Ercan GÜRSES, Erkan TOMATIR, Canan BALCI, Mustafa GÖNÜLLÜ

Postoperatif ağrı kontrolünde epidural tramadol, tramadol-droperidol ve tramadol-klonidin kombinasyonlarının karşılaştırılması

Bu çalışmada, postoperatif ağrı kontrolünde, epidural yolla uygulanan tramadol, tramadol-droperidol ve tramadol-klonidin kombinasyonlarının, etkinlik ve yan etki açısından karşılaştırılmaları amaçlandı. Etik komite ve hastaların onayı alındıktan sonra, alt batın cerrahisi geçiren ASA I-II grubu, 90 erişkin hastaya preoperatif LlJf aralığından, direnç kaybı yöntemi ile epidural kateter yerleştirildi. Postoperatif dö-nemde, rasgele üç eşit gruba ayrılan hastalardan; 1. gruba 75 mg tramadol (T), 2. gruba 75 mg tramadol-2.5 mg droperidol (TD) ve 3. gruba 75 mg tramadol-150 /ıg klonidin (TK), toplam 10 mi volümde epidural yolla uygulandı. Analjezi başlama zamanı, analjezi süresi, görsel ağrı (VAS), sedasyon, bulantı skorları, kan basın-cı, kalp hm, solunum sayısı ve Sp02 değerleri ile yan etkiler kaydedildi. Analjezi süreleri, TD ve TK gruplarında T grubuna göre ileri derecede anlamlı bir uzama gösterirken (p

Anahtar Kelimeler:

Klonidin, Tramadol, Analjezi, epidural, Droperidol, İlaç kombinasyonları, İlaç aşırı duyarlılığı, Ağrı, ameliyat sonrası

Comparison of epidural tramadol, tramadol-droperidol and tramadol-clonidine in the postoperative pain management

In this study, tramadol alone and the combinations of tramadol - clonidine and tramadol - droperidol were compared with regard to their effectiveness and side effects. Epidural catheters were placed to 90 ASA I-II group adult patients undergoing lower abdominal surgery, preoperatively through the LM by using loss of resistance method. The first group received 75 mg tramadol (T), the second group received 75 mg tramadol - 2.5 mg droperidol (TD) and the third group re-ceived 75 mg tramadol-150 /Jg clonidine (TK) in a total volume of 10 mi via epidural route. The time point of initiation and duration of analgesia, visual pain, sedation, nausea scores, blood pres-sure, heart rate, SpO2 values, respiration rate and side effects were recorded. The durations of analgesia were similar in groups TD and TK and both were signiflcantly longer than group T (p<0.001). Group TK exhibited significant increase in sedation and decrease in blood pressure and heart rate compared to other groups (p<0.01). No side effect was observed in group TD, while significant nausea - vomiting scores were evident in groups T and TK (p<0.001). No significant differences were found between the study groups with regard to the VAS scores, respiration rates, and SpO2values. in conclusion, it may be suggested that addition of droperidol or clonidine to epidural tramadol may prolong analgesia and when side effects as well as the antiemetic effect were considered, droperidol seems to be a better choice.

Keywords:

Clonidine, Tramadol, Analgesia, Epidural, Droperidol, Drug Combinations, Drug Hypersensitivity, Pain, Postoperative,

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