Gülsiye DİNÇER, SÜHEYLA ÜNVER, Yeşim ÇETİNTAŞ, Ümit KARADENİZ, HİLAL AYOĞLU, Özcan ERDEMLİ

Multimodal preemptif analjezinin intraoperatif sevofluran tüketimi ve postoperatif analjezik gereksinime etkisi

Bu çalışmada gastroenteroloji cerrahisinde major abdominal cerrahi uygulanacak hastalara, multimodal preemptif analjezi uygulamasının intraoperatif sevofluran tüketimine ve postoperatif ağrı üzerine etkilerinin araştırılması planlandı. Hastane eğitim planlama komitesinin onayı ve hastaların yazılı onayı alınarak 46 hasta çalışmaya dahil edildi. Bütün hastalara uygun dermatomdan epidural kateter takıldı. Preemptif analjezi grubundaki hastalara, 4ml %0,5'lik bupivakain, 20 $mu$g fentanil ve serum fizyolojik ile hazırlanan 10 mi solüsyon epidural kalelerden ve 75 mg diklofenak sodyum intramüsküler olarak uygulandı. Kontrol grubuna epidural kalelerden 10 ml serum fizyolojik, intramüsküler olarak 3 ml serum fizyolojik uygulandı. Anestezi indüksiyon ve idamesinde sevofluran, oksijen ve azot protoksit kullanıldı. Multimodal preemptif analjezi grubunda sevofluran tüketimi ortalama 91,7 ml (0.63 ml $dk^-1$ ), kontrol grubunda 131 ml (0.89 mi $dk^-1$ ) olarak bulundu. Multimodal preemptif analjezi uygulanan grupta sevofluran tüketiminde anlamlı oranda (% 30) azalma olduğunu gördük. Postoperatif analjezi, VAS değerleri ve total analjezik tüketiminde, iki grup arasında anlamlı fark görülmedi. Bu çalışma multimodal preemptif analjezinin, postoperatif analjezide fark yaratmadan, intraoperatif sevofluran MAC değerini ve tüketimini anlamlı olarak azalttığını gösterdi.

Anahtar Kelimeler:

Cerrahi işlemler, operatif, Analjezi, Ağrı, ameliyat sonrası, Anestezi, inhalasyon

The effects of multimodal preemptive analgesia on intraoperative sevoflurane consumption and postoperative analgesic requirements

In this study, it was planned to search the effects of multimodal preemptive analgesia on intraoperative sevoflurane consumption and postoperative analgesic requirements in patients having major abdominal surgery at gastroenterologic surgery. We studied 46 patients after hospital's education commitee approval and informed consent from each patient. Epidural catheters were placed from the sufficent dermatomal level, according to the operation to all patients preoperatively. 10 ml of solution of 0,5% bupivacaine containing 20 $mu$g fentanyl were given via epidural catheter and 75 mg diclophenac sodium intramuscularly to the preemptive analgesia group. 10 ml SF via epidural catheter and 3 ml SF intramuscularly to the control group. Se-voflurane, oxygen and nitrous oxide were used as induction and maintaince of anaesthesia. In the multimodal preemptive analgesia group, sevoflurane consumption was 91,7 ml (0.63 ml $dk^-1$) and it was 131 ml (0.89 ml $dk^-1$ ) in the control group. We saw that there was significant (30 %) reduction of sevoflurane consumption in the multimodal preemptive analgesia group. According to the VAS scores and total analgesic consumption, postoperative analgesia didn't show significant difference between the two groups. The present study showed that multimodal preemptive analgesia reduced MAC values and consumption of sevoflurane significantly without making any difference between postoperative analgesia.

Keywords:

Surgical Procedures, Operative, Analgesia, Pain, Postoperative, Anesthesia, Inhalation,

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