Ubaid ALİ, Hanief DAR, Mir AHMED, Nazir SALROO, Shah ARJMAND, Sheikh IMRAN

Laparoskopik Kolesistektomi Sonrası Ağrı Kontrolü için Bupivakainin İntraperitoneal ve Port Alanı İnfiltrasyonunun Kullanımı: Prospektif Çalışma

Amaç: Laparoskopik kolesistektomi sonrası ağrının, açık kolesistektomiden daha az yoğun olduğu, cerrahi sonrası ya da ameliyat sonrası gece boyunca ilk birkaç saat özellikle öksürük, solunum hareketleri ve mobilizasyonun bazı hastalarda halen önemli bir rahatsızlık olduğu görüldü. Materyal ve Metod: Çalışma laparoskopik kolesistektomi olan 200 hastayı içerdi. Her biri 100 hasta olan 2 gruba ayrıldı. Tamamlama pf laparoskopik kolesistektomi sonrası ilk gruba (deney grubu) bupivakain ve diğer gruba (kontrol grubu) 30 ml serum fizyolojik verildi. Bulgular: Kurtarma analjezi gereksiniminin ortalama süresi deney grubunda 8,5 saatken, kontrol grubunda bu süre 7,29 saattir. Deney grubunda diklofenakın toplam tüketimi 95mg iken, kontrollerde 108.75 mg'dır (p=0.246). Deney grubunda tramadolun toplam tüketimi 50mg, kontrol grubunda 130mg'dır (p<0.05). Ameliyat sonrası karın ağrısıyla birlikte omuz ucu ağrısı tüm zaman aralıklarında (4 saat, 12 saat, 24 saat) kontrollerle karşılaştırıldı. Deney grubunda ağrı daha azdı. Ameliyat sonrası dönemde deney grubunda sadece 2 hastada bradikardi ve 1 hastada hafif uyuşukluk gelişti. Bu 3 hastanın sadece 3-4 saat sürekli izlenmesi istendi. Hastanede ortalama yatış kontrollerde 1.93 gün iken, deneylerde 1.71 gündü. Sonuç: İntraperitoneal ve port alanı bupivakain, laparoskopik kolesistektomi ameliyatı sonrası dönemde ağrının somatik ve visseral bileşenlerini azaltır. Bu, kurtarma analjezi gereksinimini ve hastanın hastaneden taburcu olma hızını azaltır.

Anahtar Kelimeler:

Laparoskopik kolesistektomi, Ağrı, Bupivakain

Use of Intraperitoneal and Port Site Infiltration of Bupivacaine for Controlling Pain after Laparoscopic Cholecystectomy: A Prospective Study

Purpose: Pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort especially with coughing, respiratory movements and mobilization during initial few hours after surgery or during night after surgery. Material and Methods: Study included 200 patients who underwent laparoscopic cholecystectomy. They were divided into two groups of 100 patients each. One group (experimental) received bupivacaine and other group (Control) received 30 ml of normal saline after completion pf laparoscopic cholecystectomy. Results: Mean time of requirement of rescue analgesia in experimental group was 8.5 hours, whereas mean time of requirement of rescue analgesia in controls was 7.29 hrs. Total consumption of diclofenac in cases was 95mg whereas in controls it was 108.75mg (p=0.246), while as total consumption of tramadol in cases was 50 mg, whereas in controls it was 130mg (p<0.05). Postoperative abdominal pain as well as shoulder tip pain were less at all-time intervals (4h, 12h, and 24h) in cases compared to controls. Only 2 patients developed bradycardia and 1 patient developed mild drowsiness in experimental group in post-operative period. All the 3 patients required only monitoring and settled in 3-4 hours. Mean hospital stay in experimental group was 1.71 days, whereas in controls it was 1.93 days. Conclusion: Intraperitoneal and port site bupivacaine significantly reduces both somatic and visceral components of pain in post-operative period in laparoscopic cholecystectomy. It decreases the requirement of rescue analgesia and expedites discharge of patient from hospital.

Keywords:

Laparoscopic cholecystectomy, pain, bupivacaine,

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