Elvan ERHAN, Erhan OLGUN, Ahmet SUBAŞI, Bülent ÖZYAR, Gülden UĞUR

Postoperatif ağrı tedavisinde tramadol ile intravenöz ve epidural hasta kontrollü analjezinin karşılaştırılması

Bu çalışmada postoperatif ağrı tedavisinde hasta kontrollü analjezide (HKA) tramadolün intravenöz ve epidural uygulamalarının etkinlik ve yan etki profili yönünden karşılaştırılması amaçlandı. 18-65 yaşları arasında majör ürolojik cerrahi girişim geçirecek 30 olgu (ASA I-II) çalışmaya alındı. Tüm olgulara standart genel anestezi uygulandı. Postoperatif analjezi uygulamasına göre olgular iki gruba ayrıldı. HKA cihazı ile I. Gruba (n=15) iv tramadol (50 mg yükleme dozu, 5 mg sa-1 bazal infüzyon hızı, 20 mg bolus, kilitli kalma süresi 30 dakika), II. Gruba epidural tramadol (20 mg yükleme dozu, 8 mg sa-1 bazal infüzyon hızı, 5 mg bolus, kilitli kalma süresi 30 dakika) uygulandı. Ağrı şiddeti [Vizüel analog skala (VAS)], sedasyon düzeyi (5 noktalı sedasyon skalası), ortalama arter basıncı, kalp atım hızı, solunum sayısı ve yan etkiler O, 6, 12, 24, 48. saatlerde kaydedildi. Her iki grupta ihtiyaç duyulan toplam tramadol miktarı hesaplandı. Vital parametreler çalışma süresince normal sınırlarda seyretti. Her iki grupta VAS skorlarında başlangıca göre tüm ölçüm zamanlarında anlamlı düşme gözlendi (p

Anahtar Kelimeler:

Analjezi, epidural, Ağrı, ameliyat sonrası, Kalp hızı, Enjeksiyon, ven içi, Tramadol, Erişkin, Enjeksiyon, epidural, Analjezi, hasta kontrollü

Comparison of intravenous versus epidural patient controlled analgesia with tramadol for postoperative pain relief

We compared the effectiveness and side effects of epidural versus intravenous patient controlled analgesia (PCA) with tramadol for postoperative analgesia in this study. Thirty ASA I-II patients (18-65 years) undergoing major urologic operations were included. A standard general anesthetic technique was used for all patients. Patients were randomly divided into two groups with respect to postoperative analgesia technique. Group I (n=I5) received iv PCA with tramadol (50 mg loading dose, 5 mg h<sup>-1</sup> basal infusion rate, 20 mg bolus, 30 minutes lock-out time). Group II (n=15) received epidural PCA with tramadol (20 mg loading dose, 8 mg h<sup>-1</sup> basal infusion rate, 5 mg bolus, 30 minutes lock-out time). Pain score via Visual analog scale (VAS), sedation score, blood pressure, heart rate, respiratory rate, side effects at 0, 6, 12, 24 and 48 hours as well as total tramadol consumption were recorded. Vital parameters were within normal limits throughout the study. There were obvious reductions in VAS scores in both groups (p<0.01). There were no major side effects in Group II. The most common side effect in Group I was nausea-vomiting and the difference was significant between the groups (p<0.05). Total tramadol consumption was found to be similar in both groups (380±55 mg in Group I, 399(84 mg in Group II). In conclusion, tramadol is an effective analgesic via iv or epidural PCA for postoperative pain control. Epidural PCA with tramadol is better tolerated than iv PCA with tramadol because the latter one has a high incidence of nausea-vomiting.

Keywords:

Analgesia, Epidural, Pain, Postoperative, Heart Rate, Injections, Intravenous, Tramadol, Adult, Injections, Epidural, Analgesia, Patient Controlled,

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