İpek ERDOĞAN, Türkay ÇAKAN, Ayşe ÖZCAN, Esra TÜRKYILMAZ, Bülent BALTACI, Bayazıt DİKMEN

Miyomektomi sonrası lornoksikamın postoperatif ağrı üzerine etkisi

Bu prospektif randomize çalışmada, miyomektomi operasyonları sonrası lornoksikamın postoperatif analjezik etkilerini değerlendirmeyi amaçladık. MATERYAL-METOD: Miyomektomi operasyonu geçirecek ASA I-II grubu 40 hasta çalışmaya dahil edildi. Hastalar randomize olarak iki gruba ayrıldı ve % 0,75’lik ropivakain kullanılarak epidural blok yapıldı. Operasyon sonrası 1. grup hastalara morfin hasta kontrollü epidural analjezi (HKEA) + plasebo (2 ml serum fizyolojik iv), 2. grup hastalara morfin HKEA + 8 mg intravenöz lornoksikam verildi. Postoperatif 0,1, 2, 4, 6, 8, 12 ve 24. saatlerde ağrı değerlendirildi.İstatistiksel analizler ki-kare ve students-t testleri kullanılarak yapıldı. BULGULAR: Postoperatif 2., 4., 6.ve 24. saatlerde ağrı skorları Grup I’de Grup II’ye göre daha yüksekti. Toplam morfin tüketimi Grup I’de 10,45 ± 4.03 ve Grup II’de 4,25 ± 1,74 idi. SONUÇ: Miyomektomi operasyonları sonrası uygulanan tek doz intravenöz lornoksikamın ağrı tedavisi için güvenilir ve etkin olduğu, yeterli analjezi sağladığı ve morfin tüketiminde ve yan etkilerde azalma sağladığı kanaatindeyiz.

Anahtar Kelimeler:

Analjezi, epidural, Analjezi, hasta kontrollü, Ağrı ölçümü, Ağrı, ameliyat sonrası, Anti-enflamatuvar ajanlar, steroid olmayan, Jinekolojik cerrahi prosedürler, Morfin

Effect of lornoxicam on postoperative analgesia after myomectomy

BACKGROUND: In this prospective, randomized study, we evaluate the postoperative analgesic effect of lornoxicam after myomectomy operations. MATERIAL-METHOD: Forty ASA I-II patients scheduled for myomectomy operation were enrolled to this study. Patients were randomly divided into two groups and epidural block was performed with 0,75 % ropivacaine. After the operation, morphine Patient Controlled Epidural Analgesia (PCEA) combined with placebo (saline 2 ml iv) and morphine PCEA combined with lornoxicam 8 mg iv were administered to patients in Group I and Group II, respectively. Pain was assessed at the 0,1st, 2nd, 4th, 6th, 8th, 12th and 24th hours postoperatively. Chi-square and student’s t tests were used for statistical analysis. RESULTS: VAS( Visual Analog Scale) scores were higher in Group I than Group II at 2nd, 4th, 6th and 24th hours. Total morphine consumption was 10.45± 4.03 in Group I and 4.25 ± 1.74 in Group II. CONCLUSION: Single dose iv lornoxicam is a safe and an effective treatment option of post-myomectomy pain as it produces effective analgesia, reduces morphine consumption and does not increase the side effects.

Keywords:

Analgesia, Epidural, Analgesia, Patient-Controlled, Pain Measurement, Pain, Postoperative, Anti-Inflammatory Agents, Non-Steroidal, Gynecologic Surgical Procedures, Morphine,

