FİLİZ ÜZÜMCÜGİL, Canan KÜÇÜK, Hülya ORAL, Ayflen HERGÜNER, Salim ERKAYA

AMELİYAT ÖNCESİ İNTRAVENÖZ TRAMADOL VE İNTRAMUSKÜLER DİKLOFENAK SODYUM UYGULANMASI TRAMADOL-HASTA KONTROLLÜ ANALJEZİ'NİN İNTRAOPERATİF YÜKLEME DOZUNU AZALTIR: RANDOMİZE ÇALIŞMA

İntravenöz hasta kontrollü analjezi (HKA) yöntemi ile kullanılan tramadolün yükleme dozunun intraoperatif uygulanması yanetki sıklığını azaltmaktadır. Tek başına önerilen optimum intraoperatif yükleme dozu 2.5 mg kg-1olup, adjuvan ajanlarla bu doz 1.25 mg kg-1'adüşürülebilmektedir. Amacımız, ameliyattan 30 dakika önce 1 mg kg-1intravenöz tramadol ve 75 mg intramusküler diklofenak sodyumkullanıldığında, daha düşük intraoperatif yükleme dozu ve postoperatif ilk 24 saatte daha az tramadol-HKA kullanımı ile etkin analjezisağlanıp sağlanamayacağının araştırılmasıdır.Yöntem: Abdominal histerektomi uygulanan 35-65 yaş arasında, ASA I-II 45 hasta çalışmaya dahil edildi. Hastalara, operasyondan 30dakika önce, 1 mg kg-1intravenöz tramadol ve 75 mg intramusküler diklofenak sodyum uygulandı. Hastalar, cerrahi bitiminden 30 dakikaönce, Grup I (n=15) serum fizyolojik, Grup II (n=15) 0.5 mg kg-1ve Grup III (n=15) 1 mg kg-1tramadol alacak şekilde 3 grup halinderandomize edildi. Birincil parametre 24 saatteki toplam tramadol-HKA kullanımı, ikincil parametreler ise, uyanma zamanı, sedasyon skoru,postoperatif bulantı/kusma, HKA'nin ilk aktivasyon zamanı, 24 saat içerisindeki VRS ile kurtarıcı analjezik kullanımı olarak belirlendi.Bulgular: Altmışıncı dakika VRS skoru Grup III'te anlamlı şekilde düşük bulundu (p

PREOPERATIVE INTRAVENOUS TRAMADOL COMBINED WITH INTRAMUSCULAR DICLOFENAC SODIUM REDUCES INTRAOPERATIVE LOADING DOSE OF TRAMADOL-PCA: A RANDOMIZED TRIAL

Intraoperative administration of loading dose of iv tramadol-PCA (patient controlled analgesia) reduces the incidence ofside effects. Optimum intraoperative single dose is 2.5 mg kg-1, which can be reduced to 1.25 mg kg-1with adjuvant agents. Our aim is toverify the hypothesis asserting the use of 1 mg kg-1intravenous tramadol and 75 mg intramuscular diclofenac sodium 30 minutes beforesurgery would reduce the intraoperative loading dose of tramadol to provide adequate analgesia, while reducing the need for postoperativetramadol-PCA.Method: 35 to 65-year-old, 45 ASA I and II patients, undergoing elective abdominal hysterectomy under general anesthesia wereenrolled. All patients received 1 mg kg-1intravenous tramadol and 75 mg intramuscular diclofenac sodium 30 minutes before surgery. Patientswere randomized into three groups to receive either normal saline (Group I), iv tramadol 0.5 mg kg-1(Group II) or 1 mg kg-1(Group III) 30minutes before the end of surgery. The total tramadol-PCA consumption in 24 hours was our primary outcome measure. Secondary outcomemeasures were emergence times, sedation scores, PONV, time to first activation of PCA, VRSs in 24 hour period postoperatively and rescueanalgesic medication.Results: VRS score in Group III was found lower at 60thmin (p<0.001).The scores were similar in the other follow-up times. Demandedbolus doses in Group III in 24 hour was lower than those of Group I and II (p<0.001). The total amount of tramadol consumed in 24 hourwas lower in Group III (169 mg) than in Group I (323.2 mg) and II (352 (243.5-622.5) mg). Secondary outcomemeasures were similar among the groups.Conclusion: In our study, effective analgesia was provided by simultaneous administration of the 1 mg kg-1iv tramadol and 75 mg imdiclofenac sodium 30 minutes before surgery, in combination with 1 mg kg-1tramadol intraoperative loading dose, while lowering 24 hourtramadol consumption

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