Özgür YAĞAN, Tuğçe MUTLU, Ebru ÇANAKÇI, Nilay TAŞ, B. Serhan YURTLU, Volkan HANCI

Propofol Enjeksiyon Ağrısının Önlenmesinde Deksketoprofen ve Tenoksikamın Etkileri

Amaç: Çalışmamızın amacı propofol enjeksiyon ağrısının önlenmesinde tenoksikam ve deksketoprofenin etkinliğini araştırmaktır.Metod: Çalışmaya 20-60 yaş arası 150 hastanın dahil edilmesi planlandı. Hastalar randomize olarak 3 gruba ayrıldı. Genel anestezi indüksiyonu için iv olarak propofol uygulanmasından 2 dk önce hastalara; Grup I’de 2 mL salin, Grup II’de 20 mg (2mL) tenoksikam, Grup III’te ise 50 mg (2mL) deksketoprofen uygulandı. Hesaplanan propofol dozunun 4’te 1’inin uygulanması sonrası enjeksiyon ağrısı 4 puanlı verbal derecelendirme skalası (VRS) ve nümerik değerlendirme skalası (NRS) ile değerlendirildi. Bulgular: Deksketoprofen grubu, çalışma ilacı uygulaması esnasında hastaların şiddetli ağrı duyması nedeniyle 18. hastada sonlandırıldı. Toplam 118 hastanın verileri değerlendirildi. Propofol enjeksiyon ağrısı sıklığı salin grubunda %76, tenoksikam grubunda ise %38 idi ve fark istatistiksel olarak anlamlıydı (p<0,01). NRS skorları salin grubunda 3,1±2,2, tenoksikam grubunda 1,7±1,7 ve deksketoprofen grubunda 1,9±1,5 idi ve salin grubunda tenoksikam ve deksketoprofen grubu ile karşılaştırıldığında istatistiksel olarak anlamlı şekilde yüksekti (sırasıyla p<0,01 ve p<0,05). Sonuç: Çalışmamız sonucunda 20 mg iv tenoxicam ön tedavisinin, propofol enjeksiyon ağrısını azaltmada etkili olduğunu tespit ettik.

Anahtar Kelimeler:

Deksketoprofen, enjeksiyon ağrısı, propofol, tenoksikam

The Effect of Intravenous Dexketoprofen and Tenoxicam on Propofol Injection Pain

Background and Objectives: The aim of our study is to research the efficacy of tenoxicam and dexketoprofen in preventing propofol injection pain. Methods: The study included 150 patients aged from 20 to 60 years. The patients were randomly divided into 3 groups. Two minutes before iv propofol administration for induction of general anesthesia patients in Group I were given 2 mL saline, patients in Group II were given 20 mg (2 mL) tenoxicam and patients in Group III were given 50 mg (2 mL) dexketoprofen. After administering 1 quarter of the calculated propofol dose injection pain severity was assessed using a four-point verbal rating scale (VRS) and numeric rating scale (NRS).Results: Due to pain felt during administration of the study medication in the dexketoprofen group, the study was terminated after 18 patients. The data from 118 patients were assessed. The incidence of propofol injection pain in the saline group was 76%, while this was 38% in the tenoxicam group and the difference was statistically significant (p<0.01). NRS score was 3.1±2.2 in the saline group, 1.7±1.7 in the tenoxicam group and 1.9±1.5 in the dexketoprofen group and it was statistically significantly higher in the saline group compared to the tenoxicam and dexketoprofen groups (p<0.01 and p<0.05 respectively). Conclusions: At the end of our study we identified that 20 mg iv tenoxicam pretreatment was effective in reducing propofol injection pain.

Keywords:

