Tek seviyeli lomber disk herni cerrahisinde cerrahi sonrası ağrı yönetimi: Betametazon, ibuprofen ve pregabalinin karşılaştırılması

Tek seviyeli lomber disk hernilerinde cerrahi sonrası ağrı kontrolünde pregabalin, betametazon ve ibuprofenin etkinliklerini karşılaştırmak amaçlanmıştır. Gereç ve Yöntem: Randomize prospektif çalışmada 60 hasta 20’şer kişilik üç gruba (1. grup pregabalin, 2. grup ibuprofen ve 3. grup betametazon) ayrıldı. Cerrahi öncesi bel-bacak ağrıları vizüel analog skala (VAS) ve Oswestry skaları ile değerlendirilen hastalara cerrahi sırasında 100 mili gram tramodol hidroklorür verildi. Cerrahiden sonra ilk 24 saat, 1. hafta ve 1. ay bel-bacak ağrı değerlendirmesi vizüel analog skalası ve 1.ayda Oswestry skalası tekrarlanarak, uygulanan ilaçların etkinlikleri kıyaslandı. Bulgular: Preoperatif ve postoperatif bel ağrısı değerlendirmede VAS değerlerinde tüm ilaç gruplarında 1. hafta ile 1. ay sonuçları arasında anlamlı bir fark bulunmamıştır. Bunun yanısıra bacak ağrısı vizüel analog skala değerlerinde bütün ilaç grupları zamana bağlı olarak azalış gösterirken, pregabalin dışında postop 1. hafta ve 1. ay düzeyleri arasında anlamlı bir fark saptanmamış, pregabalinin erken dönemde etkisi diğer iki ilaçdan daha az bulunmuştur. Postoperatif Oswestry düzeyleri ile preoperatif Oswestry değerleri karşılaştırıldığında tüm ilaç gruplarında anlamlı bir azalış gözlenmiştir. Sonuç: Tek seviyeli lomber disk hernilerine uygulanan cerrahi sonrasında her üç grupta 1. ayın sonunda birbirine yakın postoperatif analjezi sağlansada; cerrahi sonrası ilk 24 saat ve 1. ayda betametazonun bel-bacak ağrı değerlendirmesindeki vizüel analog skala değerlerindeki düşüş daha anlamlı bulunmuştur.

Post-operative pain management for single-level lumbar disc herniation surgery: A comparison of betamethasone, ibuprofen, and pregabalin

Objectives: The aim of this study was to compare the effects of pregabalin, betamethasone, and ibuprofen on post-operativepain management in patients with single-level lumbar disc herniation surgery.Methods: The present study was a randomized prospective study conducted at a tertiary university hospital. Sixty patientswere equally divided into three groups based on whether they were treated with pregabalin (Group 1), ibuprofen (Group 2),and betamethasone (Group 3). Patients whose pre-operative back and leg pain was evaluated using a visual analog scale (VAS)and the Oswestry scale were administered 100 mg tramadol hydrochloride during surgery. The treatment efficiency was compared by assessing post-operative VAS scores at 24 h, 1 week, and 1 month after and Oswestry scale at 1 month after surgery.Results: The VAS scores for pre-operative and post-operative back pain did not show significant differences between theresults at 1 week and 1 month in any group. There was no significant drug efficacy between post-operative week 1 and postoperative month 1, except for pregabalin; an early effect was less frequently observed in the pregabalin group than in theibuprofen and betamethasone groups.Conclusion: Although the three groups treated for single-level lumbar disc herniation received similar post-operative analgesia at the end of post-operative month 1, the decrease in VAS scores for back and leg pain was significant in the betamethasone group in the 1st post-operative 24 h and post-operative month 1.

