idil TEKİN, Berna ONGUN, Korkut KAFESÇİLER

Diz artroskopisinde intraartiküler morfin ve neostigminin postoperatif analjeziye etkisi

Artroskopik diz cerrahisi sonrası, intraartiküler uygulanan morfin ve neostigminin analjezik etkinliği karşılaştırıldı. Elektif artroskopik diz cerrahisi planlanan 60 olgu çalışma kapsamına alındı.Tüm olgulara aynı genel anestezi protokolü uygulandı.Operasyon bitiminde olgular 3 eşit gruba ayrıldı; Kontorl (K) grubuna 20 mL serum fizyolojik (SF), morfin (M) grubuna 20 mLSF içinde 1 mg morfin ve neostigmin (N) grubuna 20 mLSF içinde 0.5 mg neostigmin, turnike açılmadan 10 dk önce intraartiküler olarak verildi. Postoperatif ağrı;operasyon bitiminden hemen sonra, 30.dk' da, 1.,2.,4.,6. ve 12. saatlerde VAS ile değerlendirildi. Eş zamanlı kalp atım hızı, ortalama arteriyel basınç, solunum sayısı ve yan etkiler kaydedildi.Ek analjezik gereksinimi, total analjezik tüketimi ve ilk analjezik istem süresi saptandı. Grup M ve Grup N'de hemodinamik parametreler ve ek analjezik istem ortalamaları arasında farklılık bulunmadı. Postop 30.dk' da, fleksiyon ve ekstansiyondaki VAS değeri grup M ve N' de, K' ya göre düşük bulundu (p

Anahtar Kelimeler:

Analjezi, Diz, Neostigmin, Artroskopi, Morfin, Plasebo, Cerrahi işlemler, elektif

Postoperative analgesic effects of intraarticular morphine and neostigmine after arthroscopy

Postoperative analgesic effect of intraarticular morphine and neostigmine after arthroscopy were compared. We studied 60 patients, undergoing elective knee arthroscopy. A standardized general anesthetic was administered.Patients were allocated to 3 groups at the end of the surgery. Group K (control, n=20) recieved 20 mL 0.9 % saline, group M (morphine, n=20) recieved 1 mg morphine in 20 mL 0.9 % saline and Group N (neostigmine.n=20) recieved 0.5 mg neostigmine in 20 mL 0.9 % saline intraarticularly, 10 minutes before the limb tourniquet was deflated. Postoperavite pain scores were recorded at the end of the surgery, at 30. min, 1.,2.,4.,6. and 12. hours postoperatively by VAS. Heart rate, mean arterial pressure, breathing rate and adverse effects were also recorded at the same times. Additional analgesic requirements, total analgesic consumption and first analgesic administration time were settled.There were no significant differences in hemodynamic parameters and additional analgesic requirements between the Group M and Group N.VAS scores on flexion and extention were significantly lower in group M and N compared with group K at postop 30. min At subsequent measurements, VAS scores on extention were lower in group M and N according to group K.Additional analgesic administration was very high in group K, compared with the othe groups.First analgesic administration time was not different between Group M and N.Patients didn' t copmlain from any adverse effects. Finally, we conclude that İntraarticular low-dose (1 mg) morphine and 0.5 mg neostigmine produce significant analgesic effect compared with placebo but they are not superior each other.

Keywords:

Analgesia, Knee, Neostigmine, Arthroscopy, Morphine, Placebos, Surgical Procedures, Elective,

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1. McLoughin C, Mckinney MS, Fee JPH, Boules Z. Diclofenac for day-care arthroscopy surgery : comparison with standard opioid therapy. Br J Anaesth 1990; 65 : 620-3.
2. Stein C, Comisel K, Heimerl E, Yassouridis A, et al. Analgesic effect of intra-articular morphine after knee surgery. N Engl J Med 1991; 325: 1123-6.
3. Heard SO, Edwards WT, Ferrari D, et al. Analgesic effect of intraarticuler bupivacaine or morphine after arthroscopic knee surgery : a randomised, prospective, double-blind study. Anesth Analg 1992; 74:822-6.
4. Heine MF, Tillet ED, Tsueda K, et al. Intra-articular morphine after artroscopic knee operation. Br J Anaesth 1994; 73:413-5.
5. Dalsgaard J, Felsby S, Juelsgaard P, Froekjaer J. Low-dose intra-articular morphine analgesia in day case knee arthroscopy: a randomized double-blinded prospective study. Pain 1994; 56:151-4.
6. Yang LC, Chen LM, Wang CJ, Buerkle H. Postoperative analgesia by intra-articular neostigmine in patients undergoing knee arthroscopy. Anesthesiology 1998; 88: 334-9.
7. Joshi GP, McCarrol SM, O’Brien TM, Lenance P. ‹ntra-articular analgesia following knee arthroscopy. Anesth Analg 1993; 76:333-6.
8. Katz JA, Knaeding CS, Hill JR, Henthorn TK. The pharmacokinetics of bupivacaine when injected intra-articularly after knee arthroscopy. Anesth Analg 1988; 7:871-5.
9. Stein C. Peripheral and non-neuronal opioid effects. Curr Opin Anaesthesiol 1994 ; 7 : 347-51.
10. Hood DD, Mallak KA, Eisenach JC, et al. Interaction between intrathecal neostigmine and epidural clonidine in human volunteers. Anesthesiology 1996 ; 85:315.
11. Kanbak M, Akpolat N, Ocal T, et al. Intraarticular morphine administration provides pain relief after knee arthroscopy. Eur J Anaesthesiol 1997;14:153-6.
12. Richardson MD, Bjorksten AR, Hart JA, et al. The efficacy of intra-articular morphine for postoperative knee arthroscopy analgesia. Arthroscopy 1997;13:584-9.
13. Rosseland LA, Stubhaug A, Skoglund A, et al. Intra-articular morphine for pain relief after knee arthroscopy. Acta Anaesthesiol Scand. 1999;43:252-7.
14. Buerkle H, Huge V, Wolfgart M, et al. Intra-articular clonidine analgesia after knee arthroscopy. Eur J Anaesthesiol 2000; 17:295-9.
15. Gentili M, Houssel P, Osman M, Henel D, Juhel A, Bonnet F. Intra-articular morphine and clonidine produce comparable analgesia but the combination is not more effective. Br J Anaesth 1997; 79:660-1.
16. Söderlund A, Westman L, Ersmark H, Eriksson E, Valentin A, Ekblon A. Analgesia following arthroscopy-a comparison of intra-articular morphine, pethidine and fentanyl. Acta Anaesthesiol Scand 1997; 41:6-11.
17. Raja SN, Dickstein RJ, Johnsson CA. Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery. Anesthesiology 1992; 77:1143-7.
18. Khoury GF, Chen ACN, Garland DE, Stein C. Intra-articular morphine, bupivacaine and morphine bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 1992; 77:263-6