Ertuğrul KILIÇ, Ayşe MIZRAK, SITKI GÖKSU, Mehmet CESUR

Fonksiyonel endoskopik sinüs cerrahisinde gabapentin ve nimesulidin preemptif analjezik etkinliği

Amaç: Preemptif analjezi ameliyat sonrası ağrının kontrol altına alınmasında ve cerrahinin oluşturduğu stres yanıtın engel- lenmesinde önemli bir faktördür. Amacımız gabapentin ve nimesulidin ameliyat sonrası analjezik tüketimine, vizüel analog skala (VAS) üzerine etkisini ve oluşabilecek yan etkilerini plasebo grubu ile karşılaştırmaktır. Gereç ve Yöntem: ASA I-II risk grubunda bulunan 18-70 yaş aralığında, fonksiyonel sinüs cerrahisi (FESC) geçirecek olan 90 hasta çalışmaya alındı. Hastalar rastgele üç gruba ayrıldı. Ameliyattan bir saat önce hastalara oral yolla Grup 1 de plasebo kapsül, Grup 2 de gabapentin 1200 mg, Grup 3 de nimesulid 100 mg verildi. Bütün hastalarda ameliyatta hemodinamik pa- rametreler ölçüldü. Ameliyat sonrası ilk 24 saat içerisindeki bulantı kusma, hipotansiyon, hipertansiyon, bradikardi, taşikardi gibi yan etkiler, ameliyat bitiminden itibaren ilk diklofenak ihtiyacının olduğu süre ve VAS kaydedildi. Bulgular: Ameliyat sonrası 24 saat boyunca yapılan takiplerin hepsinde ilk diklofenak ihtiyaç süresi, ameliyat bitiminden iti- baren; Grup 2 > Grup 3 > Grup 1 olarak gerçekleşti. Total diklofenak tüketimi Grup 2 de; Grup 1 ve Grup 3 e göre istatistik- sel olarak anlamlı bir şekilde düşük bulundu. Ameliyat sonrası VAS değeri Grup 2 de Grup 1 ve 3 e göre daha düşük bulundu. Sonuç: Sonuç olarak, FESC sonrası ameliyat sonrası analjezi amacıyla gabapentinin veya nimesulidin preemptif olarak gü- venli bir şekilde kullanılabileceğini düşünüyoruz.

Preemptive analgesic efficacy of gabapentin and nimesulide in the functional endoscopic sinus surgery

Summary Objectives: Preemptive analgesia is an important factor in controlling the postoperative pain and avoiding the stress response caused by the surgery. We aim to compare impact of gabapentin and nimesulide on postoperative analgesic consumption on the visual analog scale (VAS) as well as any potential side effects, to those of the placebo group. Methods: Ninety patients aged 1870 under ASA I-II risk, who were to undergo Functional Endoscopic Sinus Surgery (FESS), were included in the study. Patients were randomized into three groups. One hour before the surgery, oral placebo capsules were ad- ministered to Group I patients, Gabapentin 1200 mg to Group II patients and Nimesulide 100 mg to Group III patients. Periopera- tive hemodynamic parameters were measured for all patients. During the first 24 hours of the postoperative period, side effects such as nausea, vomiting, hypotension, hypertension, bradycardia, tachycardia were noted, and the time from end of the surgery to the first diclofenac need was recorded in addition to VAS scores. Results: In all of the follow-ups for 24 hours of the postoperative period, time from end of the surgery until the first diclofenac require- ment; Group 2 > Group 3 > Group 1. Total diclofenac consumption of group 2 was found to be signi ficantl y lower than Group 1 and Group 3 on a statistical basis. Postoperative VAS score in Group 2 was lower than Group 1 and Group 3. Conclusion: To conclude, we believe that gabapentin or nimesulide may be safel y used preemptivel y for the purposes of postoperative analgesia after FESS procedures.

