Oğuz ERİŞ, Meltem UYAR, İnan AYSEL, Elvin KURDOĞLU

Artroskopik diz cerrahisi sonrasında intraartiküler tekoksikam ile postoperatif ağrı kontrolü

Bu çalışmada artroskopik diz cerrahisi geçirecek hastalarda intraartiküler yolla uygulanacak tenoxicamin postoperatif analjezik etkinliğini göstermeyi amaçladık. Fakülte etik kurul onayı alındıktan sonra fizik durumu ASA-I-II' ye giren, yaşları 16-55 arasında değişen 30 hasta çalışmaya dahil edildi. Hastalar rastgele 15' er kişilik 2 gruba ayrıldı. Premedikasyon uygulanmaksızın tüm hastalara Standard genel anestezi protokolü uygulandı. Indüksiyonda atropine 0.01 mg.kg'1 propofol 2 mg.kg'1, fentanil 2mcg. kg'1 ve vekuronyum 0.1 mg.kg"1 IV uygulanıp takiben trakeal entübasyon sonrası anestezi idamesi %50 O2/N2O ve isofluran (0.8-2.0 %) ile sağlandı. Operasyonun sonunda artroskop intraartiküler aralıktan çıkarılmadan tüm hastalara çift kör, randomize şekilde çalışma ilacı verildi. Grup T'ye: 20 ml salin içinde 20 mg tenoksikam, Grup K'ya: sadece 20 ml salin uygulandı. Postoperatif analjeziğe ihtiyaç duyulduğunda intravenöz HKA ile morfin uygulandı. Operasyondan sonra ağrı ve sedasyon skorları; Vizüel Analog Skala (VAS), Verbal Rating Skala (VRS) ve Ramsey Sedasyon Skorları O, 20, 40. dakikalarda ve 1, 2, 4, 12, 24. saatlerde kaydedildi. Postoperatif ilk 24 saat süresince toplam morfin tüketimi ve yan etkiler kaydedildi. Veriler Anova, Chi-kare testleri ile karşılaştırıldı iki grup arasında VAS, VRS, sedasyon skorları ve özellikle de toplam morfin tüketimi açısından istatiksel olarak anlamlı fark yoktu (p> 0.05). Bu çalışmada tenoksikamın intraartiküler analjezik etkisiyle ilgili daha önce yapılmış çalışmaların tersine 20 mg intraartiküler tenoksikamın artroskopik diz cerrahisinde kontrol grubuna göre üstünlüğünün olmadığı bulunmuştur.

Anahtar Kelimeler:

Analjezi, Anti-enflamatuvar ajanlar, steroid olmayan, Artroskopi, Enjeksiyon, eklem içi, Diz eklemi, Ortopedik işlemler

Postoperative pain control by intraarticular tenoxicam after arthroscopic knee surgery

In this study we tried to find out the postoperative analgesic efficacy of tenoxicam applied by intraarticular route in patients undergoing arthroscopic knee surgery. Thirty patients ASAI-II and 16-55 years of age were enrolled. Patients received no premedication. General anesthesia was maintained with 50 % O/AfcO and isoflurane (0.8-2.0 %) after induction with atropine 0.01 mg.kg'1, propofol 2 mg.kg'1 and fentanyl 2mcg. kg'1 intravenously, vecuronium 0.1 mg.kg'1 was administered for trachéal intubation. Standard monitoring was used. At the end of the surgery and before the removal of arthroscope, the studied drug was given intraarticulariy in a double-blinded randomized manner, such that; 20 mg Tenoxicam in 20 mL saline (Group T) or 20 mL Saline only, as control group (Group K). Postoperatively analgesic rescue medication was provided by intravenous PCA morphine. Pain and sedation scores were assessed by Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), Ramsey Sedation Scores at'O, 20, 40 minutes and 1, 2, 4, 12, 24 hours after the operation. Total morphine consumption and side effects were the measured parameters in first 24 hours. Statistical analysis was performed by Anova, Chi-square tests.(p<0,05). There were no significant differences in the presence of VAS, VRS, sedation scores and especially morphine consumption between the two groups. In this study, the analgesic efficacy of 20 mg tenoxicam applied intraarticularly in arthroscopic knee surgery hasn't been found to be superior to the control group; in contrast to the previous studies showing intraarticular analgesic effect of this agent.

