Hüseyin FİDAN, Deniz ÖZZEYBEK, Zahide ELAR, Mehmet Ali ÖKTEM

Nalokson, postoperatif analjezide kullanılan morfinin immünosüpresif etkilerini inhibe ediyor mu?

Amaç: Postoperatif analjezi amacıyla uygulanan morfin ile birlikte uygulanan farklı iki doz naloksanın analjezik etkinlik, yan etkiler ve morfine bağlı gelişen immunosüpresyon üzerine olan etkilerinin araştırılması amaçlandı. Yöntem: Tüm hastalara standart genel anestezi uygulandı. Operasyon sonrası olguların tümüne postoperatif analjezi için hasta kontrollü analjezi yöntemiyle morfin uygulandı. Morfin ile eş zamanlı olarak uygulanacak nalokson yönünden randomize olarak üç gruba ayrılan hastalardan; 1.Gruba (n=10) izotonik sodyum klorür, 2.Gruba (n=10) 0.1 μg kg-1st-1 nalokson, 3.Gruba (n=10) 1 μg kg-1st-1 nalokson infüzyonuna başlandı. Tüm olgularda postoperatif analjezi uygulamasına 48 saat süreyle devam edildi. Postoperatif 0, 2, 6, 12, 24 ve 48. saatlere ait ağrı, kümülatif morfin tüketimleri ve yan etkiler kaydedildi. Preoperatif, postoperatif 0, 24 ve 48. saatlerde alınan kan örneklerinde NK hücresi (natural killer) sitotoksik aktiviteleri çalışıldı. Bulgular: Gruplar arasında ağrı düzeyi, kümülatif morfin tüketimi ve yan etkiler yönünden anlamlı fark bulunmadı. Birinci grupta NK hücresi sitotoksik aktivitesinin 48.saatte, preoperatif döneme ve postoperatif 0.saate kıyasla anlamlı derecede düştüğü belirlendi. Sonuç: Sonuç olarak naloksonun 0.1 μg kg-1st-1 ve 1 μg kg-1st-1`lik dozlarının morfinin analjezik etkinliğini artırma ve yan etkileri azaltma konusunda yetersiz kaldığı; ancak, morfinin NK hücresi sitotoksik aktivitesinde oluşturduğu süpresyonun engellenmesi yönünde dikkate değer bir etki sergilediği saptandı.

Anahtar Kelimeler:

İmmün baskılama, Analjezi, Morfin, Nalokson, Ağrı

Does naloxone inhibite the immunosupressive effects of morphine administered for postoperative analgesia?

Objective: The aim of this study is to compare two doses of naloxone used postoperatively with morphine to determine if they can increase the analgesic potency of morphine, decrease its adverse effects and reverse immunosuppression. Method: General anesthesia was given to all patients. Morphine was administered by patient controlled analgesia. Patients were randomized into three groups, the first of which (n=10) was given saline solution, the second group (n=10) received 0.1 μg kg-1st-1 naloxone infusion and the third group (n=10) got 1 mg kg-1st-1 naloxone infusion with morphine. Pain, the cumulative morphine requirements and adverse effects were recorded at postoperative 0, 2, 6, 12, 24 and 48 hours. Blood samples were obtained preoperatively and during the 0, 24th and 48th hours postoperatively to study natural killer (NK) cytotoxicity. Results: Pain scores, cumulative morphine requirements and adverse effects were not significantly different among the three groups. In the first group, NK cytotoxicity had decreased significantly by the 48th hour postoperatively when compared to the preoperative and postoperative first hours. Conclusion: Naloxone in doses of 0.1 μg kg-1st-1 and 1 μg kg-1st-1 was found insufficient to increase morphine's analgesic potency or to significantly decrease the incidence of nausea, vomiting and pruritis. However, it was determined that naloxone was effective in preventing the morphine-induced suppression of NK cytotoxic activity

Keywords:

Immunosuppression, Analgesia, Morphine, Naloxone, Pain,

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