Total diz artroplastisi sonrası postoperatif analjezi için intravenöz düşük doz ketamin infüzyonunun kullanımı: Morfin tüketimini azaltan en uygun doz hangisi?
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Dosyalar
Tarih
2020
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Yayıncı
Hatay Mustafa Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada TDA planlanan hastalara postoperatif analjezi amacı ile iki gün farklı dozlarda sürekli i.v. ketamin infüzyonu yapılması sonucu morfin tüketimini azaltan optimal dozun bulunması ve bununla beraber yan etkiler, taburculuk süresi, hasta memnuniyeti ve derlenmenin değerlendirilmesi amaçlandı. Yöntem: Etik kurul onayı alındıktan sonra, TDA planlanan ASA I-III, 18 yaş üzeri 75 kadın çalışmaya alındı. Çalışma prospektif, randomize, çift kör yürütüldü. Spinal anestezi sonra Grup I, Grup II ve Grup III'teki 25'er hastaya sırasıyla 2 μg, 4 μg, 6 μ/kg/dk i.v. başlanan ketaminin cerrahi bitiminde yarıya düşürülerek postoperatif 48. saate kadar uygulandı. Postoperatif analjezi HKA morfinle sağlandı. Uygulama boyunca vitaller, komplikasyonlar, morfin tüketimi, VAS, taburculuk süresi, aktif diz fleksiyonunun 90° olduğu günle hasta memnuniyeti kaydedildi. Bulgular: Demografik ve hemodinamik veriler bakımından gruplar arasında fark yoktu. Bu çalışmada Grup III (38,96 ± 6,08 mg), Grup II (45,52 ± 8,23mg) ve Grup I'in (53,92 ± 5,49 mg) 48 saatlik kümülatif morfin tüketimleri arasındaki farklılık anlamlıydı (p=0,001). Grup III; Grup II ve Grup I'e kıyasla %27; Grup II, Grup I'e göre %15 daha az morfin kullandı. Postoperatif takip süreçlerinde grupların hareketsiz VAS<40mm. Hareketli VAS 12. saatteki ve taburculuk süresi Grup II'de Grup I'e göre daha etkili ve anlamlı bulunurken, postoperatif 6, 12, 24, 48. sa. ve 6.haftada hareketsiz VAS, 6 ve 12. saatte hareketli VAS, taburculuk süresi ve aktif diz fleksiyonu sadece Grup III dozunda Grup I'e göre daha etkindi (p≤0,05). Sonuç: Bu çalışmada TDA'nın postoperatif yönetiminde yan etki görülmeden optimal analjezi ve rehabilitasyon sağlayacak morfin tüketimini azaltan optimal ketamin dozunun Grup III olduğu sonucuna varılmıştır.
Background and aim: In this study, it's aimed to find the optimal dose that reduces morphine consumption as a result of continuous i.v. ketamine infusion in different doses for postoperative analgesia, and to evaluate the side effects, discharge time, patient satisfaction and recovery. Methods: After the approval of the ethics committee, 75 female over 18 years of age with ASA I-III scheduled for TKA were included in the study. The study was conducted prospectively, randomly, and double blind. After spinal anesthesia, 2 μg, 4 μg, 6 μ / kg / min were started in 25 patients in Group I, Group II and Group III, respectively. The ketamine that was started was reduced to half at the end of the surgery and administered until the 48th postoperative hour. Postoperative analgesia was provided with PCA morphine. Vitals, complications, morphine consumption, VAS, discharge time, patient satisfaction with 90° active knee flexion were recorded during the application. Results: There was no difference between the groups in terms of demographic and hemodynamic data. In this study, the difference between the 48-hour cumulative morphine consumption of Group III (38.96 ± 6.08 mg), Group II (45.52 ± 8.23 mg) and Group I (53.92 ± 5.49 mg) was significant (p = 0.001). Group III; 27% compared to Group II and Group I; Group II used 15% less morphine than Group I. During the postoperative follow-up processes, the groups at rest VAS <40mm. While motion VAS at 12 hours and discharge time were found to be more effective and meaningful in Group II compared to Group I, rest VAS at postoperative 6, 12, 24, 48 hours and 6 weeks, motion rVAS at 6 and 12 hours, discharge time and active knee flexion were more effective than Group I at only Group III dose (p≤0.05). Conclusion: In this study, it was concluded that in the postoperative management of TKA, the optimal dose of ketamine that reduces morphine consumption that will provide optimal analgesia and rehabilitation without side effects is Group III. Keyword: Total knee arthroplasty, ketamine, morphine, postoperative analgesia
Background and aim: In this study, it's aimed to find the optimal dose that reduces morphine consumption as a result of continuous i.v. ketamine infusion in different doses for postoperative analgesia, and to evaluate the side effects, discharge time, patient satisfaction and recovery. Methods: After the approval of the ethics committee, 75 female over 18 years of age with ASA I-III scheduled for TKA were included in the study. The study was conducted prospectively, randomly, and double blind. After spinal anesthesia, 2 μg, 4 μg, 6 μ / kg / min were started in 25 patients in Group I, Group II and Group III, respectively. The ketamine that was started was reduced to half at the end of the surgery and administered until the 48th postoperative hour. Postoperative analgesia was provided with PCA morphine. Vitals, complications, morphine consumption, VAS, discharge time, patient satisfaction with 90° active knee flexion were recorded during the application. Results: There was no difference between the groups in terms of demographic and hemodynamic data. In this study, the difference between the 48-hour cumulative morphine consumption of Group III (38.96 ± 6.08 mg), Group II (45.52 ± 8.23 mg) and Group I (53.92 ± 5.49 mg) was significant (p = 0.001). Group III; 27% compared to Group II and Group I; Group II used 15% less morphine than Group I. During the postoperative follow-up processes, the groups at rest VAS <40mm. While motion VAS at 12 hours and discharge time were found to be more effective and meaningful in Group II compared to Group I, rest VAS at postoperative 6, 12, 24, 48 hours and 6 weeks, motion rVAS at 6 and 12 hours, discharge time and active knee flexion were more effective than Group I at only Group III dose (p≤0.05). Conclusion: In this study, it was concluded that in the postoperative management of TKA, the optimal dose of ketamine that reduces morphine consumption that will provide optimal analgesia and rehabilitation without side effects is Group III. Keyword: Total knee arthroplasty, ketamine, morphine, postoperative analgesia
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation, Total diz artroplastisi, ketamin, morfin, postoperatif analjezi, Total knee arthroplasty, ketamine, morphine, postoperative analgesia
