Mehtep TUNÇ, Fatma ULUS, Uğur GÖKTAŞ, Hilal GÜNAL SAZAK, Eser ŞAVKILIOĞLU

Torakotomi sonrası ağrı tedavisinde; tramadol ile intravenöz hasta kontrollü analjezi ve devamlı infüzyonun karşılaştırılması

SüleymanDemirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 2006 Mart; 13(1) Torakotomi sonrası ağrı tedavisinde; tramadol ile intravenöz hasta kontrollü analjezi ve devamlı infüzyonun karşılaştırılması M.Tunç, F.Ulus, U.Göktaş, H.(Günal) Sazak, E.Şavkılıoğlu Özet Bu çalışmada; torakotomi sonrası ağrı tedavisinde intravenöz Hasta Kontrollü Analjezi (HKA) ve devamlı infüzyonla kullanılan tramadolün analjezik etkisi, analjezik tüketimi ve yan etkileri açısından karşılaştırılması amaçlandı. Etik kurul onayı alındıktan sonra, elektif torakotomi planlanan 33 erişkin olgu çalışmaya dahil edildi. GrupI (G 1)'de iv HKA ile tramadol; 100 mg yükleme dozu, 20 mg bolus doz, kilitli kalma süresi 5 dk, dört saatlik doz 300 mg olacak şekilde uygulandı. Grup II (G 2)'de hastalara 3 mg.kg-1 yükleme dozunu takiben 0,35 mg kg-1sa-1 devamlı infüzyon uygulandı.Vizüel analog skala (VAS) I (istirahat halinde) ve VAS II (öksürürken), sistolik arter basıncı, diyastolik arter basıncı, kalp atım hızı, solunum sayısı, periferik oksijen saturasyonu, sedasyon derecesi, yan etkiler ve total tramadol tüketimi 15., 30., 60. dakikada, 4., 6., 12. ve 24. saatlerde kaydedildi. Her iki grupta yükleme dozunu takiben 15.dk'dan başlayarak bütün zamanlarda başlangıç değerine göre VAS I ve VAS II değerlerinde anlamlı bir düşme gözlendi (p0.05). G1'deVAS I'in 30.dk, 1. sa değerleri ve VAS II'nin 12. sa değeri anlamlı derecede yüksek; VAS II'nin 24. sa değeri anlamlı derecede düşük bulundu (p<0.05). Total tramadol tüketimi 24. saatte G1'de (882.3±300 mg), G2'ye göre (733.7±139 mg) anlamlı derecede yüksek olarak bulundu (p<0.05). Her iki grupta en sık görülen yan etki bulantı-kusma idi. Sonuç olarak torakotomi sonrası ağrı tedavisinde; tramadolün hem iv-hasta kontrollü analjezi yöntemi hem de devamlı infüzyonla kullanımı etkin ve güvenilir analjezi sağlamıştır. Devamlı infüzyon yönteminde kullanılan yüksek yükleme dozunun daha etkin ve daha erken analjezi aşlangıcı sağladığı ve devamında yapılan infüzyonla total tramadol tüketiminin artmadığı bulunmuştur. Anahtar kelımeler: Torakotomi, iv tramadol, hasta kontrollü analjezi, postoperatif ağrı Abstract Comparıson of ıv pca versus contınuous ınfusıon wıth tramadol ın postthoracotomıa analgesıa In this study, to compare the analgesic effect, analgesic consumption and side effects of of tramadol used via continuous infusion and intravenous patient controlled analgesia in post thoracotomy analgesia treatment. After approval by the local ethic committee thirty three ASAI-II adult patients scheduled for elective thoracotomy were included in the study. In Group I (n=17) loading dose was 100 mg iv tramadol via PCA, demand dose 20 mg, lock-out time was 5 min, maximum dose for 4 hours was 300 mg; in Group II (n=16) following loading dose 3 mg kg-1 tramadol, continous infusion 0,35 mg kg-1 was applied.Visual Analog Scale(VAS) I (during relaxation) and VASII (during cough), sistolik arterial blood pressure, diastolik arterial blood pressure, heart rate, respiratory rate, peripheral oxygen saturation, sedation score, side effects and total tramadol consumption were recorded at 15., 30., 60. min, 4., 6., 12. and 24. hours. Significant reductions in VAS scores throughout the study in both groups compared to initial scores was observed (p<0.05). VAS I was significantly higher at 30.min, 1.h and VAS II was significantly higher at 12.h, lower at 24.h in G I (p<0.05). Total tramadol consumption in G1 (882.3±300 mg) was significantly higher than G2 (733.7±139 mg) (p<0.05) at 24.h. The most common side effects were nausea-vomiting in both groups. As conclusion, iv tramadol usage via both PCA and continious infusion provided effective and reliable analgesia in treatment of postthoracotomy pain. It has found that high loading dosage used in continuous infusion method has provided more effective and earlier analgesia onset and total tramadol consumption has not increased by the following infusion treatment. Key words: Thoracotomy, iv tramadol, patient-controlled analgesia, postoperative pain

Anahtar Kelimeler:

Beyin iskemisi, EGb 761, Gingko biloba, lazaroid, Mannitol, U74389F

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