Sibel SEÇKİN PEHLİVAN, Ayşe ÜLGEY, ADNAN BAYRAM, CİHANGİR BİÇER, Fahri OĞUZKAYA, Adem BOYACI

The Effect of Low Dose Ketamine Infusion on Postoperative Acute and chronic Pain after Thoracotomy

Objective: The aim of this study was to investigate the effects of a perioperatively administered low dose of ketamine on postoperative acute, chronic pain following thoracotomy. Methods: Forty patients with ASA I–III and aged between 18 and 65 years were included in the study. Patients were randomly divided into two groups. Group I (n=20) was administered a ketamine 0.5 mg.kg-1 bolus followed by a 2 mcg.kg-1.dk-1 infusion for 24 hours before the incision. Group II (n=20) was given normal saline at the same dose and duration. Postoperative analgesia was achieved through patient-controlled morphine administration. Postoperative resting and moving Visual Analogue Scale values, total morphine consumption, preoperative and postoperative values of FVC, FEV1 and FEF25-75 from pulmonary function tests were recorded. Patients were evaluated in terms ofchronicpain in the surgical incision area at 1 and 3 months after the operation. Nausea, vomiting, agitation, delirium, hallucination and sedation scores were recorded. Results: No statistical difference was found between groups in terms of demographic characteristics and operational features. Visual analogue scale values at rest and on movement were significantly lower in Group I. Total morphine consumption was also significantly lower in Group I. There was no difference between the groups in terms of pulmonary function tests. There was no difference between groups in terms of the incidence of chronic pain and development during the first month after the operation, while the incidence of chronic pain in the third month was significantly lower in Group I.No significant difference was observed between groups in terms of sedation scores. The incidence of side effects such as nausea, vomiting, agitation, delirium and hallucinations was similar in both groups. Conclusion: Low-dose ketamine infusion is an efficient method in postoperative acute and chronic pain management after thoracotomy, it reduces analgesic consumption.

Düşük Doz Ketamin İnfüzyonunun Postoperatif Torakotomi Sonrasi Akut ve Kronik Ağriya Etkisi

Amaç: Torakotomi deperioperatif olarak uygulanan düşük doz ketaminin füzyonunun postoperatif akut, kronik ağrı üzerine etkisi araştırılmıştır. Yöntemler: ASA I-III, 18-65 yaş, 40 hastada çalışıldı. Hastalar randomize olarak iki gruba ayrıldı. İntraoperatif dönemde insizyondan önce 1. Gruba (Grup I, n = 20) ketamin 0,5 mg/kg bolus, idamede 2 mcg.kg-1.dk-1 infüzyon şeklinde 24 saat devam edildi. İkinci gruba (Grup II, n = 20) aynı dozda ve sürede serum fizyolojik uygulandı. Postoperatif analjezi morfin ile hasta kontrollü analjezi şeklinde uygulandı. Hastaların postoperatif dönemdeki istirahat ve hareketli Görsel Analog Skala değerleri, toplam morfin tüketimi, solunum fonksiyon testlerinden FVC, FEV1 ve FEF25-75’in preoperatif ve postoperatif değerleri kaydedildi. Hastalar operasyondan 1 ve 3 ay sonra cerrahi insizyon alanında kronik ağrı yönünden değerlendirildi. Hastalardaki bulantı, kusma, ajitasyon, deliryum, halusinasyon ve sedasyon skorları kaydedildi. Bulgular: Demografik özellikler ve operasyonel özellikler açısından gruplar arasında istatistiksel fark bulunmadı. İstirahat ve hareketli dönemdeki Görsel Analog Skala değerleri Grup I’de anlamlı düşüktü. Toplam morfin tüketimi de Grup I’de anlamlı olarak daha düşüktü. Solunum fonksiyon testleri açısından gruplar arasında farklılık yoktu. Kronik ağrının, ağrı skorlamasına göre bir ay sonraki gelişme insidansında gruplar arasında farklılık yokken, 3 ay sonraki gelişme insidansı ağrı skorlamasına göre Grup I’de anlamlı olarak daha düşük bulunmuştur. Sedasyon skorları açısından gruplar arasında anlamlı farklılık yoktu. Bulantı, kusma, ajitasyon, deliryum ve halusinasyon gibi yan etkilerin görülme oranı her iki grupta benzerdi. Sonuç: Torakotomide düşük doz ketaminin füzyonu postoperatif akut ve kronik ağrı tedavisinde etkili bir yöntemdir, analjezik tüketimini azaltmaktadır.

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