Sevim KARATAŞ ŞENOL, Zeynep ETİ, KEMAL TOLGA SARAÇOĞLU, Fevzi Yılmaz GÖĞÜŞ

Does perioperative opioid infusion increase postoperative opioid requirement?

Amaç: Opioidler, akut ameliyat sonrası ağrı tedavisinin temel komponentini oluşturmaktadırlar. Etkin ameliyat sonrası analjezi sağlamak için gereken opioid gereksiniminin artmasıyla, peroperatif opioid infüzyonu, akut opioid toleransı gelişimiyle suçlanmıştır. Akut opioid tolerans gelişiminin yanısıra opioid ajanlar arasında tolerans gelişimi konusunda farklılık olup olmadığı da halen tar- tışmalıdır. Bu çalışmanın amacı peroperatif dönemde intravenöz infüzyon şeklinde uygulanan morfn, remifentanil ve alfentanilin etkilerinin karşılaştırılmasıdır. Gereç ve Yöntem: Elektif majör abdominal cerrahi geçirecek, 60 hasta randomize olarak dört gruba ayrıldı. Grup Cye (kontrol) indüksiyonda iv 5 cc, idamede 10 cc/s salin infüzyonu, Grup Rye (remifentanil) indüksiyonda iv 1µg/kg bolus, idamede 0.25 µg/ kg/dk remifentanil infüzyonu, Grup Aya (alfentanil) indüksiyonda iv 10 µg/kg bolus, idamede 0.50 µg/kg/dk alfentanil infüzyonu, Grup Mye (morfn) indüksiyonda iv 0.1 mg/kg bolus, idamede 0.02 mg/kg/s morfn infüzyonu uygulandı. Ameliyat sonrası analjezi için iv meperidinli hasta kontrollü analjezi (HKA) uygulandı ve toplam meperidin tüketimleri kaydedildi. Ameliyat sonrası 48 saat boyunca VAS skorları ve yan etkiler kaydedildi. Bulgular: Grup Mye ait VAS skorları ameliyat sonrası birinci saatte Grup Cden anlamlı olarak daha düşük bulundu. Grup R ve Grup Mnin 24 saatlik toplam meperidin tüketimi Grup Cden anlamlı olarak daha düşüktü. Bulantı kusma insidansı bakımından gruplar arasında anlamlı bir fark yoktu. Sonuç: Sonuç olarak; majör abdominal cerrahi geçiren hastalarda peroperatif dönemde üç saat süre ile uygulanan morfn, alfentanil ve remifentanil infüzyonunun ameliyat sonrası akut toleransa yol açmadığı, aksine morfn ve remifentanil infüzyonunun ameliyat sonrası opioid gereksinimini azalttığı kanısına varılmıştır.

Peroperatif opioid infüzyonu postoperatif opioid gereksinimini artırır mı?

Objectives: Opioids are the cornerstone therapy for the optimal pain management. Perioperative opioid infusion is accused of causing acute opioid tolerance, especially as the postoperative opioid requirement increases in time to provide efcient anal- gesia. It is debatable whether there is a diference between opioid agents regarding tolerance development. We aim to compare the efects of morphine, remifentanil and alfentanil when infused intravenously during the perioperative period. Methods: Sixty patients undergoing elective major abdominal surgery were randomized into four groups. Te four groups obtained the following treatments: saline 5 cc iv bolus and 10 cc/h infusion for induction and maintenance in Group C, remi- fentanil infusion 0.25 μg/kg/min following 1μg/kg iv bolus in Group R, alfentanil infusion 0.50 μg/kg/min following 10 μg/ kg iv bolus in Group A, and morphine infusion 0.02 mg/kg/h after 0.1 mg/kg iv bolus in Group M. Meperidine 10 mg/cc iv patient-controlled analgesia was used postoperatively, and total meperidine consumptions were recorded. VAS scores and side efects were recorded during postoperative 48 hours. Results: VAS scores in Group M were found to be signifcantly lower than in Group C at the 1 st postoperative hour. Twenty- four hour total meperidine consumption in Group R and Group M were signifcantly lower than in Group C. No statistical diference was found between groups regarding the incidence of nausea and vomiting. Conclusion: Our study indicated that infusions of morphine, alfentanil and remifentanil administered to patients undergoing major abdominal surgery did not cause acute opioid tolerance. In contrast, infusion of morphine and remifentanil reduced postoperative opioid requirement.

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