Anestezi indüksiyonu öncesi uygulanan tramadol veya deksmedetomidin'in postoperatif ağrı üzerine etkileri
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Tarih
2008
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Deksmedetomidin sedatif ve analjezik etkili bir α2-adrenerjik reseptör blokeridir. Postoperatif ağrıyı ve morfin tüketimini
azaltığı gösterilmişltir; ancak potansiyel kardiyovasküler yan etkileri nedeniyle kullan›m› k›s›tl›d›r. Tramadol, meperidin ile
benzer güçte opioid bir analjeziktir ve klinik kullanımda yan etkilerinin az olmas› nedeniyle tercih edilir. Çalışmamızda anestezi
indüksiyonu öncesinde uygulanan tramadol ve deksmedetomidinin, postoperatif a¤r› üzerine etkileri ve ayn› zamanda yan etkilerinin
karfl›laflt›r›lmas› amaçlanm›flt›r.
Yöntem: Elektif flartlarda total abdominal histerektomi yap›lan ASA I-II grubu, 60 hasta çal›flmaya al›nd›. Hastalar üç gruba ayrıldı. Anestezi indüksiyonundan 10 dk önce; Grup T (n=20)’deki hastalara 1mg kg-1 iv tramadol (10 dk infüzyon), grup D
(n=20)’deki hastalara 1µg kg-1 iv deksmedetomidin (10 dk infüzyon) ve grup S (n=20)’deki hastalara % 0.9 salin (10 dk infüzyon) fleklinde verildi. Postoperatif analjezi, hasta kontrollü iv morfinle sağlandı. Operasyon süresi, ekstübasyon süresi, derlenme zaman› kaydedildi. A¤r› skoru (VAS), sedasyon skoru, kümülatif morfin tüketimi ve yan etkiler, hasta kontrollü analjezinin (HKA)
bafllat›lmas›ndan sonra 2, 6, 12 ve 24. saatlerde kaydedildi.
Bulgular: Deksmedetomidin grubunda kan basıncı ve kalp hızı daha düflük olarak bulundu (p<0.05). Postoperatif ağrı ve morfin tüketimi deksmedetomidin grubunda anlamlı derecede düflük olarak bulundu (Grup T: 29.87 mg Grup D: 20.95) (p<0.05).
VAS istatistiksel olarak anlamlı olmasa da deksmedetomidin grubunda daha düflüktü. Postoperatif sedasyon skoru ilk 6 saat
deksmedetomidin grubunda daha yüksekti, ancak fark anlamlı değildi.
Sonuç: Preoperatif olarak verilen deksmedetomidin hemodinamik olarak önemli yan etkilere sebep olmadan postoperatif morfin tüketimini tramadol’den daha fazla azaltmaktadır
Objective: Dexmedetomidine is a selective α2-adrenergic receptor blocker with sedative and analgesic effects. It has been shown to reduce postoperative pain and morphine consumption but its clinical use is limited because of its potential cardiovascular side effects. Tramadol is an opioid analgesic with a similar potency to meperidine. Although it is not as potent as morphine, it is preferred in clinical practice because of its relatively low potential side effects. We aimed to compare the effect and side effects of preoperative dexmedetomidine or tramadol administration on postoperative pain and analgesic consumption. Method: Sixty patients were randomly assigned into three groups to receive 1mg kg-1 iv tramadol, or 1µg kg-1 iv dexmedetomidine, or the same volume of saline before induction of anaesthesia. At the time of skin closure, patients were given a standardized bolus dose of morphine and then were allowed to use a patient controlled analgesia (PCA) device. Blood pressures and heart rate were recorded before and after the infusion of the drugs and induction and 1 minute after intubation. Sedation, pain score, cumulative morphine consumption and side effects were recorded 15 minutes, and 2, 6, 12, and 24 hours after initiation of PCA. Results: There were decrease in the blood pressures and heart rates of the patients in the dexmedetomidine group (p<0.05). Postoperative pain and morphine consumption were significantly reduced in the dexmedetomidine group (Group T: 29.87 mg, Group D: 20.95 mg, p<0.05). VAS was lower in the dexmedetomidine group and postoperative sedation scores were higher in the dexmedetomidine group in the first 6 hours. Conclusion: Preoperative dexmetedomidine reduced postoperative morphine consumption more effectively than tramadol without an important adverse effect on hemodynamic parameteres.
Objective: Dexmedetomidine is a selective α2-adrenergic receptor blocker with sedative and analgesic effects. It has been shown to reduce postoperative pain and morphine consumption but its clinical use is limited because of its potential cardiovascular side effects. Tramadol is an opioid analgesic with a similar potency to meperidine. Although it is not as potent as morphine, it is preferred in clinical practice because of its relatively low potential side effects. We aimed to compare the effect and side effects of preoperative dexmedetomidine or tramadol administration on postoperative pain and analgesic consumption. Method: Sixty patients were randomly assigned into three groups to receive 1mg kg-1 iv tramadol, or 1µg kg-1 iv dexmedetomidine, or the same volume of saline before induction of anaesthesia. At the time of skin closure, patients were given a standardized bolus dose of morphine and then were allowed to use a patient controlled analgesia (PCA) device. Blood pressures and heart rate were recorded before and after the infusion of the drugs and induction and 1 minute after intubation. Sedation, pain score, cumulative morphine consumption and side effects were recorded 15 minutes, and 2, 6, 12, and 24 hours after initiation of PCA. Results: There were decrease in the blood pressures and heart rates of the patients in the dexmedetomidine group (p<0.05). Postoperative pain and morphine consumption were significantly reduced in the dexmedetomidine group (Group T: 29.87 mg, Group D: 20.95 mg, p<0.05). VAS was lower in the dexmedetomidine group and postoperative sedation scores were higher in the dexmedetomidine group in the first 6 hours. Conclusion: Preoperative dexmetedomidine reduced postoperative morphine consumption more effectively than tramadol without an important adverse effect on hemodynamic parameteres.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Anestezi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
16
Sayı
4
