Effects of postoperative intravenous infusion of tramadol and addition of dexmedetomidine to tramadol on analgesia and hemodynamic parameters in gynecologic surgery: A prospective (double blind) randomised controlled trial

Abstract

Aim: We designed this double-blind study to test and compare the effects of intravenous tramadol and intravenous tramadol plus dexmedetomidine on analgesia and hemodynamic parameters for treatment of postoperative pain in gynecologic surgeries with Pfannenstiel incision.

Methods: Sixty patients undergoing total abdominal hysterectomy with Pfannenstiel incision under general anesthesia were randomly allocated into two groups. Group C (Tramadol) and Group D (Tramadol + Dexmedetomidin). The anesthetic technique was standardized. Postoperatively, the patients in both groups received patient controlled analgesia during 24 hours after surgery (tramadol 20 mg bolus for Group C, tramadol 20 mg+dexmedetomidine 10 mg first four hours, then tramadol 20 mg for Group D with a lock-out time of 15 minutes). Postoperative assessment included verbal pain score, sedation score, nausea and vomiting score, consumption of tramadol, hemodynamic parameters and patient’s satisfaction.

Results: Postoperative pain scores were significantly lower in Group D compared with Group C and patient-controlled analgesia tramadol use was significantly reduced in Group D. Total PCA tramadol use was decreased by 27% in Group D compared with Group C (p=0.001). Patient satisfaction with pain treatment was significantly improved in Group D compared with Group C (p=0.001). A significant increase in sedation scores at the 1^st, 2^nd and 4^th hours were observed in Group D. Heart rate was lower in Group D at the 1st, 2^nd and 4^th hours postoperatively (p=0.001, p=0.001 and p=0.01, respectively). Nausea and vomiting score was lower in Group D (p<0.05 for all).

Conclusion: The addition of dexmedetomidine to tramadol by patient controlled analgesia method significantly reduces tramadol consumption and increases analgesia level and patient satisfaction in gynecological operations.

Keywords

• Dexmedetomidine,gynecological operations,patient controlled analgesia,postoperative pain,tramadol

Jinekolojik cerrahide postoperatif uygulanan intravenöz tramadolün ve tramadole deksmedetomidin ilavesinin analjezi ve hemodinamik parametreler üzerine etkileri: Prospektif (çift kör) randomize kontrollü çalışma

Öz

Amaç: Bu çalışmada Pfannenstiel kesisi yapılan jinekolojik prosedürlerde postoperatif ağrı tedavisinde intravenöz tramadol ile intravenöz tramadole ilave deksmedetomidinin analjezi ve hemodinamik parametreler üzerine etkilerinin karşılaştırılması amaçlanmıştır.

Yöntemler: Genel anestezi altında elektif Pfannenstiel kesisi uygulanarak jinekolojik operasyon planlanan ASA I-II grubuna dahil 60 hasta randomize olarak iki gruba ayrıldı (Grup C (Tramadol grubu) ve Grup D Tramadol + Deksmedetomidin). Operasyon sonrası derlenme odasına alınan her iki gruptaki hastalara ameliyat sonrası 24 saat boyunca hasta kontrollu analjezi (HKA)  uygulandı (Grup C için 20 dk kilitli kalma süresi ile 20 mg tramadol bolus doz, Grup D için ilk 4 saat 20 mg tramadol+10mcg deksmedetomidin bolus doz, daha sonra 20 mg tramadol bolus doz). Postoperatif değerlendirmede, sözel ağrı skoru, sedasyon skoru, bulantı ve kusma skoru, tramadol kullanımı ile hemodinamik parametreler ve hasta memnuniyeti kaydedildi.

Bulgular: Postoperatif ağrı skorları Grup D'de, Grup C'ye göre anlamlı olarak düşüktü ve hasta kontrollü analjezi tramadol kullanımı Grup D'de anlamlı olarak azaldı. Toplam PCA tramadol kullanımı Grup D'de Grup C ile karşılaştırıldığında % 27 azaldı (p=0,001). Ağrı tedavisi ile hasta memnuniyeti Grup D'de Grup C'ye göre anlamlı olarak yükseldi (p=0,001). Grup D'de 1, 2 ve 4 saatte sedasyon skorlarında anlamlı bir artış gözlendi. Kalp hızı, Grup D'de postoperatif 1, 2 ve 4 saatte daha düşüktü (sırası ile p=0,001, p=0,001 and p=0,01, respectively). Bulantı ve kusma skoru Grup D'de daha düşüktü (hepsi için p<0,05).

Sonuç: Deksmedetomidinin PCA yöntemiyle tramadole eklenmesi, tramadol tüketimini önemli ölçüde azaltmakta ve jinekolojik operasyonlarda analjezi düzeyini ve hasta memnuniyetini artırmaktadır.

Anahtar Kelimeler

• Deksmedetomidin,jinekolojik ameliyatlar,hasta kontrollü analjezi,postoperative ağrı,tramadol

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