Laparoskopik Kolesistektomide İntravenöz İbuprofen ve Asetaminofenin Postoperatif Ağrı ve Tramadol Tüketimi Üzerine Etkinliği: Prospektif, Randomize, Çift Kör Klinik Çalışma

Amaç: Laparoskopik kolesistektomi (LC) sonrası postoperatif ağrıyı yönetmek için multimodal analjezi de dahil olmak üzere birçok teknik kullanılmıştır. İntravenöz ibuprofen (IV) kullanan çalışmaların sayısı hala sınırlı olsa da, ibuprofenin postoperatif ağrı yönetiminde potansiyel bir rolü olduğu gösterilmiştir. Bu çalışmanın birincil amacı, LC uygulanan hastalarda IV ibuprofen ve asetaminofen formlarının postoperatif 24 saatlik opioid tüketimi ve ağrı yönetimi üzerindeki etkisini değerlendirmek ve karşılaştırmaktır. Çalışmanın ikincil amacı, ibuprofen ve asetaminofenin opioidle ilişkili advers olaylar (ORAE) üzerindeki etkisini değerlendirmektir. Gereç ve Yöntemler: Bu çalışma prospektif, randomize, çift kör bir klinik çalışmaydı. Etik kurul onayı alındıktan sonra yaşları 18 ile 65 arasında değişen, American Society of Anesthesiology (ASA) skoru I-II olan ve LC planlanan 70 hasta çalışmaya alındı. Hastalar rastgele iki gruba ayrıldı. Ameliyat sırasında kontrol grubu (n=35) 100 mL salin içinde 800 mg IV ibuprofen (grup I), asetaminofen grubu (n=35) 1000 mg (grup A) aldı. Postoperatif dönemde tüm hastalara tramadollu hasta kontrollü analjezi (HKA) cihazı verildi. PCA cihazı, 10 mg bolus dozuna ayarlandı ve 15 dakikalık bir kilitleme süresine sahipti. Kör bir ağrı hemşiresi, postoperatif analjeziyi sayısal derecelendirme ölçeği (NRS) kullanarak 1, 2, 4, 6, 12 ve 24. saatlerde değerlendirdi. Postoperatif 24 saatlik dönemde postoperatif bulantı ve kusma insidansı, toplam tramadol tüketimi ve ek analjezik ihtiyacı kaydedildi. Bulgular: Bu çalışmaya LC uygulanan 70 hasta katıldı. Analjezik ilaç kullanımı grup I'de diğer grup A'ya göre istatistiksel olarak daha düşüktü. İV ibuprofen ve asetaminofen grupları arasında NRS skorları postoperatif 1, 2, 4, 6, 12 ve 24. saatlerde istatistiksel olarak benzerdi (P>0.05) . 24 saatlik opioid tüketimi grup A'da grup I'e göre istatistiksel olarak anlamlı derecede yüksekti (P<0.05). Ayrıca analjezik kullanımı grup I ve grup A'da istatistiksel olarak benzerdi (P>0,05). POBK oranları ibuprofen ve asetaminofen gruplarında benzerdi (P>0.05). ORAE'ler gruplar arasında benzerdi. Sonuç: Tramadol bazlı multimodal analjezinin bir parçası olarak ibuprofen, elektif LC cerrahisini takiben postoperatif ilk 24 saat boyunca asetaminofene kıyasla tramadol tüketimini azaltmıştır. IV ibuprofen-tramadol kombinasyonu, bir asetaminofen-tramadol kombinasyonundan üstün göründü. ORAE'ler her iki grupta da benzerdi.

Anahtar Kelimeler:

İbuprofen, asetaminofen, postoperatif ağrı, analjezi, laparoskopik kolesistektomi

Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial

Background: Many techniques, including multimodal analgesia, have been used to manage postoperative pain after laparoscopic cholecystectomy (LC). Although the number of studies using intravenous ibuprofen (IV) is still limited, ibuprofen has been shown to have a potential role in managing postoperative pain. The primary outcome of this study is to evaluate and compare the impact of IV forms of ibuprofen and acetaminophen on 24-hour postoperative opioid consumption and pain management in patients undergoing LC. The second outcome of the study is to evaluate the impact of ibuprofen and acetaminophen on opioid-related adverse events (ORAE). Materials and Methods: This study was a prospective, randomized, double-blind clinical trial. Following ethical committee approval, 70 patients aged 18 to 65, American Society of Anesthesiology (ASA) score I- II, and those scheduled for LC were enrolled in the study. Patients were randomly divided into two groups. The control group (n=35) received 800 mg IV ibuprofen (group I) in 100 mL saline during surgery, while the acetaminophen group (n=35) received 1000 mg (group A). In the postoperative period, all patients received a patient-controlled analgesia (PCA) device with tramadol. The PCA device was set to a bolus dose of 10 mg and had a lockout time of 15 minutes. A blinded pain nurse assessed postoperative analgesia at 1, 2, 4, 6, 12, and 24 hours using a numerical rating scale (NRS). The incidence of postoperative nausea and vomiting (PONV), total tramadol consumption, and the need for additional analgesics during the 24-hour postoperative period were recorded. Results: Seventy patients who underwent LC participated in this study. The use of analgesic medications was statistically lower in group I than in the other group A. NRS scores between the IV ibuprofen and acetaminophen groups were statistically similar at 1, 2, 4, 6, 12, and 24 hours postoperatively (P>0.05). 24-hour opioid consumption was statistically significantly higher in group A than in group I (P<0.05). In addition, analgesic use was statistically similar in group I and group A (P>0.05). PONV rates were similar in the ibuprofen and acetaminophen groups (P>0.05). ORAEs were similar between groups. Conclusion: Ibuprofen as part of tramadol-based multimodal analgesia reduced tramadol consumption compared to acetaminophen during the first 24 hours postoperatively following elective LC surgery. The IV ibuprofen-tramadol combination appeared superior to an acetaminophen-tramadol combination. ORAEs were similar in both groups.

Keywords:

Ibuprofen, acetaminophen, postoperative pain, analgesia, laparoscopic cholecystectomy,

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