B. Çağla Özbakış AKKURT, Kerem İNANOĞLU, Selim TURHANOĞLU, Zeynel ASFUROĞLU

Anestezi indüksiyonu öncesi uygulanan tramadol veya deksmedetomidin'in postoperatif ağrı üzerine etkileri

Amaç: Deksmedetomidin sedatif ve analjezik etkili bir α2-adrenerjik reseptör blokeridir. Postoperatif ağrıyı ve morfin tüketimini azalttığı gösterilmiştir; ancak potansiyel kardiyovasküler yan etkileri nedeniyle kullanımı kısıtlıdır. Tramadol, meperidin ile benzer güçte opioid bir analjeziktir ve klinik kullanımda yan etkilerinin az olması nedeniyle tercih edilir. Çalışmamızda anestezi indüksiyonu öncesinde uygulanan tramadol ve deksmedetomidinin, postoperatif ağrı üzerine etkileri ve aynı zamanda yan etkilerinin karşılaştırılması amaçlanmıştır. Yöntem: Elektif şartlarda total abdominal histerektomi yapılan ASA I-II grubu, 60 hasta çalışmaya alındı. Hastalar üç gruba ayrıldı. Anestezi indüksiyonundan 10 dk önce; Grup T (n=20)’deki hastalara 1mg kg-1 iv tramadol (10 dk infüzyon), grup D (n=20)’deki hastalara 1µg kg-1 iv deksmedetomidin (10 dk infüzyon) ve grup S (n=20)’deki hastalara % 0.9 salin (10 dk infüzyon) şeklinde verildi. Postoperatif analjezi, hasta kontrollü iv morfinle sağlandı. Operasyon süresi, ekstübasyon süresi, derlenme zamanı kaydedildi. Ağrı skoru (VAS), sedasyon skoru, kümülatif morfin tüketimi ve yan etkiler, hasta kontrollü analjezinin (HKA) başlatılmasından sonra 2, 6, 12 ve 24. saatlerde kaydedildi. Bulgular: Deksmedetomidin grubunda kan basıncı ve kalp hızı daha düşük olarak bulundu (p

Anahtar Kelimeler:

Ameliyat öncesi dönem, Hemodinamikler, Deksmedetodimin, Tramadol, Ağrı, ameliyat sonrası, Ağrı ölçümü, Anesteziden uyanma dönemi

Effects of dexmedetomidine and tramadol administered before induction of anesthesia on postoperative pain

Objective: Dexmedetomidine is a selective α2-adrenergic receptor blocker with sedative and analgesic effects. It has been shown to reduce postoperative pain and morphine consumption but its clinical use is limited because of its potential cardiovascular side effects. Tramadol is an opioid analgesic with a similar potency to meperidine. Although it is not as potent as morphine, it is preferred in clinical practice because of its relatively low potential side effects. We aimed to compare the effect and side effects of preoperative dexmedetomidine or tramadol administration on postoperative pain and analgesic consumption. Method: Sixty patients were randomly assigned into three groups to receive 1mg kg-1 iv tramadol, or 1µg kg-1 iv dexmedetomidine, or the same volume of saline before induction of anaesthesia. At the time of skin closure, patients were given a standardized bolus dose of morphine and then were allowed to use a patient controlled analgesia (PCA) device. Blood pressures and heart rate were recorded before and after the infusion of the drugs and induction and 1 minute after intubation. Sedation, pain score, cumulative morphine consumption and side effects were recorded 15 minutes, and 2, 6, 12, and 24 hours after initiation of PCA. Results: There were decrease in the blood pressures and heart rates of the patients in the dexmedetomidine group (p<0.05). Postoperative pain and morphine consumption were significantly reduced in the dexmedetomidine group (Group T: 29.87 mg, Group D: 20.95 mg, p<0.05). VAS was lower in the dexmedetomidine group and postoperative sedation scores were higher in the dexmedetomidine group in the first 6 hours. Conclusion: Preoperative dexmetedomidine reduced postoperative morphine consumption more effectively than tramadol without an important adverse effect on hemodynamic parameteres.

Keywords:

Preoperative Period, Hemodynamics, Dexmedetomidine, Tramadol, Pain, Postoperative, Pain Measurement, Anesthesia Recovery Period,

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