Dexketoprofen, injection pain, propofol, tenoxicam,

PDF

___

1. Tan CH,Onsiong MK.Pain on injection of propofol.Anaesthesia.1998;53:468-76.
2. Jalota L, Kalira V, George E, Shi YY, Homuss C, Radke O, Pace NL, Apfel CC. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011;342:d1110.
3. Hanci V, Ayoğlu H, Yilmaz M, Yurtlu S, Okyay RD, Erdoğan G, et al. Effect of menstrual cycle on the injection pain due to propofol. Eur J Anaesthesiol. 2010;27(5):425-7.
4. Scott RPF, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia. 1988;43:492–4.
5. Yull DN, Barkshire KF, Dexter T. Pretreatment with ketorolac and venous occlusion to reduce pain on injection of propofol. Anaesthesia 2000; 55: 284–7
6. Canbay O, Celebi N, Arun O, Karagöz AH, Saricaoğlu F, Ozgen S. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br J Anaesth. 2008 ;100(1):95-8.
7. Bahar M, McAteer E, Dundee JW, Brigs LP. Aspirin in the prevention of painful intravenous injection of disopropofol (ICI 35,868) and diazepam (Valium). Anaesthesia. 1982;37:847-8.
8. Huang YW, Buerkle H, Lee TH, et al. Effect of pretreatment with ketorolac on propofol injection pain. Acta Anaesthesiol Scand. 2002;46:1021–4.
9. Yurtlu S, Hanci V, Kargi E, Erdoğan G, Köksal BG, Gül Ş, et al. The analgesic effect of dexketoprofen when added to lidocaine for intravenous regional anaesthesia: a prospective, randomized, placebo-controlled study. J Int Med Res. 2011;39(5):1923-31.
10. Memis D, Turan A, Karamanlioglu B, Sut N, Pamukcu Z. The use of magnesium sulfate to prevent pain on injection of propofol. Anesth Analg. 2002;95:606–8.
11. Moher D, Hopewell S, Schulz KF, et al. DG; CONSORT. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012;10(1):28-55.
12. Nakane M, Iwama H. A potential mechanism of propofol-induced pain on injection based on studies using nafamostat mesilate. Br J Anaesth 1999;83:397–404.
13. Iwama H, Nakane M, Ohmori S et al - Nafamostat mesilate, a kallikrein inhibitor, prevents pain on injection with propofol. Br J Anaesth. 1998;81:963-4.
14. Cameron E, Johnston G, Crofts S et al. The minimum effective dose of lignocaine to prevent injection pain due to propofol in children. Anaesthesia. 1992;47:604–6
15. Zhang L, Bao Y, Shi D. Comparing the pain of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy. Acta Cir Bras. 2014;29(10):675-80.
16. Alipour M, Tabari M, Alipour M. Paracetamol, ondansetron, granisetron, magnesium sulfate and lidocaine and reduced propofol injection pain. Iran Red Crescent Med J. 2014;16(3):e16086.
17. He L, Xu JM, He T, Liu L, Zhu R. Dexmedetomidine pretreatment alleviates propofol injection pain. Ups J Med Sci. 2014;119(4):338-42.
18. Fujii Y, Nakayama M. Prevention of pain due to injection of propofol with IV administration of lidocaine 40 mg + metoclopramide 2.5, 5, or 10 mg or saline: a randomized, double-blind study in Japanese adult surgical patients. Clinical Therapy. 2007;29:856-61.
19. Dedic A, Adam S, Gommers D, Van Bommel J. Propofol injection pain: is it still an issue? The effect of premedication. Minerva Anestesiol. 2010;76(9):720-4.
20. Pang WW, Mok MS, Huang S, Hwang MH. The analgesic effect of fentanyl, morphine, meperidine, and lidocaine in the peripheral veins: a comparative study. Anesth Analg. 1998; 86:382–6
21. Dubey PK, Prasad SS. Pain on injection of propofol: the effect of granisetron pretreatment.Clin J Pain. 2003;19:121–4.
22. Agarwal A, Dhiraj S, Raza M, et al. Vein pretreatment with magnesium sulfate to prevent pain on injection of propofol is not justified. Can J Anaesth. 2004;51:130–3.
23. Borazan H, Erdem TB, Kececioglu M, Otelcioglu S. Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol. Eur J Anaesthesiol. 2010;27(3):253-7.
24. Yull DN, Barkshire KF, Dexter T. Pretreatment with ketorolac and venous occlusion to reduce pain on injection of propofol.Anaesthesia. 2000;55(3):284-7.
25. Karasawa F, Ehata T, Okuda T, Satoh T. Propofol injection pain is not alleviated by pretreatment with flurbiprofen axetil, a prodrug of a nonsteroidal antiinflammatory drug. J Anesth. 2000;14(3):135-7.
26. Ghai B, Makkar JK, Bala I, Wig J. Effect of parecoxib pretreatment and venous occlusion on propofol injection pain: a prospective, randomized, double-blinded, placebo-controlled study. J Clin Anesth. 2010;22(2):88-92.
27. Mohta M, Agarwal D, Sethi AK, Sandhu K. Effect of diclofenac pretreatment on pain during propofol injection. Anaesth Intensive Care. 2004;32(6):765-9.
28. Smith AJ, Power I. The effect of pretreatment with ketorolac on pain during intravenous injection of propofol. Anaesthesia. 1996;51(9):883-5.
29. Kelsaka E, Güldoğuş F, Cetinoğlu E. Effect of intravenous dexketoprofen use on postoperative analgesic consumption in patients with lumbar disc surgery. Agri. 2014;26(2):82-6.
30. Sjövall S, Kokki M, Nokela A, Halinen L, Turunen M, Kokki H. Intravenous dexketoprofen induces less injection pain than racemic ketoprofen. J Clin Pharm Ther. 2015;40(4):431-5.
31. Berg J, Fellier H, Christoph T, Grarup J, Stimmeder D. The analgesic NSAID lornoxicam inhibits cyclooxygenase (COX)-1/-2, inducible nitric oxide synthase (iNOS), and the formation of interleukin (IL)-6 in vitro. Inflamm Res. 1999;48(7):369-79.
32. Todd PA, Clissold SP. Tenoxicam. An update of its pharmacology and therapeutic efficacy in rheumatic diseases. Drugs. 1991;41(4):625-46.
33. Starek M, Krzek J. A review of analytical techniques for determination of oxicams, nimesulide and nabumetone. Talanta. 2009;77(3):925-42.
34. Moore OA, McIntyre M, Moore RA, Derry S, McQuay HJ. Single dose oral tenoxicam for acute postoperative pain in adults. Cochrane Database Syst Rev. 2009;(3):CD007591.
35. Arslan H, Topcuoglu HS, Aladag H. Effectiveness of tenoxicam and ibuprofen for pain prevention following endodontic therapy in comparison to placebo: a randomized double-blind clinical trial. J Oral Sci. 2011;53(2):157-61.

Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi-Cover

ISSN: 1309-3320
Başlangıç: 2009
Yayıncı: Tokat Gaziosmanpaşa Üniversitesi

Arşiv