Aslı DİKİCİ, NURTEN KAYACAN, BİLGE KARSLI

Laparoskopik jinekolojik cerrahide intraperitoneal, insizyonel, intraperitoneal+insizyonel levobupivakainin analjezik etkisi

Amaç: Çalışmamızda, laparoskopik jinekolojik cerrahide intraperitoneal, insizyonel ve intraperitoneal+insizyonel levobupivakainin analjezik etkinliğini araştırmayı amaçladık. Gereç ve Yöntem: Grup 1’de 20 ml levobupivakain intraperitonal olarak, Grup 2’de 20 ml levobupivakain trokarların insizyon bölgesine, Grup 3’de ise 20 ml levobupivakain intraperitoneal uygulanırken, trokar insizyon bölgelerine de 20 ml levobupivakain infiltre edildi. Postoperatif 2., 4., 12. ve 24. saatlerde hastaların omuz ağrısı, istirahat ve hareketle ortaya çıkan karın ağrısı VAS ile değerlendirildi. VAS >3 olarak değerlendirilen hastaların analjezisi yetersiz olarak kabul edildi ve diklofenak sodyum uygulandı. Olguların postoperatif ilk analjezik gereksinim zamanı, toplam analjezik tüketimi, analjezik etkinlik ve analjezik yöntemden memnuniyetleri değerlendirildi. Bulgular: Gruplar arasında VAS skorlarında anlamlı farklılık yoktu (p>0.05). Grup 2’deki hastalarda, Grup I ve Grup III’deki hastalara göre postoperatif analjezik tüketimi daha fazla ve ilk analjezik gereksinim zamanı daha kısa idi, fakat fark anlamlı değildi. Hastaların uygulanan anestezik yöntemden memnuniyetleri gruplar arasında benzerdi. Sonuç: Jinekolojik laparoskopik cerrahilerde intraperitoneal levobupivakain uygulamalarının sadece cilt insizyonuna levobupivakain uygulanan gruba göre istatistiksel olarak anlamlı olmasa da daha az omuz ve karın ağrısı, daha düşük total analjezik tüketimi ve daha etkin bir analjezi ile alternatif bir yöntem olabileceğini düşünmekteyiz. Ancak, konu ile ilgili farklı lokal anestezikleri de karşılaştıran daha ileri çalışmalara ihtiyaç vardır.

Analgesic efficacy of intraperitoneal, incisional, and intraperitoneal + incisional levobupivacaine in laparoscopic gynecological surgery

Objectives: We aimed to investigate the analgesic efficacy of intraperitoneal, incisional, and intraperitoneal + incisional levobupivacaine in laparoscopic gynecological surgery. Methods: Group 1 received levobupivacaine 20 mL intraperitoneally, Group 2 received levobupivacaine 20 mL to the trocar wounds, Group 3 received levobupivacaine 20 mL intraperitoneally and levobupivacaine 20 mL to the trocar wounds. Postoperative abdominal pain at rest and during mobilization and shoulder pain were assessed at the 2nd, 4th,12th, and 24th postoperatively by VAS. If VAS was >3, the analgesia was assessed as inadequate, and diclofenac sodium was injected. In addition, time the first analgesic requirement, total analgesic consumption, analgesic effectiveness, and the satisfaction of patients about the analgesic method were recorded during the postoperative period. Results: No significant difference was found between groups with respect to VAS (p>0.05). Patients in Group 2 had a higher postoperative analgesic consumption and lower timing of the first analgesic requirement than Groups 1 and 3, but these differences were not significant (p>0.05). The satisfaction of the patients about the analgesic technique was similar between the groups. Conclusion: The use of levobupivacaine intraperitoneally is an alternative method to reducing of postoperative shoulder and abdominal pain in gynecological laparoscopic surgery. Also, we observed a lower total analgesic consumption and more analgesic effectiveness in intraperitoneal groups than the other. Further studies are needed with different intraperitoneal local anesthetics.

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