Meltem UYAR, ABDURRAHİM DERBENT, İLKBEN GÜNÜŞEN, Meral SAKLIYAN, Elvin KURDOĞLU

Laminektomi uygulanan olgularda pre-emptif analjezinin etkisi

Bu çalışmanın amacı laminektomi uygulanan hastalarda pre-emptif olarak kullanılan petidin ve tramadol'ün postoperatif etkinliğini karşılaştırmaktır. Çalışma, Hastane Etik Kurulu tarafından onaylandı ve hastalardan yazılı izin alındı. Son 24 saat analjezik almamış olan, 18- 60 yaş arası, laminektomi uygulanan 25 hasta (12 K, 13 E ) çalışmaya dahil edildi. Olgular randomize olarak 2 gruba ayrıldı. Birinci grupta 1.5 mg.kg-1 tramadol, 2. Grupta 1.5 mg.kg-1 petidin intramuskuler olarak cerrahiden 30 dk önce yapıldı. Standart genel anestezi indüksiyonunda atropin 0.01 mg.kg-1, tiyopental sodyum 5 mg.kg-1, fentanil sitrat 1.5 mcg.kg-1, 0.1 mg.kg-1 vekuronyum ; anestezi idamesinde % 50 - 50 O2 -N2O, % 0.8- 1.5 izofluran kullanıldı. Analjezinin etkinliği ve süresi vizüel analog skala (VAS ); 0= ağrı yok ,10= duyulan en şiddetli ağrı; verbal rating skala (VRS) 4= dayanılmaz ağrı, 0= ağrı yok olacak şekilde postoperatif 0.5, 1, 3, 24. saatlerde değerlendirildi. Hastaların ek analjezik gereksinimi olduğunda tenoksikam (Tilcotil® ) intramuskuler 20 mg uygulandı. Her iki gruptaki hemodinamik parametreler, ek analjezik ilaçlar ve yan etkiler kaydedildi. Veriler anova, ki- kare ve student's- t testi ile değerlendirildi. Gruplar arasında yaş, ağırlık, operasyon süresi, hemodinamik parametreler ve VAS, VRS skorları arasında anlamlı fark saptanmadı. Başlangıç değerleriyle karşılaştırıldığında her iki grubun grup içi 24. saatteki VAS skorlarının ve 3. ile 24. saatteki VRS skorlarının anlamlı olarak azaldığı gözlendi (p

Anahtar Kelimeler:

Analjezi, Laminektomi, Meperidin, Ameliyat sonrası bakım, Tramadol, Cerrahi işlemler, elektif

The effect of pre-emptive analgesia in patients undergoing laminectomy

The aim of this study was to compare the postoperative analgesic efficacy of pethidine and tramadol administered preemptively in patients undergoing laminectomy. Twenty- five patients undergoing laminectomy ( who didn't take analgesic for 24 hours, ages between 18- 60 years, ASA I- II status, 12 F, 13 M) were included in this study. The protocol was approved by the Instutional Ethical Committee and informed consent were taken from all patients. Cases were randomised in two groups. In group (1) 1.5 mg.kg-1 tramadol, in group (2) 1.5 mg.kg-1 pethidine were administered intramuscularly 30 min before surgery. A standardised general anesthesia was maintained with 50 - 50 % O2- N2O, isoflurane 0.8- 1.5 % after induction with atropine 0.01 mg.kg-1 thiopenthal sodium 5 mg.kg-1, fentanyl citrate 1.5 mcg kg-1 intravenously, vecuronium was administered 0.1 mg.kg-1 for tracheal intubation. The efficacy and duration of analgesia were assessed using visual analogue scale (VAS), where 0= no pain, 10= worst pain imaginable; and a verbal rating scale (VRS) to rate the pain suffered as 4= most severe pain, 0= no pain; at 0.5, 1, 3, 24. hours postoperatively. Tenoxicam (Tilcotif® was administered to the patient when additional analgesic requirement existed. Haemodynamic parameters, additional analgesic drugs, adverse effects were recorded in both study group. Data were analysed using anova, chi- square and student's- t test. There was no significant difference of age, weight, operation time, haemodynamic parameters, and VAS, VRS scores between the two groups. Postoperative 24th hours VAS scores and 3rd , 24th hours VRS scores were significantly lower when compared baseline values in both groups. In conclusion, it is suggested that tramadol and pethidine, opioids which have two different mechanism of action, can be used as preemptive analgesics for preventing postoperative pain in laminectomy operations.

Keywords:

Analgesia, Laminectomy, Meperidine, Postoperative Care, Tramadol, Surgical Procedures, Elective,

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