İntravenöz parasetamolün postoperatif analjezi ve morfin tüketimine etkisi

Amaç: Bu çalışmada, postoperatif ağrı tedavisinde hasta kontrollü analjezide kullanılan morfin ile kombine edilen intravenöz parasetamolün analjezik etkinliği, yan etkiler ve morfin tüketimine etkisi değerlendirildi. Gereç ve yöntem: Çalışmaya inguinal herni operasyonu geçirecek, ASA I-II grubu 20-77 yaş arası 40 hasta dahil edildi. Randomize olarak iki gruba [Grup I (Kontrol, n=20) ve Grup II (Parasetamol, n=20)] ayrılan olgulara, standart genel anestezi protokolü uygulandı, iki gruba da operasyon sonlanmadan 15 dakika önce intravenöz 0.05 mg kg'1 morfin uygulandı. Grup II' ye operasyon sonlanmadan 15 dakika önce ve postoperatif ilk 24 saat süresince 6 saat aralıklarla, 1 gr parasetamol 100 mL içinde 10 dakikada intravenöz infüzyon şeklinde verildi. Postoperatif her iki grubada Hasta Kontrollü Analjezi (HKA) cihazı ile intravenöz morfin uygulandı. Ağrı ve sedasyon skorları 15 ve 30 dakika ile 1, 2, 4, 6, 8,12, 16 ve 24. saatlerde değerlendirildi. Çalışma sonunda total morfin tüketimi ve yan etkiler kaydedildi. Bulgular: Morfin tüketimi Grup IF de daha düşük bulundu (p0.05). Sonuç: Inguinal herni operasyonlarında intravenöz parasetamol ile morfinin birlikte kullanımı, postoperatif ilk 24 saate kullanılan morfin tüketimini azaltmakta fakat yan etkilerde azalmaya neden olmamaktadır.

The effect of intravenous paracetamol on postoperative anagesia and morphine consumption

Objective: In this study, the effects of intravenous paracetamol, combined with patient controlled intravenous morfin analgesia, were investigated postoperative analgesia and morfin consumption. Method: Fourty, ASA I-II, 20-77 aged patients scheduled for inguinal hernia operation were enrolled to this study. All patients received a standardized anesthetic protocol and were randomly divided into two groups Group I [(Control, n=20) and Group II (Parasetamol, n=20)]. Both of the groups received 0.05 mg kg'1 morphin 15 min before the end of the surgery. Group II patients received 1 gr parasetamol in 100 mL as intravenous infusion 15 min before end of the surgery and repeated at every 6 hours during postoperatively first 24 hours. Both of the groups received morphin intravenously at the end of the surgery via a patient controlled analgesia (PCA) device. Pain and sedation scores were assessed at 15, 30th minutes and 1,2, 4, 6, 8, 12, 16, 24th hours after surgery. Morphine consumption and adverse effects were noted after the study. Results: The morphine consumption was lower in the Group II than Group I (p<0.05). No significant difference was observed in sedation scores, pain scores and advers effects between the groups (p>0.05). Conclusion: Intravenous paracetamol usage with morphine decreases morphine consumption at first 24 hours but does not decrease side effects in inguinal hernia operations.

Kaynakça

1.Juhl GI, Norholt SE, Tonnesen E, Hiesse-Provost O, Jensen TS. Analgesic efficacy and safety of intravenous paracetamol (acetaminophen) administered as 2 g starting dose following third molar surgery. Eur J Pain 2006; 10: 371-7.

2.Kehlet H, Dahi JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg 1993; 77: 1048-56.

3.Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Curr Opin Anaesthesiol 2006; 19: 562-5.

4.Dahl V, Raeder JC. Non-opioid postoperative analgesia. Acta Anaesthesiol Scand. 2000; 44: 1191-203.

5.Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth. 2002; 88: 199-214.

6.Bannwarth B, Pehourcq F: Pharmacological rationale for the clinical use of paracetamol: pharmakinetic and pharmadynamic issues. Drugs 2003; 63: 2-5

7.Day RO, Graham GG, Whelton A: The position of paracetamol in the world of analgesics. Am J Ther 2000; 7:51-4.

8.Jarde O, Baccard E. Parenteral versus oral route increases paracetamol eficency. Clin Drug Invest 1997; 14: 474-7.

9.Moller PL, Sindet-Pedersen S, Petersen CT, Juhl GI, Dillenschneider A, Skoglund LA. Onset of acetaminophen anagesia: comparison of oral and intravenous routes after third molar surgery. Br J Anaesth 2005; 94: 642-8.

10.Remmy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Curr Opin Anaesthesiol 2006; 19: 562-5.

11.Silvanto M, Munsterhjelm E, Savolainen S, et al. Effect of 3 g of intravenous paracetamol on post-operative analgesia, platelet function and liver enzymes in patients undergoing tonsillectomy under local anaesthesia. Acta Anaesth Scand 2007; 51: 1147-54

12.Larson AM, Poison J, Fontana RJ, et al. Acetminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 2005; 42: 1364-72.

13.Callesen T. Inguinal hernia repair: anaesthesia, pain and convalescence. Dan Med Bull 2003; 50: 203-18.

14.Aubrun F, Kalfon F, Mottet P, et al. Adjunctive analgesia with intravenous propacetamol does not reduce morphine-related adverse effects. Br J Anaesth 2003; 90: 314-9.

15.Peduto VA, Ballabio M, Stefanini S. Efficacy of propacetamol in the treatment of postoperative pain. Morphine-sparing effect in orthopedic surgery. Italian Collaborative Group on Propacetamol. Acta Anaesthesiol Scand 1998; 42: 293-8.

16.Delbos A, Boccard E. The morphine-sparing effect of propacetamol in orthopedic postoperative pain. J Pain Symptom Manage 1995; 10: 279-86.

17.Fletcher D, Negre I, Barbin C, et al. Postoperative analgesia with i.v. propacetamol and ketoprofen combination after disc surgery. Can J Anaesth 1997; 44: 479-85.

18.Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth 2005; 94: 505-13.

19.Palazzo MG, Strunin L. Anaesthesia and emesis. II: Prevention and management. Can Anaesth Soc J 1984; 31: 407-15.

20.Marret E, Kurdi O, Zufferey P, Bonnet F. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anest-hesiology 2005; 102:1249-60.

21.Elia N, Lysakowski C, Tramer MR. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analy-ses of randomized trials. Anesthesiology 2005; 103:1296-304.

Kaynak Göster