Alparslan APAN, Emine Arzu KÖSE, Muhammet Hilmi KOPUTAN, Gökşen ÖZ

The effects of tramadol and levobupivacaine infiltration on postoperative analgesia in functional endoscopic sinus surgery and septorhinoplasty

Amaç: Prospektif, randomize ve çilf kör çalışmada septorinoplasti (SRP) ve endoskopik sinus cerrahisi (ESC) ameliyatlarından sonra levobupivakain ve tramadol infiltrasyonunun postoperatif analjezik etkilerinin araştırılması amaçlandı. Gereç ve Yöntemler: Çalışmaya elektif olarak ESC ve SRP operasyonları gerirecek ASA I-III sınıfı altmış erişkin hasta alındı. Anestezi indüksiyonu intravenöz propofol 2-2.5 mg/kg-1, roküronyum bromid 0.6 mg/kg-1, and fentanil 1 μg/kg-1 ile gerçekleştirildi. İdame %2 sevofluran ile N2O/O2 karışımı (FiO2: 35%) ile sağlandı. Operasyondan 10 dakika önce cerrahi sahaya tramadol 0.5 mg/kg-1(Group T: n= 20), levobupivakain %0.25(Group L: n= 20), ve lidokainin %1(Group C: n= 20) adrenaline solüsyonu 1/200000 infiltre edildi (ESC için 5 mL ve SRP için10 mL). Postoperatif dönemde hastaların tümüne hasta kontrollü analjezi cihazı ile fentanil uygulandı (bolus doz: 15 μg ve kilit aralığı:10 dak). Ağrı postoperative ilk 24 saatte 11 dereceli vizüel analog skala (VAS) ile 4 saat ara ile değerlendirildi. Postoperatif dönemde analjezik gereksinim, opioid tüketimi ve yan etkiler belirlenerek kaydedildi. Bulgular: Tramadol verilen grubun fentanil gereksinim ve tüketimi istatistiksel açıdan farklı bulundu. 24 saatlik fentanyl dozları Grup C, L ve T için sırası ile 345.2 ± 168.8,6 μg, 221.1 ± 120.6 μg; and 184.1 ± 130,3 μg (p= 0.002) olarak belirlendi. Tramadol ve kontrol grubunun fentanil gereksinimlerinde 16, 20 ve 24. saat peryotlarda (p= 0.012, p= 0.004. ve p= 0.002) farklılık saptandı. Yan etki profili benzerdi. Sonuç: Bulgularımız ESC ve SRP operasyonlarından önce preemptif tramadol infiltrasyonunun levobupivakainin etkili, pratik ve güvenli bir alternatifi olduğunu düşündürmektedir.

Endoskopik sinüs cerrahisi ve septorinoplastide tramadol ve levobupivakain infiltrasyonunun postoperatif analjezi üzerine etkileri

Objective: The aim of this prospective, randomized, double-blind study was to investigate the postoperative analgesic effects of levobupivacaine or tramadol infiltration administered prior to surgery in septorhinoplasty (SRP) or endoscopic sinus surgery (ESS). Material and Methods: Sixty ASA class I-III adult patients electively undergoing SRP or ESC were included the study. Induction of anesthesia was performed with propofol 2-2.5 mg/kg, rocuronium bromide 0.6 mg/kg and fentanyl 1 μg/kg i.v. Sevoflurane 2% with an N2O/O2 mixture (FiO2: 35%) was used for maintenance. Tramadol 0.5 mg/kg (Group T: n=20), levobupivacaine 0.25% (Group L: n=20) and lidocaine 1% (Group C: n=20) in a 1/200,000 adrenaline solution was infiltrated into the surgical area 10 min before the operation (5 mL for ESS and 10 mL for SRP). All patients received fentanyl (bolus dose: 15 μg and lockout interval: 10 min) with a patient-controlled analgesia device during the postoperative period. Pain was assessed using an 11-point visual analogue scale (VAS) every 4 h for the first 24 h. Analgesic requirements, opioid consumption and side effects in the postoperative period were recorded. Results: There was a statistically significant decrease in postoperative fentanyl demand and consumption in patients receiving tramadol. Fentanyl doses in the 24 h period were 345.2±168.8 μg, 221.1±120.6 μg and 184.1±130.3 μg (p=0.002) for the Groups C, L and T, respectively. There were statistically significant differences in fentanyl requirements between the tramadol and control groups at the 16, 20 and 24 h time points (p=0.012, p=0.004 and p=0.002, respectively). The side effect profiles were similar. Conclusions: Our study indicates that the preemptive tramadol infiltration technique is an efficient, practical and safe alternative to levobupivacaine in ESS or SRP operations.

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