BELGİN AKAN, PAKİZE KIRDEMİR, Demet ALBAYRAK, Nermin GÖĞÜŞ

Erişkinlerde preemptif analjezi için tramadol ve diklofenak sodyum kullanımı

Postoperatif ağrının tedavisi, cerrahi travma ile oluşan nosiseptif yolun duyarlılığının azaltılması ile mümkün olabilir. Bu azalma, kullanılan analjezik ilacın etkinliği ve verilme zamanına bağlı olabilir. Laparoskopik kolesistektomi sonrası oluşan şiddetli ağrı erken taburcu olmayı önleyebilmektedir. Bu çalışmanın amacı, indüksiyonda verilen tramadol ve diklofenak sodyumun postoperatif ağrı üzerine etkisini incelemektir. Çalışmamıza laparoskopik kolesistektomi uygulanacak 30 hasta dahil edildi. İndüksiyondan 15 dk önce, Grup I (n=15) 1,5 mg kg1 tramadol, Grup II, (n=15) 1 mg kg1 diklofenak sodyum iv olarak verildi. 5 mg kg'1 tiyopental ve 0,1 mg kg1 vekuronyum ile anes¬tezi indüksiyonu; %2 izofluran + % 50 N2O/O2 ile idamesi sağlandı. Operasyon sırasında 5 dakika aralıklarla kalp atım hızı (KAH), sistolik (SAB) ve diyastolik (DAB) arter basınçları ölçüldü. Anestezi sonlandıktan sonra 10 dakika aralıklarla Modifiye Aldrete Skoru ile uyanma zamanı, Ramsey Sedasyon Skoru ile sedasyon zamanı, Vizuel Analog Skala (VAS) ile de analjezi kalitesi 10., 20., 30., ve 45. dk, 1., 2., 3., 6., 12., ve 24. saatlerde ölçüldü. VAS > 5 olan hastalara 1 mg kg'1 meperidin im olarak uygulan¬dı. Postoperatif bulantı, kusma, kaşıntı ve terleme gibi yan etkiler; ilk analjezik gereksiniminin zamanı ve toplam analjezik miktarı kaydedildi. İstatistiksel değerlendirme Student's t testi ve Mann Whitney U testi kullanılarak yapıldı ve p

Anahtar Kelimeler:

Ağrı, ameliyat sonrası, Analjezi, Tramadol, Kolesistektomi, laparoskopik, Diklofenak, Erişkin

Preemptive analgesia with tramadol and diclofenac sodium in adults

Postoperative pain relief may be improved by reducing sensitization of nociceptive pathways caused by surgical trauma. Such a reduction may depend on the timing and efficacy of analgesic drugs. Severe pain after laparoscopic cholecystectomy can prevent early discharge. The purpose of this study is to compare the postoperative analgesic efficacy of iv tramadol and diclofenac sodium administered before induction of anesthesia. Thirty patients scheduled for elective laparoscopic cholecystectomy were included in the study. In group I (n:15), 1.5 mg kg"1 iv tramadol, in group II (n: 15) 1 mg kg"1 diclofenac sodium was given 15 minutes before induction of anesthesia. Anesthe¬sia was induced with 5 mg kg1 tiopental and 0.1 mg kg'1 vecuronium and maintained with 2 % isoflurane and 50 % N2OIO2 mixture. Heart rate (HR), systolic (SAP) and diastolic (DAP) arterial pressure were measured every 5 minutes during the ope¬ration. After cessation of anesthesia, the Aldrete Score was recorded every 10 minutes, sedation time was measured with the Ramsey Sedation Score. Pain was measured with the VAS at the 10th, 20th, 30th, 45th minutes and the 1st, 2nd, 3rd, 6th, 12th, and 24th hours. 1 mg kg'1 meperidine was given im when VAS>5. Adverse effects such as nausea, vomiting, pruritis, and shivering as well as the first analgesic time and total analgesic requirement were recorded. For the statistical analysis, the Mann Whitney U test and Student's t test were used. P values less than 0.05 were considered significant. The demographic data, sedation scores, recovery time and adverse effects were similar in all groups. VAS scores and anal¬gesic requirements were significantly lower in Group I. As a result, preemptive^tramadol administration is suggested for postoperative pain relief, early discharge and reduced analgesic need in patients undergoing laparoscopic cholecystectomy.

Keywords:

Pain, Postoperative, Analgesia, Tramadol, Cholecystectomy, Laparoscopic, Diclofenac, Adult,

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