İlker SOLMAZ, Ayşegül Ceylan, Mehmet Burak EŞKİN, Ahmet COŞAR

Ketamin ve tramadolün postoperatif kateter kaynaklı mesane rahatsızlığı üzerine etkilerinin karşılaştırılması

Amaç: Kateter kaynaklı mesane rahatsızlığı (KKMR) post anestezik hastalarda yaygın görülen bir durumdur. Bu çalışmanın amacı tramadolün ve ketaminin KKMR bulgusunun azaltılmasındaki etkinliklerinin karşılaştırılmasıdır.Gereç ve Yöntem: Çalışmamız Üroloji ameliyathanesinde genel anestezi altında peruktan nefrolitotomi ameliyatı olan 90 hasta ile yapılmıştır. Hastalara intraoperatif foley sonda takıldı. Uyandırma işleminden 20 dk önce grup K hastaya ketamin (250 ugr/kg) grup T hastaya tramadol (1,5 mg/kg) ve grup S hastaya plasebo (%0,9 sf) ilaç IV uygulandı. Hastaların post op 5., 10., 15., 30. dk'da VAS değeri, hemodinamik parametreleri kaydedildi. VAS’ı 3 ve üzeri olan üç gruptaki hastalara, acil analjezi için meperidin 0.5-1 mg/kg IV meperidin verildi. KKMR nin seviyesi ve bulantı bağımsız bir gözlemci tarafından 0., 1., 4., 6. saatlerde ayrıca değerlendirildi. 3. derece bulantı - kusması olan hastalara anti-emetik olarak, 4mg iv ondansetron verildi.Bulgular: Ekstübasyondan 20 dakika önce verilen, ketamin ve tramadolün, VAS değerlerini azalttığı, KKMR skorlarını düşürdüğü, ek analjezik gereksiniminin tramadol grubunda daha az olduğu sonuçlarına ulaşıldı.Sonuç: Biz genel anestezi altında elektif perkütan nefrolitotomi operasyonu uygulanan hastalarda, tramadolün, postoperatif KKMR şiddeti ve insidansını azaltmada güvenli ve etkili bir yöntem olabileceği kanısındayız.

Anahtar Kelimeler:

tramadol, ketamin, üriner kateter

The comparison of the effects of ketamine and tramadol on postoperative catheter-related bladder discomfort

Objective: CRBD is a condition that occurs commonly in postanesthetic patients who undergo intraoperative urinary catheterization. The aim of this study is to investigate and compare the effects of ketamine and tramadol on severity and incidence of CRBD. The patients that underwent elective percutaneous nephrolithotomy operations under general anesthesia were monitorized perioperatively.Material and Method: After induction of anaesthesia Foley urinary catheters were introduced. 20 minutes before extubation placebo (0.9% NaCl), 250 µg/kg ketamine IV and 1.5 mg/kg tramadol IV were administered to the patients in the group S, K and T, respectively. VAS (Visual Analogue Scale), arterial blood pressure, heart rate, saturation of arterial oxygen are assessed and recorded at 5, 10, 15 and 30 minutes postoperatively. Severity of CRBD and incidence of nausea are assessed and recorded by an observer who was blind to the study at 0, 1, 4 and 6 hours postoperatively. If VAS 3, 0.5-1 mg/kg meperidine IV were administered to the patients as an urgent analgesia. Patients with 3rd degree nausea and vomiting were given anti-emetic and 4 mg iv ondansetron.Results: In conclusion we have found that ketamine and tramadol which were given 20 minutes before extubation reduced the VAS and CRBD scores, and analgesic need in tramadol group was lesser than the other two groups.Conclusion: We think that in patients who undergo elective percutaneous nefroliotomy under general anesthesia tramadol is a safe and effective method which reduces severity and incidence of postoperative CRBD.

Keywords:

tramadol ketamine, urinary catheter, bladder,

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