Postoperatif ağrı tedavisinde intravenöz hasta kontrollü analjezi yöntemi ile kullanılan tramadol, tramadol-metamizol ve tramadol lornoksikamın karşılaştırılması

Bu çalışmada, alt abdominal cerrahide intravenöz HKA yöntemi ile kullanılan tramadol, tramadol-metamizol ve tramadol-lornoksikam kombinasyonlarının postoperatif analjezik etkilerinin karşılaştırılması amaçlandı. Alt abdominal cerrahi girişim uygulanacak 60 erişkin kadın hasta çalışmaya dahil edildi. Hastalar randomize olarak üç gruba ayrıldılar. Grup I (tramadol) için, 50 ml izotonik NaCl içinde 500 mg tramadol (10 mg/ml tramadol); Grup II (tramadol- metamizol) için, 50 ml izotonik NaCl içinde 250 mg tramadol + 3000 mg metamizol (5 mg/ml tramadol + 60 mg/ml metamizol) ve Grup III (tramadol- lornoksikam) için ise, 50 ml izotonik NaCl içinde 250 mg tramadol + 20 mg lornoksikam (5 mg/ml tramadol + 0,4 mg/ml lornoksikam ) içeren solüsyonlar hazırlandı. Her üç grupta da operasyon bitiminden 30-40 dakika önce başlanarak, 10 ml, 30 dakikada gidecek şekilde yükleme dozu uygulandı. Hasta ağrıdan ilk yakındığı zaman HKA uygulaması başlatıldı. Ağrı VAS ile ilk 1 saatte 15 dak. ara ile daha sonra ise 2., 4., 8., 12., 18. ve 24. saatlerde değerlendirildi. Eş zamanlı olarak vital parametreler, yan etkiler, sedasyon skorları ve total analjezik tüketimleri de değerlendirildi. Toplam tramadol ve antiemetik tüketimi ile postoperatif bulantı kusma insidansı, sadece tramadol kullanılan grup I’ de, diğer iki gruba göre belirgin derecede yüksek olarak tesbit edildi. Sonuç olarak; HKA yöntemi ile tramadol-metamizol ve tramadol-lornoksikam kombinasyonları uygulandığında, daha az yan etki ile etkin bir postoperatif analjezi sağlandı.

Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain

Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain. The aim of the present study was to compare of the postoperative analgesic effects of tramadol, combinations of tramadol-metamizol and tramadol-lornoxicam administered by intravenous Patient Control Analgesia (PCA) in lower abdominal surgery. Sixty adult, female patients who undergoing lower abdominal surgery, were included in this study. Patients were randomized to three groups. The solutions were prepared containing 500 mg tramadol in 50 ml saline (10 mg/ml tramadol) for Group I, 250 mg tramadol+3000 mg metamizol in 50 ml saline (5 mg/ml tramadol+60 mg/ml metamizol) for Group II and 250 mg tramadol+20 mg lornoxicam in 50 ml saline (5mg/ml tramadol + 0.4mg/ml lornoxicam) for Group III. Loading dose 10 ml was administrated within 30 min 30 to 40 min before the end of the surgery. PCA was started at the first complaint of pain. Pain was evaluated by VAS in every 15 minute intervals at the first hour and later at 2nd, 4th, 8th, 12th, 18th and 24th hours postoperatively. Vital parameters, side-effects, sedation scores and total analgesic consumptions were also recorded concurrently.. Total tramadol and anti-emetic consumption, the incidence of postoperative nausea and vomiting (PONV) were significantly higher in group I than the other groups (p<0.05). In conclusion; Tramadol-metamizol and tramadol-lornoxicam combinations administered by intravenous PCA provide efficient postoperative analgesia with less side effects.

Kaynakça

Carpenter RL, Abram SE, Bromage PR: Consensus statement on acute pain management. Reg Anaest Pain Med 1996; 21: 152-156.

Grundmann U, Wörnle C, Biedler A et al.: The efficacy of the nonopioid analgesics parecoxib, paracetamol and metamizol for postoperative pain relief after lumbar microdiscectomy. Anesth Analg. 2006 Jul; 103(1): 217-22

Ilias W, Jansen M: Pain control after hysterectomy: An observer-blind, randomised trial of lornoxicam versus tramadol. Br J Clin Pract. 1996; 197-202.

