Hicran Dönmez Özkan, Pınar Açkurt Okutan, Özlem Kocatürk, Senem Yiğit Özer

Genel Anestezi Altında Tamamlanan Kök Kanal Tedavilerinde Parasetamol ve Tenoksikamın Postoperatif Ağrı Düzeyi ve Kurtarma Analjezisi Gereksinimi Üzerine Etkisinin Değerlendirilmesi: Retrospektif Bir Araştırma

Amaç: Bu çalışmanın amacı, standart genel anestezi protokolleri altında tek seansta kök kanal tedavileri tamamlanan sağlıklı erişkinlerde analjezi amacı ile parenteral uygulanan parasetamol ve tenoksikamın erken dönem postoperatif ağrı üzerine etkinliklerinin araştırılmasıdır. Gereç ve Yöntemler: Bu retrospektif araştırmada, şiddetli bulantı refleksi ve/veya anksiyete sebebiyle genel anestezi altında kök kanal tedavileri tek seansta gerçekleştirilen 83 yetişkin hastanın verileri incelenmiştir. Hastalar, analjezi gereksinimlerinin sağlanması için genel anestezi sonlanmadan 30 dakika önce 15 mg/kg parasetamol (grup P) veya 0,5 mg/kg tenoksikamın (grup T) intravenöz olarak uygulanmasına göre iki gruba ayrılmıştır. Sonrasında, hastaların derlenme odasına alındıktan sonra 5. dakikadaki ve takip eden 2. saatteki erken postoperatif dönem vizüel analog skala (VAS) ölçümleri kayıt edilmiştir. Her iki grupta da 2 saat sonunda VAS skorları 4 üzerinde olan hastalara kurtarma analjezisi uygulanmış ve kayıt edilmiştir. Veriler istatistiksel olarak analiz edilmiştir. Bulgular: Dahil edilme kriterlerini karşılayan toplam 68 hasta değerlendirmeye alınmıştır. Postoperatif ağrı değerleri açısından hem 5. dakikada hem de 2. saatte grup T’de grup P’ye göre istatistiksel olarak anlamlı olarak daha düşük VAS skor ortalamaları gözlenmiştir. Her iki grupta da VAS skor ortalamaları zamanla aynı ölçüde azaltmıştır ve gruplar arası fark istatistiksel olarak anlamlı değildir (p=0,452). Ayrıca, kurtarma analjezi ihtiyacı bakımından da iki grup arasında anlamlı fark görülmemiştir (p=0,571). Sonuç: Genel anestezi altında uygulanacak kök kanal tedavilerinde postoperatif ağrı yönetimi açısından parenteral olarak uygulanan tenoksikam, parasetamole kıyasla daha etkin analjezi sağlamaktadır

Effects of Paracetamol and Tenoxicam on Postoperative Pain and Need for Rescue Analgesia in Root Canal Treatments Performed Under General Anesthesia: A Retrospective Study

Objective: This study aimed to investigate the effects of parenterally administered paracetamol and tenoxicam on early postoperative pain regarding analgesia in healthy adults who had completed root canal treatments (RCTs) in a single visit under standard general anesthesia protocols. Materials and Methods: In this retrospective study, the data of 83 adult patients who underwent RCTs under general anesthesia in a single visit due to severe nausea reflex and/or anxiety were analyzed. Patients were divided into two groups according to the intravenous administration of 15 mg/kg paracetamol (P group) or 0.5 mg/ kg tenoxicam (T group) 30 min before the end of general anesthesia to meet their analgesia requirements. Thereafter, early postoperative period visual analog scale (VAS) scores were recorded at the 5th minute after the patients were taken to the recovery room and at the subsequent 2nd hour. After 2 h, rescue analgesia was given to patients with VAS scores >4 in both groups and recorded. Data were analyzed statistically. Results: A total of 68 patients who met the inclusion criteria were evaluated. Regarding postoperative pain values, the average VAS score was significantly lower in the T group at both the 5th minute and 2nd hour than in the P group. In both groups, the mean VAS scores were decreased by the same amount over time, and the differences between the groups were not significant (p=0.452). Moreover, no significant difference was found between the two groups in terms of the need for rescue analgesia (p=0.571). Conclusion: Tenoxicam, administered parenterally, provides more effective analgesia for postoperative pain management compared with paracetamol when it is used in RCTs under general anesthesia.

