SEMRA KARAMAN, NÜZHET SEDEN KOCABAŞ, Sedat ERGUN, Vicdan FIRAT, Meltem UYAR, Fatih ŞENDAĞ

Intraperitoneal ropivacaine or ropivacaine plus meperidine for laparoscopic gynecological procedures

Amaç: Laparoskopik cerrahi sonrası postoperatif ağrı laparatomiye göre daha hafftir ve hastalar intraperitoneal lokal anestezik ve opioid uygulamalarından fayda görebilir. Çalışmamızda jinekolojik laparoskopik cerrahi uygulanacak hastalarda intraperitoneal uy- gulanan %0.75lik ropivakain ve meperidinle kombinasyonun postoperatif analjezi üzerine etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Jinekolojik laparoskopi sonunda, randomize çift-kör çalışma protokolüne göre intraperitoneal enjeksiyon uygu - landı. Hastalar üç gruba ayrıldı: R Grubuna (n=18) %0.75lik ropivakain 3 mg/kg 200 ml salin içinde; RM Grubuna (n=17) %0.75lik ropivakain 3 mg/kg ve meperidin 50 mg 200 ml salin içinde; K Grubuna (n=18) 200 ml salin trokarla uygulandı. Has- talara ağrısı olduğunda (VAS 3) diklofenak sodyum ve eğer ağrısı geçmezse 1 mg/kg meperidin i.v. uygulandı. Bulgular: Ağrı skorları ve analjezik gereksinimi postoperatif ilk bir saat için RM grubunda daha düşük bulundu. Daha sonraki dö - nemde ağrı skorları tüm gruplar için benzerdi ve 24 saatlik total analjezik tüketimi açısından fark saptanmadı. Her üç grup arasın - da omuz ağrısı ve yan etkiler yönünden fark saptanmadı. Sonuç: Jinekolojik laparoskopik cerrahi sonrası intraperitoneal %0.75lik ropivakain ile meperidin kombinasyonu ropivakain ya da sa- line göre postoperatif ilk bir saatte daha düşük ağrı skorları ve analjezik tüketimi sağlamaktadır.

Jinekolojik laparoskopik cerrahide intraperitoneal ropivakain ve ropivakain ile meperidin kombinasyonu

Objectives: Postoperative pain after laparoscopic surgery is less intense than after laparotomy and patients may beneft from an intraperitoneal injection of local anesthetic and opioids. We aimed to compare intraperitoneal 0.75% ropivacaine with 0.75% ropivacaine plus meperidine for postoperative analgesia in patients undergoing gynecologic laparoscopy. Methods: At the end of gynecologic laparoscopy, in a double-blind, randomized manner, one of the following injections was given intraperitoneally. Patients were allocated into three groups: Patients in R Group (n=18) were given 0.75% ropivacaine 3 mg/kg in 200 mL saline; patients in RM Group (n=17) were given meperidine 50 mg plus 0.75% ropivacaine 3 mg/kg in 200 mL saline; patients in C Group (n=18) were given 200 mL saline through the trocars. All patients were given diclofenac sodium when they had pain (VAS 3) and 1 mg/kg meperidine i.v. was also given when pain persisted. Results: Te pain scores and analgesic requirements during the frst postoperative hour were signifcantly lower in the RM Group than those in the R and C Groups. Beyond that time, the pain scores were similar in all groups and there were no diferences in total analgesic requirement in 24 h between groups. Te three groups were comparable for shoulder pain and side efects. Conclusion: Te intraperitoneal infltration of 0.75% ropivacaine plus meperidine reduced pain scores and analgesic require- ment during the frst one hour after gynecologic laparoscopy compared with the intraperitoneal infltration of ropivacaine or saline.

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