Metehan AKARSU, Sema TUNCER, RUHİYE REİSLİ, Şeref OTELCİOĞLU

Postoperatif hiperaljezinin önlenmesinde magnezyumun rolü

Amaç: İntraoperatif remifentanil kullanımında akut opioid toleransına bağlı olarak postoperatif ağrı, opioid tüketimi ve insizyon cevresinde hiperaljezi artmaktadır. Bu çalışmada amacımız, remifentanile bağlı gelişen postoperatif hiperaljezinin önlenmesinde magnezyumun etkinliğini değerlendirmektir. Gereç ve Yöntem: Abdominal histerektomi planlanan ASA I-II grubu 60 olgu çalışmaya alındı ve randomize olarak 2 gruba ayrıldı. Anestezi öncesi grup I’e (kontrol) serum fizyolojik, grup II’ye (magnezyum) 50 mg/kg magnezyum (10 dk) i.v. uygulandı. Anestezi indüksiyonu 1 μg/kg remifentanil ve 4-5 mg/kg tiopental, idamesi 0.4 μg/kg/dk remifentanil ve 0.5 MAK sevofluran ile sağlandı. Sevofluran konsantrasyonu otonomik cevaplara göre titre edildi. Operasyon sonlanmadan 30 dakika önce 0.15 mg/kg i.v. morfin, cerrahinin sonunda ise olgulara i.v. hasta kontrollü analjezi cihazı ile tramadol uygulandı. Ağrı skoru, tramadol isteği ve sunumu postoperatif 2., 4., 6., 12., 24. ve 48. saatlerde değerlendirildi. Total tramadol tüketimi 24. ve 48. saatlerde kaydedildi. Periinsizyonel hiperaljezi operasyon öncesi ve postoperatif 24. ve 48. saatlerde algometre ve elektronik von-Frey ile ağrı eşiği ölçülerek değerlendirildi. Bulgular: Ağrı skorları ve toplam tramadol tüketimi magnezyum grubunda daha düşük bulundu (p

The role of magnesium in preventing postoperative hyperalgesia

Objectives: Intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain, opioid requirement and specifically periincisional hyperalgesia. The aim of this study was to investigate the effect of magnesium in preventing remifentanil-induced hyperalgesia. Methods: This study was performed on 60 (ASA I-II) patients planned for abdominal hysterectomy. Sixty patients were randomized into two equal groups. Before anesthesia, saline solution was given to the patients in group I (control group), 50 mg/kg i.v. magnesium in group II (magnesium group). Anesthesia was induced with 1 μg/kg remifentanil combined with 4-5 mg/kg thiopental and 0.5 mg/kg atracurium, maintained with 0.5 MAC sevoflurane and 0.4 μg/kg/min remifentanil in both groups. Sevoflurane concentration was titrated according to autonomic responses. Thirty minutes before the anticipated end of surgery, a 0.15 mg/kg bolus dose of morphine was intravenously. At the end of surgery, patients received tramadol i.v via a PCA device. Pain score, tramadol demand and delivery were assessed at 2, 4, 6, 12, 24 h after surgery. Total tramadol consumption were recorded for 24-48 h after surgery. Periincisional hyperalgesia was assessed by measuring pain threshold to pressure by using an algometer and electronic von Frey filaments before operation and at 28-48 h postoperatively. Results: The pain scores and cumulative tramadol consumption were significantly lower in the magnesium group compared with the control group (p<0.05). Pressure and mechanical pain threshold were significantly less at 24-48 h postoperatively in control group than magnesium group. Conclusion: Magnesium administered preemptively reduced remifentanil-induced hyperalgesia.

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