Alev ŞAYLAN, Özgür CANBAY, Nalan ÇELEBİ, Saadet ÖZGEN

Extracorporeal shock wave lıthotrıpsy (eswl) uygulanan erişkin hastalarda intravenöz parasetamol ve remifentanil infüzyonunun analjezik ve sedatif etkinliği

Amaç: Extracorporeal shock wave lithotripsy (ESWL); düşük komplikasyon ve morbidite oranına sahip, ağrılı olabilen bir işlemdir. Bu prospektif çalışmada da ESWL yöntemi ile ürolitiazis tedavisi yapılan erişkin hastalarda işlem öncesi 1 gr ve 2 gr intravenöz(iv) parasetamol infüzyonunun, remifentanil infüzyonu ile birlikte uygulanımlarının sedatif ve analjezik etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya dahil edilen 69 hasta randomize, çift kör olarak 3 gruba ayrıldı. Grup U ya remifentanil infüzyonu 0,025 μg kg -1 dk -1dan başlandı ve ek analjezik ihtiyacı oldukça maksimum doz 0,4 μg kg-1 dk-1 olmak üzere 0,025 μg kg-1 dk-1 lık artışlar sağlandı. Grup UP1 ve Grup UP2 ye sırasıyla 1 ve 2 gram iv parasetamol infüzyonu yapıldı ve Grup U ile benzer şekilde remifentanil uygulandı. Tüm gruplarda 5 er dk ara ile SpO2, kan basıncı, dakikadaki nabız ve solunum sayısı, VAS değerleri, Ramsay skalasına göre sedasyon düzeyleri, total remifentanil infüzyon dozu kaydedildi. ESWL işlemi bitmeden 3 dk önce remifentanil infüzyonu sonlandırıldı. Peroperatif midazolam ve postoperatif diklofenak sodyum gereksinimi, yan etkiler, hasta ve ürolog memnuniyeti; diğer parametrelerle birlikte değerlendirildi. Bulgular: Her üç grup da demografik özellikler açısından benzer idi. Elde edilen verilere göre 3 grup arasında total remifentanil infüzyon miktarı, VAS ve Ramsay sedasyon skorlamalarında zaman içinde benzer değişim saptandı ve istatistiksel olarak anlamlı fark bulunamadı. Sonuç: Bu çalışmanın sonucunda ortaya çıkan istatistik verilerine göre; ESWL vakalarında remifentanil infüzyonuna preemptif 1 gr veya 2 gr iv parasetamolün eklenmesinin sedasyon ve analjezi kalitesi üzerine etkinliği olmadığı, tek başına remifentanil infüzyonunun sedoanaljezi için yeterli olabileceği sonucuna varıldı.

The analgesic and sedative efficacy of intravenous paracetamol and remifentanil in adult patients undergoing extracorporeal shock wave lithotripsy (eswl)

Objective: Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive procedure with low complication and morbidity rates and may be painful. The aim of this prospective study was to evaluate sedative and analgesic efficacy of 1 and 2 gr intravenous (iv) paracetamol infusions administered in combination with remifentanil before procedure. Material and Methods: Sixty-nine patients were randomised double blind into three groups. In Group U, remifentanil infusion was initiated at 0.025 μg kg-1 min-1 and as additional analgesy was required, with maximum dose of 0,4 μg kg-1 min-1, 0.025 μg kg-1 min-1 incremental increases were made. Group UP1 and Group UP2 were administered respectively 1 and 2 grams iv paracetamol and similar to Group U, remifentanil was administered. In all groups, with 5 minute intervals, SpO 2, blood pressure, heart and respiration rate, VAS values, sedation levels according to Ramsay scale and total remifentanil infusion dose were recorded. 3 minutes before ESWL procedure was finished, remifentanil infusion was discontinued. Peroperative midazolam and postoperative diclofenac sodium need, side effects, patient and urologist satisfaction were evaluated together with other parameters. Results: All three groups had similar demographic characteristics. According to the findings, similar change was observed in three groups in total remifentanil infusion dose, VAS and Ramsay sedation scores with no statistically significant difference between them. Conclusion: According to results of the present study; it was concluded that in ESWL cases, the addition of preemptive 1 gr or 2 gr iv paracetamol to remifentanil infusion had no effect on sedation and quality of analgesia and that remifentanil infusion on its own was adequate for sedoanalgesia.

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