The effect of opioid administration by different routes on the psychological functions of elderly patients
Epidural ve intravenöz morfin uygulamaları sırasında hastaların psikolojik durumunda oluşan değişiklikler yeterince bilinmemektedir.Epidural ve intravenöz olarak uygulanan morfinin plazma konsantrasyonlarının benzer olduğu ancak serebrospinal sıvıdaki konsantrasyonlarının farklı olduğu ise bilinmektedir.Bu randomize tek kör çalışmada major ortopedik girişimler sonrası uygulanan iki farklı analjezik rejimin yaşlı hastaların psikolojik ve mental fonksiyonları üzerine olan etkileri araştırılmıştır.Hasta kontrollü analjezi yöntemi kullanılarak E grubundaki hastalara epidural yoldan, IV grubundaki hastalara ise intravenöz yoldan morfin uygulanmıştır. Tüm hastaların psikolojik durumu Kısa Semptom Envanteri kullanılarak operasyondan bir gün önce ve operasyondan iki gün sonra değerlendirilmiştir. Kısa Semptom Envanterinin sonuçları Rahatsızlık Ciddiyet İndeksi (RCİ) kullanılarak yorumlanmıştır.Bu indeks kullanılarak ayrıca depresyon, somatizasyon, obsesif-kompulsif kişilik, anksiyete, kişiler arası duyarlılık, fobik anksiyete, düşmanlık, paranoid düşünce ve psikotizm gibi dokuz farklı (alt grup) psikolojik durum ile ilgili çıkarımlar yapılmıştır.Preoperatif ve postoperatif RCİ sonuçları arasında anlamlı bir farklılık saptanmamıştır (p>0.05).Sadece kişiler arası duyarlılık alt skalası IV grupta basal değere göre anlamlı olarak düşük bulunmuştur (p0.05) Bu çalışma, epidural ve intravenöz morfin kullanımı sonrasında her iki gruptaki hastalarda da postoperatif dönemde psikolojik streste artış olmadığını göstermiştir.Ancak intravenöz morfin alan hastalarda, postoperatif dönemde kişiler arası iletişimi gösteren paremetrelerde olumlu sonuçlar elde edilmiştir
Anahtar Kelimeler:
Yaşlı, Analjezikler, opioid, Morfin, İlaç uygulama yolları
Farklı yollarla olan opiod uygulamalarının yaşlı hastalardaki psikolojik fonksiyonlara etkisi
Psychological status of patients during epidural and intravenous (iv) morphine administration are not known enough. It’s known that after administration of morphine epidurally and intravenously plasma concentrations are similar but the concentrations in cerebrospinal fluide are different. The effects of two postoperative analgesia treatment regimens on the psychological and mental functions of the elderly after major orthopedic surgery were investigated in this randomized, blinded study. Morphine was used epidurally in Group E and intravenously in Group IV with patient controlled analgesia method for postoperative analgesia treatment. All patients were assessed for psychological status the day before surgery and 2 days after surgery using the Brief Symptom Inventory (BSI). The results of the BSI were assessed with the Global Severity Index (GSI). Nine subscales were also derived: depression, somatization, obsessive-compulsive, anxiety, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, and psychoticism. There was not significant difference between the groups for preoperative and postoperative GSI results (p > 0.05). Only interpersonal sensitivity subscale results in Group IV were decreased compared to the baseline (p < 0.001). Preoperative BSI and submeasurement test scores revealed no correlation with total morphine consumption in both groups (p > 0.05). Mental changes like agitation, time and place disorientation were seen equally in both groups. This study showed that after epidural and intravenouse morphine administration, no psychologycal changes were observed in the postoperative period compared with baseline. Patients who received morphine intravenously were showed less interpersonal sensitivity in the postoperative period.
Keywords:
Aged, Analgesics, Opioid, Morphine, Drug Administration Routes,
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- ISSN: 1300-0012
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 2018
- Yayıncı: Ali Cangül
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