Ayten AKGÜL, Osman Nuri AYDIN, Volkan DAYANIR, Selda ŞEN, Bakiye UĞUR, Erkin KIR

Usage of remifentanil and fentanyl in intravenous patient-controlled sedo-analgesia

Amaç; topikal anestezi altında fakoemülsifikasyon yöntemi ile gerçekleştirilen katarakt cerrahisi sırasında fentanil veya remifentanilin hasta kontrollü sedoanaljezideki etkinliğini araştırmaktı. Prospektif, randomize, çift kör çalışma için etik komite izni alındı. Katarakt cerrahisi geçirecek ASA I-III 120 olgu randomize olarak 3 gruba ayrıldı. Fentanil 0.7 μg/kg yükleme dozu sonrası, 10 μg bolus dozda 5 dakika kilitli kalma süresi, remifentanil 0.3 μg/kg yükleme, 20 μg bolus ve 3 dakika kilitli kalma süresi ayarlanarak hasta kontrollü analjezi (HKA) cihazı ile verildi. Kontrol grubunda serum fizyolojik herhangi bir ilaç katılmadan verildi. Kardiyorespiratuvar sistem bulguları, sözel ağrı skoru ve sedasyon skorları preoperatif, intraoperatif 5., 10., 15., 20. ve 30. dakikalarda kaydedildi. Cerrahi sırasındaki rahatsızlık, HKA cihazına basma ve komplikasyonlar kaydedildi. İlaç verilen gruplarda sözel ağrı skala sonuçları, 15. dakikada kontrol grubundakinden daha düflüktü. Sedasyon skoru; remifentanil grubunda 5. dakikada (p=0.019), fentanil grubunda ise 10. dakikada (p=0.007) kontrol grubundan anlamlı olarak daha yüksekti. Hasta kontrollü analjezi cihazına basan hasta sayısı kontrol grubunda, ilaç verilen gruplardan anlamlı fazla idi (p

Anahtar Kelimeler:

İlaç uygulama, topikal, Anestezi, Katarakt, Katarakt çıkartılması, Fentanil, Analjezi, hasta kontrollü, Oftalmolojik cerrahi işlemler

Topikal anestezi altında katarakt cerrahisi sırasında intravenöz hasta-kontrollü analjezide remifentanil ve fentanilin kullanımı

Our aim was to investigate the effects of patient-controlled sedo/analgesia with fentanyl or remifentanil during cataract surgery with phacoemulsification method under topical anaesthesia. The ethical committee has approved the prospective, randomized, double-blind study. ASA I-III, 120 patients underwent cataract surgery were randomly allocated to 3 groups. Fentanyl was administered in 0.7 μg/kg loading, 10 μg bolus dose with 5 minutes lockout time, remifentanil was administered 0,3 μg/kg loading, 20 μg bolus dose with 3 minutes lockout time by patient controlled analgesia (PCA) equipment. In the control group, saline solution was given without any analgesic drug. Cardiorespiratory system findings, verbal pain scale and sedation scores were recorded preoperatively and intraoperatively at the 5th, 10th, 15th, 20th and 30th minutes. Discomfort during surgery, pressing the PCA button, and complications were recorded. The verbal pain scale scores was significantly lower in the drug groups than the those in control group at the 15th minute. The sedation scores was significantly higher in the remifentanil group at the 5th minute (p=0.019) and in the fentanyl group at the 10th minute (p=0.007) than those in the control group. The number of patients pressing the PCA button was much higher in the control group than the drug groups (p<0.05). Patient comfort and surgeon satisfaction were higher in the drug groups (p<0.05). Intravenous-PCA sedo/analgesia addition to topical anaesthesia provides an advantage in sedo/analgesia, patient comfort, and surgeon satisfaction. PCA is a convenient and safe method, especially at the beginning of the operation when anxiety is intense, and during healon/lens implantation.

Keywords:

Administration, Topical, Anesthesia, Cataract, Cataract Extraction, Fentanyl, Analgesia, Patient-Controlled, Ophthalmologic Surgical Procedures,

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