Gözde GÜRSOY ÇİRKİNOĞLU, Fikret MALTEPE, Vasfi KARATOSUN, Şule ÖZBİLGİN, Bayram ÜNVER, Ayten DENİZ

Bilateral diz protezi yapılan hastalarda postoperatif analjezi için standart intravenöz hasta kontrollü analjezi dozu yeterli olur mu?

Total diz protezi (TDP) hem unilateral prosedür hem de aynı seferde bilateral prosedür şeklinde uygulanabilir. Operasyon sonrası etkin postoperatif analjezi, komplikasyonları azaltır ve fonksiyonel iyileşmeyi kolaylaştırır. Çalışmamızın amacı, aynı seferde bilateral TDP yapılan hastaların unilateral TDP yapılan hastalara göre kliniğimizin standart intravenöz hasta kontrollü analjezi (İV-HKA) protokolüne verdiği yanıtların farklı olup olmadığını araştırmaktır. Gereç ve Yöntem: Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesinde 01.01.2014- 31.12.2017 tarihleri arasında, ASA (American Society of Anesthesiologists-Amerikan Anestezistler Cemiyeti) fiziksel durum sınıflandırmasına göre ASA I-III risk grubundan, 18-99 yaş arasında, spinal anestezi altında tek seferde bilateral ya da unilateral TDP operasyonu yapılmış ve postoperatif dönemde morfin bazlı İV-HKA kullanan hastaların verileri retrospektif olarak incelenmiştir. Bulgular: Tek seferde bilateral TDP yapılan 68, unilateral TDP yapılan 124 hastanın kayıtlarına ulaşılmıştır. Kadın cinsiyet her iki grupta da daha yüksek bulunmuştur. Operasyon öncesi ve toplam hastanede yatış süresi unilateral TDP grubunda daha yüksektir. Bilateral TDP grubunda postoperatif 0-24 ve 24-48 saatleri arasında hastaların analjezik talepleri, teslim miktarları ve kullandıkları ortalama morfin miktarı unilateral gruptan anlamlı olarak yüksek bulunmuştur. İki grup arasında morfin yan etkileri benzerdir. 24-48 saatleri arasında visuel analog skala (VAS) skorları unilateral TDP grubunda daha yüksek bulunmuştur. Sonuç: Çalışmamızın sonucunda, bilateral TDP hastalarının postoperatif dönemde daha yüksek morfin kullanımı olsa da opioide bağlı yan etkilerin anlamlı farklılık göstermediği ve kullanmakta olduğumuz standart doz İV-HKA protokolümüzün iki grup için de güvenli ve etkin sınırlarda olduğu gösterilmiştir.

Anahtar Kelimeler:

total diz protezi, ağrı yönetimi, anesteziyoloji

Is a standard intravenous patient-controlled analgesia protocol sufficient for patients with bilateral knee arthroplasty?

The aim of this study is to investigate whether patients undergoing one-stage bilateral total knee arthroplasty and those undergoing unilateral total knee arthroplasty differed in their responses to a standard intravenous patient-controlled analgesia protocol. Data from patients with the physiological status I-III according to American Society of Anesthesiologists, aged 18-99 years, undergoing one-stage bilateral or unilateral total knee arthroplasty under spinal anesthesia between January 2014 and December 2017 and offered a standard intravenous patient-controlled analgesia with morphine were retrospectively reviewed. Demographic data, Visual Analogue Scale scores and postoperative complications were examined. The total dose of analgesics consumed, analgesia demands, doses delivered and the ratio of delivered doses to demands in 0- 24 hours and 24-48 hours after surgery available in the patient-controlled analgesia pump monitoring forms were recorded. Records about 68 patients who had one-stage bilateral total knee arthroplasty and 124 patients who had unilateral total knee arthroplasty were accessed. The analgesia demands and analgesic doses delivered and utilized by the patients with one-stage bilateral total knee arthroplasty were significantly higher in 0-24 hours and 24-48 hours after surgery. Side-effects of the analgesia were similar in both groups. Visual Analogue Scale scores in 24-48 hours after surgery were higher in the patients with unilateral total knee arthroplasty. Although the patients with one-stage total knee arthroplasty received significantly higher doses of morphine, side-effects due to this opioid did not differ significantly. This showed that the standard intravenous patient-controlled analgesia protocol utilized was reliable and effective in both patient groups.

Keywords:

total knee arthroplasty, pain management, anaesthesiology,

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