consumption between group III and IV at all times. We concluded that, ondansetron, when administered as antiemetic prophylaxia in patients receiving tramadol and morphine as PCA, did not effect morphine consumption whereas did increased tramadol consumption.
Keywords:
Analgesia, Patient-Controlled, Morphine, Tramadol, Ondansetron,
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- ISSN: 1300-0012
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 2018
- Yayıncı: Ali Cangül
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