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1. Govind J. Lumbar radicular pain. Aust Fam Physician 2004;33(6):409–12.
2. Buvanendran A, Fiala J, Patel KA, Golden AD, Moric M, Kroin JS. The incidence and severity of postoperative pain following inpatient surgery. Pain Med 2015;16(12):2277–83.
3. Penprase B, Brunetto E, Dahmani E, Forthoffer JJ, Kapoor S. The efficacy of preemptive analgesia for postoperative pain control: A systematic review of the literature. AORN J 2015;101(1):94–105.
4. Taylor CP. Mechanisms of analgesia by gabapentin and pregabalin--calcium channel alpha2-delta [Cavalpha2 delta] ligands. Pain 2009;142(1-2):13–6.
5. Ng LC, Sell P. Outcomes of a prospective cohort study on peri-radicular infiltration for radicular pain in patients with lumbar disc herniation and spinal stenosis. Eur Spine J 2004;13(4):325–9.
6. Karst M, Kegel T, Lukas A, Lüdemann W, Hussein S, Piepenbrock SEffect of celecoxib and dexamethasone on postoperative pain after lumbar disc surgery. Neurosurgery 2003;53(2):331–6.
7. Lundin A, Magnuson A, Axelsson K, Kogler H, Samuelson L. The effect of perioperative corticosteroids on the outcome of microscopic lumbar disc surgery. Eur Spine J 2003;12(6):625–30.
8. Langmayr JJ, Obwegeser AA, Schwarz AB, Laimer I, Ulmer H, Ortler M. Intrathecal steroids to reduce pain after lumbar disc surgery: A double-blind, placebo-controlled prospective study. Pain 1995;62(3):357–61.
9. McCormick Z, Kennedy DJ, Garvan C, Rivers E, Temme K, Margolis S, et al. Comparison of pain score reduction using triamcinolone vs. betamethasone in transforaminal epidural steroid injections for lumbosacral radicular pain. Am J Phys Med Rehabil 2015;94(12):e122–4.
10. Ciftci B, Ekinci M, Celik EC, Kaciroglu A, Karakaya MA, Demiraran Y, et al. Comparison of ıntravenous ıbuprofen and paracetamol for postoperative pain management after laparoscopic sleeve gastrectomy. A randomized controlled study. Obes Surg 2019;29(3):765–70.
11. Sandborn WJ, Hanauer SB, Buch A. Comparative pharmacokinetics of equimolar doses of 5-aminosalicylate administered as oral mesalamine (Asacol) and balsalazide: A randomized, single-dose, crossover study in healthy volunteers. Aliment Pharmacol Ther 2004;19(10):1089–98.
12. Lee JW, Kim SH, Lee IS, Choi JA, Choi JY, Hong SH, et al. Therapeutic effect and outcome predictors of sciatica treated using transforaminal epidural steroid injection. AJR Am J Roentgenol 2006;187(6):1427–31.
13. Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc 2009;46(6):515–21.
14. Olmarker K, Holm S, Rosenqvist AL, Rydevik BJ. Experimental nerve root compression. A model of acute, graded compression of the porcine cauda equina and an analysis of neural and vascular anatomy. Spine 1991;16(1):61–9.
15. Finckh A, Zufferey P, Schurch MA, Balagué F, Waldburger M, So AK. Short-term efficacy of intravenous pulse glucocorticoids in acute discogenic sciatica. A randomized controlled trial. Spine (Phila Pa 1976) 2006;31(4):377–81.
16. Karppinen J, Malmivaara A, Kurunlahti M, Kyllönen E, Pienimäki T, Nieminen P, et al. Periradicular infiltration for sciatica: A randomized controlled trial. Spine (Phila Pa 1976) 2001;26(9):1059–67.
17. Zhang Y, Yang XJ, Zeng TH, Qiu YY, Wang YT, Liang FG. A Retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation. Chin J Traumatol 2017;20(1):34–8.
18. Wang H, Huang B, Zeng W, Li C, Zhang Z, Wang J, et al. Comparison of early and late percutaneous endoscopic lumbar discectomy for lumbar disc herniation. Acta Neurochir (Wien) 2013;155(3):1931–6.
19. Ahn Y, Lee SH. Postoperative spondylodiscitis following transforaminal percutaneous endoscopic lumbar discectomy: Clinical characteristics and preventive strategies. Br J Neurosurg 2012;26(4):482–6.
20. Soutworth S, Peters J, Rock A, Pavliv L. A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen 400 and 800 mg every 6 hours in the management of postoperative pain. Clin Ther 2009;31(9):1922–35.
21. Zhang Z, Xu H, Zhang Y, Li W, Yang Y, Han T, et al. Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials. J Clin Anesth 2017;43:84–9.
22. Reuben SS, Buvanendran A, Kroin JS, Raghunathan K. The analgesic efficacy of celecoxib, pregabalin, and their combination for spinal fusion surgery. Anesth Analg 2006;103(5):1271–7.
23. Kashefi P, Honarmand A, Safavi M. Effects of preemptive analgesia with celecoxib or acetaminophen on postoperative pain relief following lower extremity orthopedic surgery. Adv Biomed Res 2012;1:66.
24. Kelsaka E, Güldoğus F, Çetinoğlu E. Effect of intravenous dexketoprofen use on postoperative analgesic consumption in patients with lumbar disc surgery. Agri 2014;26(2):82–6.
25. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 2009;22(5):588–93.
26. Zhang J, Ho KY, Wang Y. Efficacy of pregabalin in acute postoperative pain: A meta-analysis. Br J Anaesth 2011;106(4):454–62.
27. Yu L, Ran B, Li M, Shi Z. Gabapentin and pregabalin in the management of postoperative pain after lumbar spinal surgery: A systematic review and meta-analysis. Spine (Phila Pa 1976) 2013;38(22):1947–52.
28. Fujita N, Tobe M, Tsukamoto N, Saito S, Obata H. A randomized placebo-controlled study of preoperative pregabalin for postoperative analgesia in patients with spinal surgery. J Clin Anesth 2016;31:149–53.
29. Ittichaikulthol W, Virankabutra T, Kunopart M, Khamhom W, Putarawuthichai P, Rungphet S. Effects of pregabalin on post operative morphine consumption and pain after abdominal hysterectomy with/without salphingo-oophorectomy: A randomized, double-blind trial. J Med Assoc Thai 2009;92(10):1318–23.
30. Kumar KP, Kulkarni DK, Gurajala I, Gopinath R. Pregabalin versus tramadol for postoperative pain management in patients undergoing lumbar laminectomy: A randomized, double-blinded, placebo-controlled study. J Pain Res 2013;24(6):471–8.
31. Balaban F, Yağar S, Özgök A, Koç M, Güllapoğlu H. A randomized, placebo-controlled study of pregabalin for postoperative pain intensity after laparoscopic cholecystectomy. J Clin Anesth 2012;24(3):175–8.