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1. 3. Davies NJH, Cashman JN. Lees synopsis of anaesthesia. (Çeviri Editörü: Turan IÖ). Power J, Cashman J. Akut ağrı te- davisi. (Çeviri Editörü: Yapakçı O). (13. Baskı). İstanbul: Güneş Kitapevi; 2008. s. 303-30.
2. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute post- operative pain management: I. Evidence from published data. Br J Anaesth 2002;89(3):409-23.
3. Bilen A. Postoperatif ağrı tedavisi. Klinik Gelişim 2007;68:37- 45.
4. Paul G. Acute neuropathic pain: diagnosis and treatment. Cur Opin Anaesthesiol 2008;2:590-5.
5. Gilron I. Gabapentin and pregabalin for chronic neuropathic and early postsurgical pain: current evidence and future di- rections. Curr Opin Anaesthesiol 2007;20(5):456-72.
6. Durmus M, Kadir But A, Saricicek V, Ilksen Toprak H, Ozcan Ersoy M. The post-operative analgesic effects of a combina- tion of gabapentin and paracetamol in patients undergoing abdominal hysterectomy: a randomized clinical trial. Acta Anaesthesiol Scand 2007;51(3):299-304.
7. Rainsford KD; Members of the Consensus Report Group on Nimesulide. Nimesulide - a multifactorial approach to in- flammation and pain: scientific and clinical consensus. Curr Med Res Opin 2006;22(6):1161-70.
8. Kissin I. Preemptive analgesia: problems with assessment of clinical significance. Methods Mol Biol 2010;617:475-82.
9. Melzack R, Wall PD. Ağrı tedavisi el kitabı. (Çeviri Editörü: Edirne S). Cousins M, Power I. Akut ve postoperatif ağrı. (Çe- viri Editörü: Keskinbora K, Aydınlı I). İstanbul: Güneş Tıp Kita- pevi; 2006. s. 13-30.
10. White PF. The changing role of non-opioid analgesic tech- niques in the management of postoperative pain. Anesth Analg 2005;101(5 Suppl):S5-22.
11. Alanoğlu Z, Özgencil E, Çakar S, Ateş Y, Tüzüner F. Tiroidekto- mi Operasyonu Sonrası Ağrı Tedavisinde Preoperatif Lornok- sikam ve Diklofenak Uygulamasının Postoperatif Tramadol Gereksinimi Üzerine Etkinliği. Türk Anest Rean Der Dergisi 2006;34:368-76.
12. McMains KC. Safety in endoscopic sinus surgery. Curr Opin Otolaryngol Head Neck Surg 2008;16(3):247-51.
13. Kaye AD, Baluch A, Kaye AJ, Gebhard R, Lubarsky D. Pharma- cology of cyclooxygenase-2 inhibitors and preemptive an- algesia in acute pain management. Curr Opin Anaesthesiol 2008;21(4):439-45.
14. Amorocho MR, Sordillo A. Anesthesia for functional endoscopic sinus surgery: a review. Anesthesiol Clin 2010;28(3):497-504.
15. Javer AR, Alandejani T. Prevention and management of com- plications in frontal sinus surgery. Otolaryngol Clin North Am 2010;43(4):827-38.
16. Lee J, Constantinides M. Trends in functional rhinoplasty 2008. Curr Opin Otolaryngol Head Neck Surg 2009;17(4):295- 301.
17. Leykin Y, Casati A, Rapotec A, Dalsasso M, Barzan L, Fanelli G, et al. Comparison of parecoxib and proparacetamol in endo- scopic nasal surgery patients. Yonsei Med J 2008;49(3):383-8.
18. Leykin Y, Casati A, Rapotec A, Dal Sasso M, Barzan L, Fanelli G, et al. A prospective, randomized, double-blind compari- son between parecoxib and ketorolac for early postopera- tive analgesia following nasal surgery. Minerva Anestesiol 2008;74(9):475-9.
19. Takmaz SA, Kaymak C, Pehlivan BS, Dikmen B. Effect of pre- operative 900 and 1200 mg single oral dose of gabapentin on postoperative pain relief and tramadol consumption in open cholecystectomy surgery. Agri 2007;19(3):32-8.
20. Kazak Z, Meltem Mortimer N, Sekerci S. Single dose of preop- erative analgesia with gabapentin (600 mg) is safe and effec- tive in monitored anesthesia care for nasal surgery. Eur Arch Otorhinolaryngol 2010;267(5):731-6.
21. Aho M, Kokki H, Nikanne E. Nimesulide versus Ibuprofen for Postoperative Tonsillectomy Pain : A Double-Blind, Ran- domised, Active Comparator-Controlled Clinical Trial. Clin Drug Investig 2003;23(10):651-60.
22. Rapchuk IL, OConnell L, Liessmann CD, Cornelissen HR, Fra- ser JF. Effect of gabapentin on pain after cardiac surgery: a randomised, double-blind, placebo-controlled trial. Anaesth Intensive Care 2010;38(3):445-51.
23. Alston RP, Pechon P. Dysaesthesia associated with sternoto- my for heart surgery. Br J Anaesth 2005;95(2):153-8.
24. Woolf CJ, Chong MS. Preemptive analgesia--treating post- operative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77(2):362-79.
25. Khademi S, Ghaffarpasand F, Heiran HR, Asefi A. Effects of preoperative gabapentin on postoperative nausea and vom- iting after open cholecystectomy: a prospective randomized double-blind placebo-controlled study. Med Princ Pract 2010;19(1):57-60.
26. Dahl JB, Møiniche S. Pre-emptive analgesia. Br Med Bull 2004;71:13-27.
27. Sen H, Sizlan A, Yanarates O, Emirkadi H, Ozkan S, Da- gli G, et al. A comparison of gabapentin and ketamine in acute and chronic pain after hysterectomy. Anesth Analg 2009;109(5):1645-50.