Ümit KARADENİZ, Özcan ERDEMLİ, SÜHEYLA ÜNVER, Hediye YAŞITLI, HİLAL AYOĞLU

Laparoskopik kolesistektomi sonrası postoperatif ağrı tedavisinde intraperitoneal bupivakain enjeksiyonu ve infüzyonu

Laparoskopik kolesistektomi sonrası paryetal, viseral ve omuz ağrısı olmak üzere üç tip postoperatif ağrı oluşmaktadır. Bu prospektif çalışmanın amacı laparoskopik cerrahide, intraperitoneal lokal anestezik uygulamasının erken postoperatif ağrıya etkisini araştırmaktır. Elektif kolesistektomi ameliyatı olacak, 67 hasta, Hastane Eğitim ve Planlama Komitesi ve hasta izni alındıktan sonra randomize olarak dört gruba ayrıldı. Kontrol (Grup l) grubuna plasebo solüsyon uygulandı. 20 mL, %0.5 bupivakain solüsyonu bir kateter yardımı ile intraperitoneal olarak; pre-kolesistektomi grubuna (Grup H) pnömoperitoneum oluşturulduktan sonra bolus enjeksiyon; post-kolesistektomi grubuna (Grup III) operasyon sonunda bolus enjeksiyon; infüzyon grubuna (Grup IV) operasyondan sonra postoperatif dönemde dört saat boyunca intraperitoneal infüzyon şeklinde uygulandı. Hastaların postoperatif dönemdeki ağrıları vizuel ağrı skalası (VAS) ile değerlendirildi. Kullanılan analjezik ajan miktarı (meperidin), omuz ağrısı, bulantı ve kusmanın insidansları kaydedildi. Postoperatif VAS ağrı skorları, kontrol grubuna göre diğer gruplarda daha az olmasına rağmen, ilk dört saatte, sadece infüzyon grubunda istatistiksel olarak anlamlı farklılık bulundu, (p

Anahtar Kelimeler:

Kolesistektomi, laparoskopik, İleriye dönük çalışma, Bupivakain, Ağrı, ameliyat sonrası, Analjezi

Intraperitoneal bupivacaine infusion and injection for postoperative pain management in laparoscopic cholecystectomy

Laparoscopic cholecystectomy causes three types of pain (visceral, parietal and shoulder pain). The purpose of this prospective study was to evaluate the effect of intraperitoneal local anesthetics on postoperative pain scores in laparoscopic surgery. Sixty seven patients who were undergoing elective cholecystectomy were studied after obtaining approval by the ethics committee. Patients were randomly divided into four groups. Group I (control) received placebo solution. 20 ml %0.5 bupivacaine solution was given intraperitonealy via a catheter as follows; Group II (pre-cholecystectomy) received bolus injection immediately after insufflation of CO2; Group III (post-cholecystectomy ) received bolus injection at the end of the operation; Group IV (infusion ) received infusion after the operation during postoperative period f or four hours. The degree of postoperative pain was assessed using visual analog scale (VAS). Consumption of analgesic agents (meperidine), the presence of shoulder pain, nausea and vomiting were recorded. Although, VAS pain scores in groups II, III and IV was lower than that of control group, it was only significant in Group IV. Analgesic requirement was also lower in Group IV. Intraperitoneal local anesthetic treatment did not reduce the incidence of shoulder pain, nausea and vomiting. Intraperitoneal infusion of local analgesics is recommended f or postoperative pain treatment in laparoscopic surgery.

Keywords:

Cholecystectomy, Laparoscopic, Prospective Studies, Bupivacaine, Pain, Postoperative, Analgesia,

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