PDF

___

1. Köroğlu A, Durkan R. An evaluation of the etiology and the treatment procedures of dental anxiety syndrome encountered in dental applications. J Dent Fac Atatürk Uni 2010; 2010: 205- 12.
2. Erten H, Akarslan ZZ, Bodrumlu E. Dental fear and anxiety levels of patients attending a dental clinic. Quintessence Int 2006; 37: 304-10.
3. Firat D, Tunc EP, Sar V. Dental anxiety among adults in Turkey. J Contemp Dent Pract 2006;7:75-82. 4. Ay S, Öztürk M. Bilinçli sedasyon. Cumhuriyet Dental Journal 2000; 3: 121-6.
5. Baygin O, Tuzuner T, Isik B, Kusgoz A, Tanriver M. Comparison of pre-emptive ibuprofen, paracetamol, and placebo administration in reducing post-operative pain in primary tooth extraction. Int J Paediatr Dent 2011; 21: 306-13.
6. Strassels SA, McNicol E, Suleman R. Postoperative pain management: a practical review, part 1. Am J Health Syst Pharm 2005; 62: 1904-16.
7. Forrest JB, Heitlinger EL, Revell S. Ketorolac for postoperative pain management in children. Drug Saf 1997; 16: 309-29.
8. Çetin N, Eşer İ. Hasta kontrollü analjezi yöntemine ilişkin verilen hasta eğitiminin postoperatif ağrının giderilmesine etkisinin incelenmesi. Ege Üniversitesi Hemşirelik Fakültesi Dergisi 2006; 22: 15-25.
9. Pasero C, McCaffery M. When patients can’t report pain. Assessing patients with communication difficulties. Am J Nurs 2000; 100: 22-3.
10. Linas N, Faulks D, Hennequin M, Cousson PY. Conservative and endodontic treatment performed under general anesthesia: A discussion of protocols and outcomes. Spec Care Dentist 2019; 39: 453-63.
11. Çağıran EY, Efeoğlu C, Balcıoğlu T, Koca H. Mental retarde hastalarda dental tedavi: Retrospektif inceleme. Turkiye Klinikleri J Med Sci 2011; 31: 830-6.
12. Özkan AS, Erdoğan MA, Şanlı M, Kaçmaz O, Durmuş M, Çolak C. Retrospective Evaluation of Dental Treatment under General Anaesthesia. Turk J Anaesthesiol Reanim 2015; 43: 332-6.
13. Gondim E Jr, Setzer FC, Dos Carmo CB, Kim S. Postoperative pain after the application of two different irrigation devices in a prospective randomized clinical trial. J Endod 2010; 36: 1295- 301.
14. Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. Int Endod J 2008; 41: 91-9.
15. Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS. Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 1988; 14: 261-6.
16. Kaya Üreyen K, Çiçek E, Aşçı H. Endodontide ağrı ve analjezik kullanımı. SDÜ Sağlık Bilimleri Dergisi 2013; 4: 39-45.
17. Unal SS, Aksoy M, Ahiskalioglu A, Erdem AF, Adanur S. The effect of intravenous preemptive paracetamol on postoperative fentanyl consumption in patients undergoing open nephrectomy: a prospective randomized study. Niger J Clin Pract 2015; 18: 68- 74.
18. İnal MA, Baran İ, Polat R, Özlü O. Laparoskopik kolesistektomi cerrahisinde anestezi indüksiyonu sonrası verilen deksketoprofen trometamol ve tenoksikamın postoperatif tramadol tüketimi üzerine etkilerinin karşılaştırılması. Türkiye Klinikleri J Anest Reanim 2016; 14: 7-13.
19. Needleman HL, Harpavat S, Wu S, Allred EN, Berde C. Postoperative pain and other sequelae of dental rehabilitations performed on children under general anesthesia. Pediatr Dent 2008; 30: 111-21.
20. Wong M, Copp PE, Haas DA. Postoperative Pain in Children After Dentistry Under General Anesthesia. Anesth Prog 2015; 62: 140- 52.
21. Niemi-Murola L, Pöyhiä R, Onkinen K, Rhen B, Mäkelä A, Niemi TT. Patient satisfaction with postoperative pain management-- effect of preoperative factors. Pain Manag Nurs 2007; 8: 122-9.
22. Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S. Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia. Indian J Anaesth 2011; 55: 347-51.
23. Alaçam T, Görgül G, Darendeliler S, Bala O. Endodontik tedavi ̇ sonrası ağrı kontrolünde naproksen sodyumun kullanılması. GÜ Dişhek Fak Derg 1991; 8: 1-19.
24. Wells LK, Drum M, Nusstein J, Reader A, Beck M. Efficacy of Ibuprofen and ibuprofen/acetaminophen on postoperative pain in symptomatic patients with a pulpal diagnosis of necrosis. J Endod 2011; 37: 1608-12.
25. Fuller M, Younkin K, Drum M, Reader A, Nusstein J, Fowler S. Postoperative Pain Management with Oral Methylprednisolone in Symptomatic Patients with a Pulpal Diagnosis of Necrosis: A Prospective Randomized, Double-blind Study. J Endod 2018; 44: 1457-61.
26. Jarde O, Boccard E. Parenteral versus oral route increases paracetamol efficacy. Clin Drug Invest 1997; 14: 474-81.
27. O’Hanlon DM, Thambipillai T, Colbert ST, Keane PW, Given HF. Timing of pre-emptive tenoxicam is important for postoperative analgesia. Can J Anaesth 2001; 48: 162-6.
28. Şentürk T. Non-Steroid anti-inflamatuvar ilaçlar (NSAİİ). İç Hastalıkları Derg 2014; 2: 490-5.
29. Day RO, Graham GG, Whelton A. The position of paracetamol in the world of analgesics. Am J Ther 2000; 7: 51-4.
30. Cheung LK, Rodrigo C. Tenoxicam for pain relief following third molar surgery. Anesth Pain Control Dent 1992; 1: 229-33.
31. Gunusen I, Karaman S, Acar A, Sargin A, Firat V. The efficacy of paracetamol versus tenoxicam on postoperative pain and morphine consumption after abdominal hysterectomy: a placebo-controlled, randomized study. Clin Exp Obstet Gynecol 2012; 39: 49-52.
32. Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 2002; 88: 199-214.
33. Khalili G, Salimianfard M, Zarehzadeh A. Comparison between paracetamol, piroxicam, their combination, and placebo in postoperative pain management of upper limb orthopedic surgery (a randomized double blind clinical trial). Adv Biomed Res 2016; 5: 114.
34. Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg 2010; 110: 1170-9.
35. Merry AF, Swinburn PF, Middleton NG, Edwards JL, Calder MV. Tenoxicam and paracetamol-codeine combination after oral surgery: a prospective, randomized, double-blind, placebocontrolled study. Br J Anaesth 1998; 81: 875-80.
36. Ng YL, Glennon JP, Setchell DJ, Gulabivala K. Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment. Int Endod J 2004; 37: 381-91.
37. Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J 2011; 44: 583-609.