Julia AB, Andrew F, Lee B. Lornoxicam: A review of its pharmacology and therapeutic potential in management of painful and ınflammatory conditions. Drugs 1996; 51(4): 639-57.

Karaca M, Kocoglu H, Göcmen A: Comparison of lornoxicam with tramadol in patient-controlled analgesia after gynecological surgery. Eur J Gynaecol Oncol 2006; 27(1): 78-80.

Karanikolas M, Swarm RA: Current trends in perioperative pain management. Anesthesiology Clinics of North America, 2000; 18: 575-599.

Lauretti GR, Mattos AL, Lima IC: Tramadol and beta-cyclodextrin piroxicam: effective multimodal balanced analgesia for the intraand postoperative period. Reg Anesth 1997 May-Jun; 22(3): 243-8

Lehmann KA, Paral KA, Sabatowski R: Postoperative pain therapy with hydromorphone and metamizole. A prospective randomized study in intravenous patient-controlled analgesia (PCA). Anaesthesist. 2001; 50(10): 750-756.

Macintyre PE: Safety and efficacy patient-controlled analgesia. Br J Anaesth 2001: 87; 36-46.

Miyoshi HR, Leckband SG: Systemic Opioid Analgesics. In: Loeser JD, Butler SH, Chapman CR, Turk DC. Bonica’s Management of Pain. 3th edition. Philadelphia, Lippincott Williams and Wilkins, 2001: 1682-1709.

Nikoda VV, Maiachkin RB, Bondarenko AV: Use of lornoxicam in the early postoperative pain. Anesth. 2001; 82: 47-50.

Pang WW, Mok MS et al.: Comparison of patient-controlled analgesia (PCA) with tramadol or morphine Can J Anaesth 1999 Nov; 46(11): 1030-1035.

Pang WW, Huang S, Tung CC, Huang MH: Patient-controlled analgesia with tramadol versus tramadol plus lysine acetyl salicylate. Anesth. Analg 2000; 91: 1226-1229.

Picard P, Bazin JE, Conio N, Ruiz F, Schoeffler P: Ketorolac potentiates morphine in postoperative patient-controlled analgesia. Pain 1997 Dec; 73(3): 401-6.

Radbrunch L, Grond S, Lehmann KA: A risk-benefit of assesment of tramadol in the management of pain. Drug Saf 1996; 15(1): 8-29.

Scott L, Perry C: Tramadol a review of its use in perioperative pain. Drugs 2000 Jul; 60 (1): 139-176.

Shipton EA: Tramadol present and future. Anaesth Intensive Care. 2000; 28(4): 363-374.

Silvasti M, Svartling N et al.: Comprasion of intravenous patientcontrolled analgesia with tramadol versus morphine after microvascular breast recontruction. European Journal of Anaesthesiology 2000; 17: 448-455.

Sunshine A, Roure L et al.: Analgesic efficacy of piroxicam in the treatment post operative pain. American Journal of Medicine. 1998; 84: 16-22.

Tarkkilla PL: Comparison of respiratory effects of tramadol and pethidine. Eur J Anaesthesiol. 1998 Jan; 15(1): 64-68.

Tarradel R, Pol O, Farre M: Respiratory and analgesic effects of meperidine and tramadol in patients undergoing orthopedic surgery. Meth Find Exp Clin Pharmacol. 1996 Apr; 18(3): 211-8.

Torres LM, Rodriguez MJ et al.: Efficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: a randomized, double-blind, multicenter study. Reg Anesth and Pain Med. 2001; 26(2): 118-124.

Ünlügenç H ve ark.: A comparative study on the analgesic effect of tramadol, tramadol plus magnesium, and tramadol plus ketamine for postoperative pain management after major abdominal surgery Acta Anaesthesiol Scand. 2002 Sep; 46(8): 1025-30.

Vickers MD, O’Flaherty D, Szekely SM, Read M, Yoshimuzi J: Tramadol: Pain relief by an opioid whithout depression of respiration. Anaesthesia, 1992; 47: 291-296.

Kaynak Göster