Sezai ÖZKAN, Sibel POÇAN, Çınar TOPÇUOĞLU, Orhan ÇAKIR, Merih GÖKBEN

İntravenöz hasta kontrollü analjezide meperidin ve tramadol kullanımının postoperatif nöroendokrin yanıt ve analjezik etki açısından karşılaştırılması

Çalışmamızda, meperidin ve tramadolün, intravenöz hasta kontrollü analjezi (iv HKA) yöntemi ile uygulanmasının, postoperatif ağrı kontrolü üzerine etkinliğini karşılaştırmayı amaçladık. Çalışmaya; etik komite izni alındıktan sonra, elektif üst abdominal cerrahi uygulanan ve ASA I-II grubundan 60 olgu alındı. Tüm olgulara 5 mg kg-1 tiyopental ve 0.1 mg kg-1 vekuronyum indüksiyonundan sonra izofluran anestezisi [% 1 izofluran+ N2O/O2 (%60/40)] uygulandı. Postoperatif devrede analjezik gereksinimi olduğunda (Vizüel Analog Skala= VAS 3/10 üzerinde) olgular rastgele 2 eşit gruba ayrılarak; I. Gruba iv HKA meperidin (Grup M) ve II. Gruba iv HKA tramadol (Grup T) uyguladık. Grup M'de, meperidin yükleme dozu 50 mg, bazal infüzyon hızı 5 mg sa-1 ve iv HKA bolus dozu 5 mg olarak ayarlandı. Grup T'de ise; tramadolün yükleme dozu 50 mg, bazal infüzvon hızı 5 mg sa-1 ve iv HKA bolus dozu 20 mg olarak ayarlandı. Her iki grupta da kilitli kalma süreleri 30 dk olarak belirlendi. Preoperatif(1), postoperatif analjezik uygulama öncesi (II), postoperatif 2. saat (III) ve postoperatif 24. saatlerdeki (IV) vital bulgular; kalp atım hızı, sistolik arter basıncı ve diyastolik arter basıncına ek olarak, açlık kan şekeri, adrenalin, noradrenalin ve kortizol düzeyleri saptandı. Ağrı tedavisinin etkinliği; VAS, nöroendokrin yanıt ve hemodinamide olan değişiklikler ile değerlendirildi. M ve T uygulanan olgularda VAS değerleri, nöroendokrin yanıt ve hemodinamik açıdan benzer bulgular saptandı. Sonuç olarak; analjezik etkinlik açısından benzer özelliklere sahip olan meperidin ve tramadolün her ikisinin de, iv HKA yöntemi ile emniyetli olarak kullanılabileceği kanısına vardık.

Anahtar Kelimeler:

Analjezi, hasta kontrollü, Nörosekretör sistemler, Tramadol, Meperidin, Ağrı, ameliyat sonrası, Hidrokortizon

Comparison of the use of meperidine and tramadol during intravenous patient-controlled analgesia on postoperative neuroendocrine response and analgesic efficacy

In our study we aimed to compare the pain relief effects of meperidine and tramadol in the postoperative period via patient controlled analgesia (PCA). After obtaining Ethic Committee approval and informed consents of the patients, we studied 30 ASA I or II class patients undergoing upper abdominal surgery. In all patients, sodium tiopentone 5 mg kg-1 + vecuronium 0.1 mg kg-1 for induction, isoflurane I % + O2N2O (40/60 %)for maintenance were administered. When analgesia was required in the postoperative period (Visual Analog Scale= VAS greater than 3/10), the cases were randomly allocated into two groups as meperidine (M) and tramadol (T) with iv PCA for groups I and II, respectively. 50 mg of loading dose followed by 5 mg h-1 of infusion rate and 5 mg of bolus dose was adjusted for group M, while 50 mg of loading dose followed 5 mg h-1 of infusion rate and 20 mg of bolus dose was adjusted for group T. Lockout periods were determined as 30 minutes for both groups. We recorded hemodynamic signs; systolic and diastolic arterial pressures, heart rate, and blood glucose, adrenaline, noradrenaline and cortisol levels in the preoperative (I), before analgesic administration (III), postoperative 2nd (III) and 24th hours (IV). VAS and endocrine changes were evaluated together to demonstrate the effectiveness of the pain management. VAS scores, neuroendocrine responses and hemodynamic parameters were found to be similar between M and T groups. In conclusion, meperidine and tramadol having similar analgesic properties could be used safely by iv PCA.

Keywords:

Analgesia, Patient Controlled, Neurosecretory Systems, Tramadol, Meperidine, Pain, Postoperative, Hydrocortisone,

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