Nükhet SİVRİKOZ, AHMET KEMALETTİN KOLTKA, Ece GÜREŞTİ, Mehmet BÜGET, NÜZHET MERT ŞENTÜRK, Süleyman ÖZYALÇIN

Perioperative dexketoprofen or lornoxicam administration for pain management after major orthopedic surgery: a randomized, controlled study

Amaç: Non-steroidal antienflamatuvar ilaçlar (NSAİİ) multimodal ameliyat sonrası ağrı tedavisinde kullanılması önerilen ilaçlar- dır. Bu çalışmanın amacı majör ortopedik cerrahi sonrasında kullanılan deksketoprofen ve lornoksikamın ameliyat sonrası analjezik etkinliğini ve morfin tüketiminde yaptığı azalmayı incelemektir. Gereç ve Yöntem: Etik kurul izni ve hasta onamı alındıktan sonra genel anestezi altında elektif kalça veya diz total protezi uygula- nacak 120 hasta iki doz 50 mg deksketoprofen (GD), iki doz 8 mg lornoksikam (GL) veya plasebo (GP) alacak şekilde randomize edildi. Ameliyat sonrası dönemde, 0.01 mg.kg-1 bolus doz ve kilitli kalma 10 dak olacak şekilde morfin içeren HKA bazal infüzyon olmadan başlandı. Ağrı değerlendirmesi ameliyat sonrası 1, 2, 4, 6, 8, 12 ve 24. saatlerde istirahat ve hareket halinde VAS ile yapıldı. Bulgular: Gruplar arasında yaş, cinsiyet, ASA değeri, kalça ve diz protezi yapılan hasta sayısı, ağırlık, boy ve operasyon süresi açısından fark yoktu. GD ve GL hastalarının istirahat ve aktif hareket halindeki VAS değerleri GPdeki hastalardan anlamlı olarak daha düşüktü. GDnin istirahat ve aktif hareket halindeki VAS değerleri GLden daha düşük olarak bulundu. GD ve GLdeki has- taların ameliyat sonrası morfin tüketimi GPdekilerden anlamlı olarak daha düşüktü. GDdeki hastaların toplam morfin tüketimi GLden daha düşük bulundu. Sonuç: Elli mg deksketoprofenin ve 8 mg lornoksikamın intravenöz yoldan günde iki doz uygulanmasının majör ortopedik cerrahi sonrası plaseboya göre daha iyi analjezi sağladığı ve morfin tüketimini azalttığı bulundu. İki aktif ilaç karşılaştırıldığında ise analjezik etkinlik ve morfin tüketimi açısından deksketoprofen lornoksikamdan daha üstün bulundu.

Majör ortopedik cerrahi sonrası ağrı tedavisinde deksketoprofen veya lornoksikam kullanımı: Randomize ve kontrollü bir çalışma

Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain manage- ment. The purpose of this study was to evaluate the postoperative pain relief and opioid-sparing effects of dexketoprofen and lornoxicam after major orthopedic surgery. Methods: After obtaining ethical committee approval and informed consent, 120 patients undergoing elective hip or knee replacement under general anesthesia were randomized to receive two intravenous injections of 50 mg dexketoprofen (GD), 8 mg lornoxicam (GL) or saline as placebo (GP) intravenously. Postoperatively, patient-controlled analgesia (PCA) morphine was started as a 0.01 mg.kg-1 bolus dose, with lockout time of 10 minutes without continuous infusion. Pain assessment was made using the Visual Analogue Scale (VAS) at rest or during movement at postoperative 1, 2, 4, 6, 8, 12, and 24 hours. Results: The three groups were similar in terms of age, gender, American Society of Anesthesiologists (ASA) class, number of patients who underwent hip or knee surgery, weight, height, and operation duration. Patients in GD and GL demonstrated sig- nificantly reduced pain scores at rest and active motion compared to GP, with lower scores in the dexketoprofen group. Patients in GD and GL used significantly less morphine in the postoperative period compared to GP. The total morphine consumption of patients in GD was lower than in GL. Conclusion: Intravenous application of 50 mg dexketoprofen twice a day and 8 mg lornoxicam twice a day improved analgesia and decreased morphine consumption following major orthopedic surgery. When the two active drugs were compared, it was found that dexketoprofen was superior to lornoxicam in terms of analgesic efficacy and opioid consumption.

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