Sevda AKDENİZ, Serap SAMUT BÜLBÜL, Gamze ERTAŞ, Ebru POLAT, Hamiyet ŞENOL ÇAKMAK

Sünnet Ağrısı Kontrolünde Intravenöz Asetamınofenın Preemptıf ve Intraoperatıf Uygulamasının Karşılaştırılması

Amaç: Bu çalışmanın amacı, çocuklarda postoperatif sünnet ağrı palyasyonunda intravenöz asetaminofenin preemptif ve intraoperatif kullanımının etkinliğini karşılaştırmaktır. Yöntemler: Samsun Üniversitesi, Samsun Eğitim ve Araştırma Hastanesi, Çocuk Cerrahisi Anabilim Dalı'nda Mayıs 2021-Mayıs 2022 tarihleri arasında veri tabanımız kullanılarak sünnet yapılan hastaların kayıtları geriye dönük olarak değerlendirildi. Hastalar asetaminofen uygulama zamanına göre preemptif (Grup 1) ve intraoperatif (Grup 2) olmak üzere iki gruba ayrıldı. Çocukların sosyodemografik özellikleri, klinik ve vital bulguları ile Yüz, Bacaklar, Aktivite, Ağlama ve Teselli Edilebilirlik (FLACC) ölçeği gruplar arasında karşılaştırıldı. Bulgular: Çalışmaya Grup 1'de 95 (%46,6) ve Grup 2'de 109 (%53,4) olmak üzere toplam 204 hasta alındı. Gruplar arasında yaş ortalaması, vücut kitle indeksi, derlenme odasında kalış süresi, ameliyat süresi ve hastanede kalış süreleri açısından anlamlı fark saptanmadı. Vital bulgular, preoperatif, indüksiyon, intraoperatif ve postoperatif dönemlerde farklılık göstermedi. Grupların ameliyattan 30 dakika sonra ortalama ağrı skorları arasında anlamlı fark gözlendi (p = 0.024). Ancak ameliyattan bir ve üç saat sonraki ortalama ağrı skorları arasında anlamlı fark gözlenmedi (sırasıyla, p = 0,063 ve p = 0,708). Grup 1'de 13 (%13,7) ve Grup 2'de 17 (%15,6) hastaya ek analjezi uygulandı (p=0,7). Sonuç: Çocuklarda sünnet sonrası intravenöz asetaminofen kullanımı güvenlidir ve iyi tolere edilmektedir. Her ne kadar preemptif asetaminofen, postoperatif ilk 30 dakikada daha üstün bir analjezi sağlasa da, ameliyattan sonra ki birinci ve üçüncü saatlerde, asetaminofenin preemptif ve intraoperatif kullanımının ağrının giderilmesinde benzer ve kabul edilebilir bir etkinliğe sahiptir.

Anahtar Kelimeler:

Asetaminofen, ağrı, analjezi, pediatri, preemptif, sünnet

A Comparison of The Effects of Pre-Emptive and Intraoperative Intravenous Acetaminophen Administration on Pain Management After Circumcision

Aim: The aim of this study was to compare the efficacy of the pre-emptive and intraoperative use of intravenous acetaminophen in post-circumcision pain in children. Methods: The records of patients who had undergone circumcision were retrospectively evaluated using our database in the Samsun University, Samsun Training and Research Hospital, Department of Pediatric Surgery, Turkey, from May 2021 to May 2022. Patients were divided into two groups based on administration of pre-emptive (Group 1) and intraoperative (Group 2) acetaminophen. Baseline characteristics, vital signs, outcomes, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores were then compared between the groups. Results: Two hundred four patients, 95 (46.6%) in Group 1 and 109 (53.4%) in Group 2, were enrolled in the study. No significant difference was determined in terms of mean body mass index, age, length of stay in the recovery room, operative time, or length of hospital stay. Vital findings exhibited no difference in preoperative, induction, intraoperative, or postoperative recordings. Significant differences were observed between the groups’ mean pain scores 30 minutes after surgery (p = 0.024). However, no such significant differences were observed at one and three hours after surgery (p = 0.063 and p = 0.708, respectively). Rescue analgesia was performed in 13 (13.7%) cases in Group 1 and 17 (15.6%) in Group 2 (p = 0.7). Conclusions: Pre-emptive intravenous acetaminophen reduced pain 30 minutes after circumcision. Pre-emptive and intraoperative use of acetaminophen resulted in similar and acceptable efficacy in pain relief one and three hours after surgery.

Keywords:

Acetaminophen, analgesia, circumcision, pain, pediatrics, pre-empitive,

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