Laparoskopik Kolesistektomi Sonrası Akut Ağrı Tedavisinde Pregabalin ve Ketaminin Karşılaştırılması

Amaç: Pregabalin ve ketamin perioperatif ağrı yöteminde kullanılan popüler adjuvan analjeziklerdir. Bu çift kör plasebo kontrollü çalışmada pregabalin ve ketaminin elektif laparoskopik kolesistektomi sonrası akut ağrı tedavisinde preventif analjezik etkisini karşılaştırdık.Yöntemler: Laparoskopik kolesistektomi operasyonu geçirecek yetmiş beş hasta (18-65 yaş arası) rastgele 3 gruba ayrıldı: kontrol grubuna (grup C) operasyondan 1 saat önce oral olarak plasebo kapsül verildi, indüksiyonda bolus 5 ml iv serum fizyolojik sonrasında operasyon bitimine kadar serum fizyolojik infüzyonuna devam edildi. Ketamin grubuna (grup K) operasyondan 1 saat önce oral plasebo kapsül verildi. Indüksiyonda bolus 0.5 mg kg-1 ketamin 5 ml serum fizyolojik içinde iv verildi sonrasında operasyon bitimine kadar 10 µg kg-1 dk1 ketamin infüzyonuna devam edildi. Pregabalin grubu (grup P) operasyondan 1 saat önce oral olarak 300 mg pregabalin kapsül verildi. Indüksiyonda bolus 5 ml iv serum fizyolojik sonrasında operasyon bitimine kadar serum fizyolojik infüzyonuna devam edildi. Anestetezi yöntemi stadardize edildi. Postoperatif 24 saat boyunca toplam tramadol tüketimi, visual analog skala (VAS), postoperatif bulantı ve kusma (POBK) insidansı, sedasyon skoru, ilaçlara bağlı komplikasyonlar değerlendirildi.Bulgular: Postoperatif toplam tramadol tüketimi grup C'ye göre pregabalin ve ketamin grubunda anlamlı şekilde düşük bulundu (p=0.001). Tramadol gereksinimi pregabalin ve ketamin grubunda benzerdi. Postoperatif 30. dakika VAS değerleri ketamin ve tramadol grubunda grup C'ye göre anlamlı düşük bulunmuştur (p=0.001). Ek analjezik ihtiyacı, POBK insidansı ve sedasyon skoru >2 açısından üç grup benzerdi.Sonuç: Laparoskopik kolesistektomi sonrası ketamin ve pregabalin sedasyon düzeyi veya POBK insidansını ektilemeden tramadol tüketimini azaltarak postoperatrif ağrı kontrolüne katkıda bulunur

A Comparison of Pregabalin and Ketamine in Acute Pain Management After Laparoscopic Cholecystectomy

Objective: Pregabalin and ketamine are popular analgesic adjuvants for improving perioperative pain management. We designated this double-blind, placebo controlled study to test and compare the preventive effects of pregabalin and ketamine on postoperative pain management after elective laparoscopic cholecystectomy. Methods: Seventy five patients (18 to 65 years of age) undergoing laparoscopic cholecystectomy were randomly assigned to one of the following 3 groups: control group (group C) received oral placebo capsule 1 h before surgery and bolus plus intravenous (iv) infusion of saline during surgery; ketamine group (group K) received oral placebo capsule 1 h before surgery and 0.3 mg kg-1 iv bolus plus 0.05 mg kg-1 h-1 iv infusion of ketamine during the surgery; pregabalin group (group P) received oral pregabalin 150 mg 1 h before surgery and bolus plus iv infusion of saline during surgery. The anesthetic technique was standardized, total tramadol consumption, visual analog scale (VAS), incidence of postoperative nausea and vomiting (PONV), sedation score and complications related to the drugs used in the study were assessed in the postoperative 24 h period. Results: Postoperative total tramadol consumption were significantly lower in the pregabalin and ketamine group compared to the group C (p=0.001). Tramadol requirement was similar between pregabalin and ketamine groups. At 30 min postoperatively, VAS values were lower in the pregabalin and ketamine groups compared with group C (p=0.001). There was no difference between the three groups in the need for supplemental analgesia, incidence of PONV and sedation score >2. Discussion: Pregabalin and ketamine improved postoperative pain control and decreased analgesic consumption after laparoscopic cholecystectomy with a good safety profile without any changes in sedation level or PONV

Kaynakça

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