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Akın A, Esmaoğlu A, Boyacı A. Total kalça protezi uygulanan hastalarda piroksikamın preemptif analjezik etkinliği. Türk Anest Rean Cem Mecmuası. 2002;30:161-5.
Arslan M, Tuncer B, Babacan A, Taneri F, Karadenizli Y, Onuk E, et al: Postoperative analgesic effects of lornoxicam after thyroidectomy: a placebo controlled randomized study. Agri. 2006;18:27-33.
Benzon HT, Wong HY, Belavic AM Jr,Goodman I, Mitchell D,Lefheit T, et al. A randomized double-blind comparison of epidural fentanyl infusion versus patient controlled analgesia with morphine for post thoracotomy pain.Anesth Analg. 1993;76:316-22.
Blaicher AM, Landsteiner HT, Zwerina J, Leitgeb U, Volf I,Hoerauf K. Effect of non-selective,nonsteroidal antiinf lammatory drugs and cyclo-oxygenase 2 selective inhibitors on the PFA-100 closure time. Anaesthesia 2004; 59: 1100-3.
Cavaliere F, Antonelli M, Arcangeli A, Conti G, Costa R,Pennisi MA, et al. A low dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically ill patients. Can J Anaesth. 2002;49:1088-94
Detlet E, Albrechtsen M, Stolke D. A comparison of patientcontrolled analgesia with lornoxicam versus morphine in patients undergoing lumbar disk surgery. Anesth Analg. 1998;86:1045-50.
Dionne RA, Campbell RA, Cooper SA, Hall DL, Buckingham B.Supression of post operative pain by preoperative administration of ibuprofen in comparison to placebo, acetaminophen and acetaminophen plus codeine. J Clin Pharmacol. 1983;23:37-43.
Erdine S. Ameliyat sonrasi agri tedavisi. Ağrı Sendromları ve tedavisi, Gizben Matbaacılık, 2nd Edn. Istanbul: 2003:43.
Gong ZY, Ye TH, Qin XT, Yu GX, Guo XY, Luo AL. Patientcontrolled analgesia with lornoxicam in patients under going gynecological surgery. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2001;23:472-5.
Huang JJ, Taguchi A, Hsu H, Andriole GL Jr, Kurz A. A preoperative oral rofecoxib does not decrease postoperative pain after radical prostatectomy. A prospective, randomize, double-blinded, placebo-controlled trial. J Clin Anesth. 2001;13:94-7.
Ilias W, Jansen M. Pain control after hysteroctomy: An observer-blind, randomised trial of lornoxicam versus tramadol. Br J Clin Pract. 1996;50:197-202.
Karaman S, Gunusen I, Uyar M, Firat V: The effect of preoperative lornoxicam and ketoprofen application on the morphine consumption of postoperative patient controll ed analgesia. J Int Med Res. 2006;34:168-175.
Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth. 2001; 87:36-46.
Malan TP, Marsh G, Hakki SI, Grossman E, Traylor L, Hubbard RC. Parecoxib sodium, a parenteral cyclooxygenase 2 selective inhibitor, improves morphine analgesia and is opioid sparing following total hip arthroplasty. Anesthesiology 2003; 98: 950-6.
Mitchell RW, Smith G. The control of acute post-operative pain. Br J Anaesth.1989;63: 147-158.
Ng A, Smith G, Davidson AC. Analgesic effects of parecoxib following total abdominal hysterectomy. Br J Anaesth. 2003;90:746-9.
Owen H, Glavin RJ, Shaw NA. Ibuprofen in the management of post operative pain. Br J Anaesth. 1986;58:1371-5.
Papadima A, Lagoudionakis EE, Antonakis PT, Pattas M,Kremastinou F, Katergiannakis V, et al. Parecoxib vs lornoxicam in the treatment of postoperative pain after laparoscopic cholecystectomy: a prospective randomized placebo-controlled trial. Eur J Anaesthesiol.2007;24:154-8.
Radhofer-Welte S, Rabasseda X. Lornoxicam, a new potent NSA ID with an improved tolerability profile. Drugs Today. 2000;36:55-76.
Rogers JE, Fleming BG, Macintosh KC, Johnston B, Morgan- Hughes JO. Effect of timing of ketorolac administration on patient-controlled opioid use. Br J Anaesth. 1995;75: 15-8.
Schafer AI. Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis. J Clin Pharmacol. 1995;35:209-19
Serpell MG, Thomson MF:.Comparison of Piroxicam with placebo in the management of pain after total hip replacement. Br J Anaesth. 1989;63:354-6.
Sinatra RS. Acute pain management and acute pain services. In:Cousins MJ, Bridenbaugh PO, editors. Neural blockade: In clinical anesthesia and management of pain. Philadelphia: Lippincott- Raven; 1998. p. 793-835.
Staunstrup H, Ovesen J, Larsen UT, Elbaek K, LarsenU, Kroner K. Efficacy and tolerability of lornoxicam in postoperative pain. J Clin Pharmacol. 1999;39:834 – 41.
Sunshine A, Roure C, Colon A, Olson NZ, Gonzalez L, Siegel C,et al. Analgesic efficacy of piroxicam in the treatment postoperative pain. Am J Med. 1988;84:16 – 22.
Thompson JP, Sharpe P, Kiani S, Owen-Smith O. Effect of meloxicam on postoperative pain after abdominal hysterectomy. Br J Anaesth. 2000;84:151-4.
Tramer MR. Efficacy and advers effect of prophylactic antiemetics during patient-controlled analgesia therapy:a quantitative systematic review. Anesth Analg. 1999;88:1354-61
Tramer MR. A rational approach to the control of postoperative nausea and vomiting evidence from systematic reviews. Part I. Efficacy and horn of antiemetic interventions and some methodological issues. Acta Anaesthesiol Scand.2001;45:4-13.
Trampitsch E, Pipam W, Moertl M, Sadjak A, Dorn C, Sittl R, et al. Preemptive randomized, double-blind study with lornoxicam in gynecological surgery. Schmerz. 2003;17:4-10.