Betül GÜVEN AYTAÇ, İsmail AYTAÇ, Ayşe LAFÇI, Aysun POSTACI, Bayazıt DİKMEN

Laparoskopik kolesistektomide ağrı yönetiminin derlenme parametreleri üzerine etkisi

Amaç: Laparoskopik kolesistektomi ameliyatı geçiren hastalarda intraoperatif kullanılan analjeziklerin postoperatif ağrı ve derlenme üzerine etkilerini gözlemlemeyi amaçladık. Gereç ve Yöntemler: ASA I-III risk grubunda, 20-85 yaş arası, LK geçiren hastalar çalışmaya dahil edildi. Kullanılan analjeziklerin isimlerine göre gruplar adlandırıldı: İntraoperatif analjezi uygulanmayan hastalar kontrol grubu (Grup C); tramadol (Grup T); metamizol (Grup M); diklofenak (Grup D); parasetamol (Grup P); tramadol + metamizol (Grup TM); tramadol + diklofenak (Grup TD); tramadol + parasetamol (Grup TP). Görsel analog skala (VAS) ≤ 4 sağlayabilen analjezikler etkili olarak kabul edildi. Derlenme odasında VAS 4’den büyük olan hastalara ek analjezikler uygulandı. Hastaların derlenmesi Aldrete Skoru ile belirlendi. Bulgular: Kontrol grubunda 31 hasta, tramadol grubunda 35 hasta, metamizol grubunda 36 hastada, diklofenak grubunda 32 hasta, parasetamol grubunda 31 hasta, Tramadol + metamizol grubunda 56 hasta, tramadol + diklofenak grubunda 31 hasta ve tramadol + parasetamol grubunda 32 hasta bulunmaktaydı. Analjezik kullanan tüm gruplarda, intraoperatif analjezikler ile ilk saatte VAS≤4 sağlanamadı. Hastalarda tek analjezik veya iki analjezik birlikte kullanıldığında ilk bir saat içinde, en düşük ek analjezik gereksinimi GP ve GTP grubunda idi. İntraoperatif analjezik uygulanmayanlarda Aldrete skorları en düşük düzeyde gözlendi. Sonuç: Laparoskopik kolesistektomide ağrının erken postoperatif dönemde yapılması gerektiğini düşünüyoruz. Tüm analjezikler, farmakokinetik profillerinin bilgisi temelinde uygulanmalıdır.

Anahtar Kelimeler:

laparoskopik kolesistektomi, postoperatif ağrı, non-steroid analjezikler

The effect of pain management in laparoscopic cholecystectomy on recovery parameters

Aim: We aimed to observe the effects of analgesics used intraoperatively on the postoperative pain and recovery in patients underwent LC . Material and Methods: ASA I-III group, aged 20-85 patients, who underwent LC surgery were included in the study. We denominated as groups the distribution of analgesics used in eight groups: control group(Group C) for patients without intraoperative analgesia; tramadol (Group T); metamizole (Group M); diclofenac (Group D); paracetamol (Group P); tramadol+metamizol (Group TM); tramadol+diclofenac (Group TD); tramadol+paracetamol (Group TP). Analgesics that can provide visual analog scale (VAS) ≤ 4 was considered effective. Additional analgesics were administered to the patients whom VAS was above 4 in recovery room. Recoveries of patients was determined with Aldrete Score. Results: 31 patients control group, in 35 patients tramadol, in 36 patients, metamizole, in 32 patients diclofenac and in 31 patients paracetamol, in 56 patients tramadol+metamizol, in 31 patients tramadol+diclofenac and in 32 patients tramadol+paracetamol were used. In all groups used analgesics, VAS≤ 4 could not be provided in first hour. In the patients used one analgesic alone and two analgesics together, lowest need for additional analgesics was in GP and GTP group within the first one hour. Aldrete scores were lowest in whom did not receive analgesics intraoperatively. Conclusion: We consider that the management of pain in laparoscopic cholecystectomy should be done early postoperative period. All analgesics should be administered on the basis of the knowledge of their pharmacokinetic profiles.

Keywords:

laparoscopic cholecystectomy, postoperative pain, non-steroid analgesics,

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