Lomber spinal cerrahide preemtif tramadol veya lornoksikamın postoperatif tramadol tüketimine etkileri

Amaç: Postoperatif ağrı kontrolünde, opioid ve nonsteroid antiinşamatuar ilaçlar (NSA‹) preemptif olarak sıklıkla kullanılmaktadırlar. Bu çalışma, spinal cerrahide preemptif tramadol veya lornoksikam kullanımının, postoperatif tramadol tüketimine etkisini ve yan etki insidansını karşılaştırmak için planlanmıştır. Yöntem: Tek seviye lomber diskektomi planlanan, ASA I-III risk grubunda, yaşları 18-60 arasında değişen 60 hasta çalışmaya alındı. Hastalar, rastlantısal olarak iki gruba ayrıldı (n=30). ‹ndüksiyondan 30 dakika önce Grup L’ ye 8mg lornoksikam, Grup T’ ye 100mg tramadol intravenöz olarak verildi. ‹ndüksiyonda tiyopental sodyum, vekuronyum bromid, idamede sevoşuran, NO2 ve O2 kullanıldı. Postoperatif 1., 2., 4., 6., 12. ve 24. saatlerde vizuel analog skala (VAS) skoru, kalp hızı (KH), ortalama arter basıncı (OAB), bulantı, kusma, ortostatik hipotansiyon gibi yan etkiler kaydedildi. Postoperatif analjezi için her iki grupta da tramadol ile hasta kontrollü analjezi (HKA) uygulandı ve tüketilen tramadol miktarı kaydedildi. Bulgular: Her iki grupta demografik veriler, cerrahi ve anestezi süreleri benzerdi. Postoperatif dönemde KH, OAB ve VAS değerleri benzerdi. Gruplar karşılaştırıldığında yan etki insidansında, tramadol tüketimi ve hasta memnuniyetinde fark bulunamamıştır. Sonuç: Lomber disk cerrahisinde premptif lornoksikam, tramadol kadar iyi ve etkili postoperatif analjezi sağlamıştır.

The effect of preemptive lornoxicam or tramadol on postoperative tramadol consumption in lumbar spinal surgery

Objective: Opioids and nonsteroid antiinflammatory agents are being widely used preemptively in postoperative pain management. This study has been planned in order to measure the effect of preemptive tramadol or lornoxicam on tramadol consumption and adverse effect incidence postoperatively in spinal surgery. Methods: 60 ASA I-III patients who were 18-60 years of age and scheduled for lumbar discectomy were included in the study. The patients were randomly allocated into two groups (n=30). Group L was given 8 mg lornoxicam, Group T was given 100 mg tramadol intravenously 30 minutes prior to surgery. Thiopental sodium and vecuronium bromide was used for induction, NO2 and O2 and sevoflurane was used for maintenance. Visuel analog skala (VAS) scores, heart rate (HR), mean arterial pressure (MAP) and adverse effects such as nausea, vomiting, orthostatic hypotension were recorded in the 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. Both groups received patient controlled analgesia (PCA) with tramadol for postoperative analgesia and tramadol consumption was recorded. Results: There was no difference between demographic data and duration of anesthesia or surgery. Postoperative HR, MAP and VAS values were similar in both groups. There was no difference between adverse effect incidence, tramadol consumption and patient satisfaction. Conclusion: Preemptive lornoxicam provides postoperative analgesia comparable to tramadol in lumbar spinal surgery.

Kaynakça

1. Thienthong S, Jirarattanaphochai K, Krisanaprakornkit W, Simajereuk S, Tantanatewin W. Treatment of Pain After Spinal Surgery in the Recovery Room by Single Dose Lornoxicam: A Randomized, Double Blind, Placebo Controlled Trial.J Med Assoc. Thai 2004; 87(6): 650-5.

2. Arslan M, Tuncer B, Babacan A, et al. Postoperative analgesic effects of lornoxicam after thyroidectomy: A placebo controlled randomized study. Ağrı, 18: 2, 2006; 27-33.

3. Ilias W, Jansen M. Pain control after hysterectomy:an observer blind, randomised trial of lornoxicam versus tramadol. Br J Clin Pract 1996; 50: 197-202.

4. Norholt SE, Sindet PS, Larsen U. Pain control after dental surgery: double-blind, randomised trial of lornoxicam versus morphine. Pain 1996; 67: 335-43.

5. Rosenow DE, Albrechtsen M, Stolke D.A comparison of patient controlled analgesia with lornoxicam versus morphine in patients undergoing lumbar disc surgery. Anesth Analg 1998; 86: 1045-50.

6. Rosenow DE, van Krieken F, Stolke D, Kursten FW. Intravenous administration of lornoxicam, a new NSAID, and pethidin for postoperative pain. Clin Drug Invest 1996; 11: 11-19.

7. Likert, RA. A technique for the measurement of attitudes. Archives of Psychology.1932; 140: 44-60.

8. Katz J. Preemptive analgesia; importance of timing. Can J Anaesth 2001; 48: 105-14.

9. Memis D. Hekimoglu S, Kaya G, Atakan HI, Kaplan M. Efficacy of Levobupivacaine Wound İnfiltration With and Without Intravenous Lornoxicam for Post-Varicocole analgesia. Clin Drug İnvest 2008; 28: 353-356.

10. Kavanagh BP, Katz J, Sandler AN, Nierenberg H, Roger S, Boylan JF. Multimodal analgesia before thoracic surgery does not reduce postoperative pain. Br J Anaesth 1994; 73: 184-9.

11. Dahl JB, Rosenborg J, Dirkes WE, Mogensen T, Kehlet H. Prevention of postoperative pain by balanced analgesia. BJ. Anaesth. 1990; 64: 518-20.

12. Mc Cormack K. The Spinal actions of nonsteroidal anti-inflamatory drugs and the dissociation between their anti-inflamatory and analgesic effects. Drugs 1994; 47: 28-45.

13. Karaman Y, Kebapcı E, Gurkan A. The preemptive analgesic effect of lornoxicam in patients undergoing majaor abdominal surgery: A randomised controlled study. International Journal of Surgery 2008; 6: 193-196.

14. Trampitsch E, Pipam W, Moertl M. Preemptive double blind study with lornoxicam in gynecological surgery. Schmerz 2003; 17: 4-10

15. İnanoglu K, Gorur S, Akkurt CO, Guven OE, Kararmaz A.The analgesic efficacy of preoperative versus postoperative lornoxicam in varicocele repair. Journal of Clinical Anesthesia. 2007; 19: 587-590.

16.Şencan A, Cavlak B, Adanır T. Preemptif Uygulanan Tramadol ile Lornoksikam’ın Postoperatif Ağrı Üzerine Etkilerinin Karşılaştırılması. Türk Anest Rean Der Dergisi 2007; 35(5): 299-304.

Kaynak Göster