H. Evren EKER, Neslihan ALKIŞ, FİLİZ ALKAYA SOLMAZ

Erişkin tonsillektomilerde multimodal analjezi uygulamalarının karşılaştırılması: Prospektif klinik çalışma

Amaç: Erişkin hastalarda tonsillektomi sonrası postoperatif ağrı kontrolünde farklı analjezi yöntemlerinin, opioid tüketimi ve yan etkileri açısından karşılaştırılması planlanmıştır. Yöntem: ASA I-II, 45 hasta çalışmaya dâhil edilmiştir. Grup A’da (n=15) 1µg kg-1 dk-1 dozda alfentanil infüzyonu, Grup B’de (n=15) tonsillektomi ardından toplam 6 mL % 0.25 bupivakain hidroklorid her bir tonsiller alana uygulanırken, Grup C’de (n=15) operasyon süresince analjezik uygulanmadı. Operasyon bitiminde tüm hastalara, hasta kontrollü analjezi (HKA) yöntemi ile intravenöz (iv) tramadol uygulanmaya başlandı ve postoperatif ilk yarım saatte, 1., 2., 4., 6. ve 24. saatlerde görsel analog skala (VAS) ve sözel ağrı skalası (VPS) ile ağrı skorlarının yanı sıra sedasyon skoru, tramadol tüketimi, anajezik istemi sayısı ve yan etkiler değerlendirildi. Bulgular: Postoperatif iv HKA yöntemi ile uygulanan toplam tramadol miktarı Grup B’de (105±40 mg), Grup A (248±43 mg) ve Grup C (271±115 mg)’ye göre daha düşük bulunmuştur (p

Anahtar Kelimeler:

Tonsillektomi, Tramadol, Erişkin, İleriye dönük çalışma, Anestezi, lokal, Alfentanil, Ağrı, ameliyat sonrası

Comparison of multimodal analgesia regimens for adult tonsillectomy: Prospective clinical study

Objective: In the management of postoperative pain control after tonsillectomy for adult patients; different pain regimens, opioid consumption and side effects were compared. Method: ASA I-II, 45 patients participated in the study. In group A, preemptive 1µg kg-1 min-1 alfentanyl infusion was administered; in group B, following the tonsillectomy a total of 6 mL 0.25 % bupivacaine hydrochloride was infiltrated around each tonsiller area. In group C, patients did not receive any analgesic drug during surgery, but following the operation, iv tramadol patient controlled analgesia (PCA) was performed. Pain intensity with visuel analog scale (VAS) and verbal pain scale (VPS) scores were recorded at 30 minutes, and 1, 2, 4, 6 and 24 hours postoperatively like sedation scores, tramadol consumption, demand rate and side effects. Results: The consumption of tramadol through IV PCA in Group B (105±40mg) was significantly less than in Group A (248±43mg) and Group C (271±115mg) (p<0.05). The demand rate in Group B (20±15) was significantly less than in Group A (67±47) and Group C (84±53) (p<0.05). VAS and VPS indicated no differences in pain scores between the groups but nausea and vomiting percentages were significantly less in Group B (%5) than in Group A (%20) and Group C (%22) (p<0.05). Conclusion: Sufficient pain treatment was achieved with all of the pain management regimens; however, postoperative opioid consumption and related side effects were decreased with local anesthetic infiltration.

Keywords:

Tonsillectomy, Tramadol, Adult, Prospective Studies, Anesthesia, Local, Alfentanil, Pain, Postoperative,

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1. Kehlet H & Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001; 87(1): 62-72.
2. Nikandish R, Maghsoodi B, Khademi S et al. Peritonsillar infiltration with bupivacaine and pethidine for relief of post-tonsillectomy pain: a randomised double-blind study. Anaesthesia 2008; 63(1): 20-5.
3. Rawal N. Postoperative pain treatment for ambulatory surgery. Best Pract Res Clin Anaesthesiol 2007; 21(1): 129-48.
4. Dahl V, Raeder JC. Non-opioid postoperative analgesia. Acta Anaesthiol Scand 2000; 44(10): 1191-203.
5. Dahl JB, Frederiksen HJ. Wound infiltration for operative and postoperative analgesia. Curr Opin Anaesthesiol 1995; 8: 835–40.
6. Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49(6): 924-34.
7. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97(2): 534-40.
8. Pavlin DJ, Chen C, Penaloza DA et al. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg 2002; 95(3):627-34.
9. Vasan NR, Stevenson S, Ward M. Preinsicional bupivacaine in posttonsillectomy pain relief. Arch Otolaryngol Head Neck Surg 2002; 128(2): 145-9.
10. Jebeles JA, Reilly JS, Gutierrez JF et al. The effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia. Pain 1991; 47(3): 305-8.