Mehtap TUNÇ, Fatma ULUS, Hilal GÜNAL, Tülin BİLGİLİ, Eser ŞAVKILIOĞLU, Hakan TUNÇ

Torakotomi sonrası ağrı tedavisinde hasta kontrollü epidural analjezi yoluyla tramadol kullanımına TENS'in etkisi

Çalışmamızda torakotomi sonrası analjezide, HKEA (Hasta Kontrollü Epidural Analjezi) yöntemi ile tramadol kullanımına TENS'in etkisini araştırmayı amaçladık. Elektif torakotomiye alınacak, ASA I-II, 30 olgu rasgele olarak 15'er kişilik iki gruba ayrıldı. Her iki gruba 50 mg yükleme dozu, 5 mg/sa bazal infüzyon, 10 mg bolus, 20 dakika kilitli kalma süresi olacak şekilde HKEA ile tramadol uygulandı. G2' de HKEA ile TENS kombinasyonu uygulandı. Postoperatif ağrı VAS I (istirahat) ve VAS II (öksürük), sedasyon ise Ramsey skoru ile değerlendirildi. TENS'in solunum terapisine katılıma etkisi öksürük gücü skorlaması ile değerlendirildi. SAB, DAB, KAH, solunum sayısı, SpO2, tramadol talep sayısı, total tramadol tüketimi 15., 30., 60., 90. dk 3. ,5. ,9., 12., 20. ve 24. saatlerde kaydedildi. Her iki grubun VAS skorlarında başlangıç değerlerine göre anlamlı derecede azalma gözlendi (p0.05). Sonuç olarak, torakotomi sonrası ağrı kontrolünde HKEA yöntemi ile tramadol verilen olgularda TENS 'in analjeziye katkısı görülmesine rağmen; tramadol tüketimini ve ek analjezik gereksinimini azaltmadığı ve öksürük gücünü artırmadığı görüldü.

The effect of TENS on epidural patient controlled analgesia with tramadol for postthoracotomy pain relief

In this study, we aimed to investigate the effect of TENS on epidural patient controlled analgesia with tramadol for postthoracotomy pain relief. Thirty ASA I-II patients undergoing elective thoracotomy were randomly divided into two groups with 15 in each. Both groups received tramadol via epidural PCA protocol of 50 mg loading dose, 5 mg/h basal infusion, 10 mg bolus, 20 minutes lockout time. The patients in Group II were administered TENS in addition to epidural PCA. Postoperative pain and sedation were evaluated via VAS I (during relaxation), VAS II (during cough) and Ramsey Sedation Score respectively. The effect of TENS on participation of the patients in respiratory therapy were evaluated with coughing strong score (can't cough, doesn't want to cough: 0, poorly coughing: 1, can cough: 2, coughing productively: 3, coughing strongly: 4). Systolic and diastolic blood pressures, heart rates, respiratory rates, peripheral oxygen saturations, tramadol demand measurements and total tramadol consumptions were noted at 15., 30., 60., 90. min, 3., 5., 9., 12., 20. and 24. Methamizol doses given to patients whose VAS I scores 5 and more as supplemental analgesic were noted. We observed significant reductions in VAS scores in both groups compared with initial scores (p0.05). In conclusion, inspite of it's analgesic effect in the control of postthoracotomy pain in patients receiving tramadol via epidural PCA, TENS neither decrease tramadol consumptions and supplemental analgesic need nor increase coughing strong score.

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