Keywords:

Analgesia, Anti-Inflammatory Agents, Non-Steroidal, Arthroscopy, Injections, Intra-Articular, Knee Joint, Orthopedic Procedures,

PDF

___

1. Van Lancker P, Vandekerckhove B, Cooman F: The analgesic effect of preoperative administration of proparacetamol, tenoxicam or a mixture of both in arthroscopic, outpatient knee surgery. Acta Anaesthesiol Belg 1999;50 (2):65-9.
2. Mather LE: Do the pharmacodynamics of the nonsteroidal antiinflammatory drugs suggest a role in the management of postoperative pain. Drugs 1992;44 : 1-12.
3. Odd GN: Clinical pharmacokinetics of tenoxicam. Drug disposition. Clinical pharmocinetics. 1994;26(1): 16-43.
4. De Andres J, Valia JC, Barrera et al: Intra-artıcular analgesia after artroscopic knee surgery: comparison of three different regimens. Eur J Anaesthesiolog 1998; 15 (1):10-5.
5. Bjornsson A, Gupta A, Vegfors M: Intraarticular morphine for postoperative analgesia following knee arthroscopy. Reg Anesth 1994;19:104-8.
6. Dalsgaard J, Felsby S, Juelsgaard P et al: Low dose Intraarticular morphine analgesia in day case knee arthroscopy.a randomised double-blinded prospective. Pain 1994;56:151-4.
7. Raja SN, Dickstein RE, Johnson CA: Comparison of postoperative analgesic effects of intrarticular bupivacaine and morphine following arhroscopic knee surgery. Anesthesiology 1992;77:1143-147.
8. Whitford A, Healy M, Joshi GP, McCarroll SM, O'Brien TM: The effect of touriquet release time on analgesic efficacy of intraarticular morphine after arthroscopic knee surgery. Anesth Analg 1997; 84:791-793.
9. Heard SO, Edwaed WT, Ferrari D et al: Analgesic effect of intrarticular morphine and bupivacai or morphine after arthroscopic knee v surgery. A randomized, prospective, double-blind study. Anesth Analg 1992;74:822-6.
10. Smith I, Shively RA, White PF: Effects of ketorolac and bupivacaine on recovery after out patient artroscopy. Anesth Analg 1992;75:208-12.
11. Convery PN, Milligan KR, Quinn P et al: Low dose intraarticular ketorolac for pain relief following artroscopy of the knee joint. Anaesthesia 1998;53(11): 1125-9.
12. Gupta A, Axelsson K, Alvin Ret al: Postoperative pain following knee artroscopy; the effects of intraarticular ketorolac and/or morphine. Reg Anesth Pain Med 1999;24(3):225-30.
13. Reuben SS, Connelly NR: Postartroscopic analgesia for outpatient athroscopic knee surgery with bupivacaine and ketorolac. Anesth Analg 1995;80.1154-7.
14. Reuben SS, Connelly NR: Postartroscopic meniscus repair analgesia with intraarticular ketorolac or morphine. Anesth Analg 1996;82.1036-9.
15. Elhakim M, Fathy, A, Elkott A, et al: Intraartikuier tenoxicam releves post-arhroscopy pain. Acta Anaesthesiologica Scand 1996;40.1223-1226.
16. Cook TM, Tuckey JP, Nolan JP. Analgesia after day-case knee artroscopy:double-blind study of intraarticular tenoxicam, intraarticular bupivakain and placebo. Br J Anaesth 1997;78:163-8.
17. Colbert ST, Curran E, O'Hanlon DM et al: Intra-articular tenoxicam improves postoperative analgesia in knee arthroscopy. Can J Anaesth 1999; 46:653-7.
18. özakıncı lö, Akseki D, özcan PE ve ark: Diz artroskopisinde preoperatif ve postoperatif intraartikuier tenoksikam uygulamasının değerlendirilmesi. Ağrı 2001; 13:2-3,46-49
19. özakıncı İÖ, özyalçın S, Yücel A. Preemptif uygulanan tenoksikam ve petidinin postoperatif analjezik etkinliklerinin karşılaştırılması. Ağrı 1998;10:37-51
20. Elhakim M, Nafie M, Eid A et al: Combination of intra-articular tenoxicam, lidocaine and pethidine for outpatient knee arthroscopy. Acta Anaesthesiol Scand 1999; 803-8.