Elektrokonvülsif Terapi Sonrası Görülen Baş Ağrısı Tedavisinde Preoperatif Asetaminofen, Deksketoprofen Trometamolün Karşılaştırılması
GİRİŞ ve AMAÇ: Elektrokonvülsif tedavi (EKT); mani,şizofreni, akut katatoni gibi ciddi psikiyatrik bozukluklarıntedavisinde etkili, hayat kurtarıcı ve belirgin yan etkisiolmayan bir tedavi yöntemidir.Baş ağrısı, bu tedavi sonrasıyüksek insidansla (%26-85) görülen ciddi birkomplikasyonudur.Bu çalışmada hipotezimiz,işlem öncesideksketoprofen trometamol uygulamasının EKT sonrası altısaat içinde baş ağrısını asetaminofenden daha etkili bir şekildeazaltacağı yönündedir. YÖNTEM ve GEREÇLER: Bu prospektif, çift kör, tekmerkezli çalışmada, elektrokonvülsif tedavi uygulanan 18 ila80 yaş arası toplam 225 psikiyatrik hastayı inceledik.EKT'denönce üç analjezik stratejisi (1) asetaminofen 1g / 100mlizotonik, (2) deksketoprofen trometamol 50mg / 100mlizotonik; ve (3) 100 ml plasebo intravenöz olarakuygulandı.Baş ağrısı şiddeti; VAS (Vizüel Analog Skalası), kalphızı, noninvaziv kan basıncı, oksijen saturasyonu, solunum hızı,sedasyon (Ramsey Sedasyon Skalası) kullanılarak EKT'den 2saat 4 saat ve 6 saat sonra değerlendirildi. Analjezikgereksinimleri ve yan etkiler kaydedildi. BULGULAR: En sık tanı depresyon (% 41), ardındanşizoaffektif bozukluk (% 38) ve obsesif kompulsif bozukluk (%21) idi.Baş ağrısı VAS skorları 2 ve 4 saatte gruplar arasındafark bulunmadı, ancak deksketoprofen-trometamol alanhastalarda işlemden 6 saat sonra baş ağrısı devam etti. Dördüncü saatte, plasebo grubundaki hastaların % 11'inediğer iki gruba kıyasla kurtarma analjezi gerekti (p = 0,000). TARTIŞMA ve SONUÇ: EKT prosedürü sonrası altı saatlikdönem içinde baş ağrısını azaltmak için deksketoprofen,asetaminofen ve plasebonun etkinliği arasında klinik olarakönemli bir fark bulamadık.
Comparison of Preoperative Acetaminophen, DeksketoprofenTrometamol on Headache Treatment after Electroconvulsive Therapy
INTRODUCTION: Electroconvulsive therapy (ECT) is aneffective, life-saving treatment method with no significant sideeffects in the treatment of serious psychiatric disorders such asmania, schizophrenia, and acute catatonia. Headache is aserious complication seen with a high incidence (26-85%) afterthis treatment. Our hypothesis in the study is that pre procedure administration of dexketoprofen trometamol willreduce headache more effectively than acetaminophen withinsix hours after ECT. METHODS: In this prospective, double-blind, single-centerstudy,we studied a total of 225 psychiatric patients aged 18 to80 years having ECT.Before ECT, three analgesic strategieswere (1) acetaminophen 1g / 100ml isotonic, (2) dexketoprofentrometamol 50mg / 100ml isotonic; and (3) 100 ml of placebowas administered intravenously.Headache intensity using VAS(Visual Analog Scale ), heart rate, noninvasive blood pressure,oxygen saturation, respiratory rate, sedation (Ramsey SedationScale), were evaluated at 2, 4 and 6 hours after the ECT.Analgesic requirements and side effects were recorded. RESULTS: The most common diagnosis was depression(41%), followed by schizoaffective disorder (38%), andobsessive compulsive disorder (21%). No difference was foundbetween groups in the headache VAS scores at 2 and 4 hoursbut patients who received dexketoprofen-trometamol havepersistent headache at 6 hours after the procedure. At the 4thhour, 11% of patients in placebo group required rescueanalgesia compared to the other two groups (p = 0,000). DISCUSSION AND CONCLUSION: We found no clinicallysignificant difference between the efficacy of dexketoprofen,acetaminophen, and placebo for reducing headache within thesix-hour period after the ECT procedure.
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