Meltem EREN, AHMET KEMALETTİN KOLTKA, Gül Köknel TALU, MEHMET AŞIK, Süleyman ÖZYALÇIN

Diz artroskopilerinden sonra intraartiküler olarak uygulanan lornoksikam, bupivakain ve serum fizyolojiğin analjezik etkinliğinin karşılaştırılması

Günübirlik yapılan artroskopik diz operasyonlarında ağrı taburcu olmayı ve erken rehabilitasyonu önleyen önemli bir engeldir. Bu çalışmada diz artroskopisi operasyonlarından sonra intraartiküler uygulanan lornoksikam, bupivakain ve serum fizyolojiğin postoperatif ağrı üzerine olan etkileri karşılaştırılmıştır. Etik komitenin izni ve hastaların onamları alındıktan sonra yaşları 18-65 arasında değişen ve ASA değeri I-II olan, artroskopik menisektomi uygulanacak 90 hasta bu randomize, tek kör, prospektif çalışmaya alındı. Hastalar üçe ayrıldı (her grupta 30 hasta): Grup L’de (GL) hastalara 8 mg lornoksikam; Grup B’de (GB) hastalara 50 mg bupivakain ve Grup S’de (GS) hastalara serum fizyolojik 20 mL intraartiküler olarak uygulandı. Postoperatif analjezide ilk 4 saat boyunca intravenöz tramadol hidroklorit 50 mg uygulanırken çalışmanın kalanı boyunca parasetamol 500 mg ve kodein 7.5 mg preparatı uygulandı. Sayısal ağrı skalası (SAS) kullanılarak 4, 12, 24 ve 48. saatlerdeki istirahat, aktif ve pasif hareketler sırasındaki ağrı düzeyleri, ilk 4 saatteki tramadol tüketimi, 48 saat sonundaki toplam analjezik tüketimi (tablet olarak) kaydedildi. Tramadol gereksinimi olan hastalar açısından GS ile GL ve GS ile GB arasında anlamlı farklar olduğu (p

Anahtar Kelimeler:

Karşılaştırmalı çalışma, Artroskopi, Enjeksiyon, eklem içi, Bupivakain, Diz

Comparison of analgesic activity of intraarticular lornoxicam, bupivacaine and saline after knee arthroscopy

Postoperative pain is an important factor for discharge and rehabilitation in daycase arthroscopic knee surgery. This study compared the efficacy of intraarticular application of lornoxicam, bupivacaine and placebo on postoperative pain after arthroscopic knee surgery. With the approval of the local ethics committee and informed consent of the patients, 90 patients (ASA score I-II), aged between 18-65 years undergoing arthroscopic meniscectomy were included in this randomized, blinded, prospective study and were divided into three groups (30 patients each): 8 mg lornoxicam were applied to Group L (GL), 50 mg bupivacaine to Group B (GB) and normal saline to Group S (GS) in 20 mL volume intraarticularly. Postoperative analgesia was maintained by intravenous tramadol-HCl 50 mg/h at the first 4 h and then paracetamol 500 mg plus codeine 7.5 mg preparation as needed. The numeric rating scale (NRS) values were evaluated at rest and at active-passive motion at 4, 12, 24 and 48 h, total analgesic consumption were recorded. There were statistically significant differences between GS and GL and GS and GB in term of tramadol consumption (p<0.05 and p<0.05). The analgesic consumption of GL patients at the end of 48 h were lower than GB and GS (p<0.001 and p<0.05). The NRS values of GL were always lower than the other groups with statistical significance at certain times. We concluded that intraarticular lornoxicam provided better pain control than bupivacaine and saline in arthroscopic knee surgery.

Keywords:

Comparative Study, Arthroscopy, Injections, Intra-Articular, Bupivacaine, Knee,

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