Modifiye Radikal Mastektomi Operasyonlarında Postoperatif Analjezi Amaçlı Uygulanan İntravenöz Parasetamolün Morfin Tüketimi Üzerine Etkisi

Year 2009, Volume: 42 Issue: 3, 100 - 104, 01.12.2009

Cengizhan Emre Gonca Tuncel Menşure Kaya Özgür Canoler Mehmet Özgür Yıldırım Nihal Kadıoğulları

Abstract

Paracetamol is combined with opioids or used alone for management of post-operative pain. İn this study, we investigated the effect of intravenous (IV) paracetamol on morphine consumption used for post-operative pain after modified radical mastectomy. SixtyASA l-lll patients scheduled for modified radical mastectomy under general anesthesia were randomly allocated into two groups by using closed envelope system (Group P; n= 30, Group S; n= 30). Anesthesia was induced with fentanil 1-2/vg/kg, cisatracurium 0.15 mg/kg and propofol 2-2.5 mg/kg, maintained with sevoflurane 1-2%, N20 66%/Oz. Group P received paracetamol 1 g, infused in 15 minutes one hour before the end of surgery and at six hours intervals in post-operative 24 hours. Şaline infusion was given to Group S at the same time. Ali patients were connected to a patient controlled analgesia device adjusted to deliver morphine 5 mg as loading, 1 mg bolus and five minutes lock-out time. A bolus of morphine 5 mg was administered if visu-al analog scale (VAS) s 4. l/AS scores, sedation, respiratory rate, heart rate, blood pressure, Sp02, morphine consumption and side effects were recorded. Demographic parameters were similar. Morphine consumption was less in Group P (p< 0.001). The demand and delivery doses of morphine was higher in Group S (p< 0.001). VAS scores were lower in paracetamol group (p< 0.008). Aithough the side effects such as nausea-vomiting, urinary retention and itching were more in Group S, it was not sta-tistically significant. İn this study, aithough statistically not significant, we have demonstrated that paracetamol used for post-operative pain can reduce morphine consumption and side effects while providing an effective analgesia.

Keywords

Mastectomy, post-operative analgesia, morphine, paracetamol.

The Effect of Irıtravenous Paracetamol on Morphine Consumption Used for Post-Operative Pain After Modified Radical Mastectomy

Abstract

Postoperatif ağrı tedavisinde parasetamoi, tek başına veya opioidlerle kombine edilerek kullanılmaktadır. Bu çalışmada, modifiye radikal mastektomi uygulanan hastalarda postoperatif analjezi amacıyla kullanılan intravenöz (IV) parasetamolün morfin tüketimi üzerine etkisi araştırıldı. Genel anestezi ile modifiye radikal mastektomi uygulanacak ASA l-lll 60 hasta çalışmaya alındı. Premedikasyon yapılmayan hastalar kapalı zarf çekme yöntemiyle randomize olarak iki gruba ayrıldı (Grup P; n= 30, Grup S; n= 30). Anestezi indüksiyonu 1-2 pg/kg fentanil, 0.15 mg/kg cisatrakuryum ve 2-2.5 mg/kg propofol, idame %1-2 sevofluran, %66 N20/02 ile sağlandı. Grup P'ye cerrahi bitiminden bir saat önce ve postoperatif 24 saat süreyle, altı saat arayla 1 g IV paraseta-mol 15 dakika in füzyon şeklinde uygulandı. Grup S'ye aynı zaman aralıklarında şalin in füzyonu yapıldı. Postoperatif her iki gruba da morfin ile hazırlanmış hasta kontrollü analjezi cihazı bağlandı. Morfin dozları 5 mg yükleme dozu, beş dakika kilit süresi ve 1 mg bolus olarak ayarlandı. Vizüel analog skala (VAS) >4 ise 5 mg IV morfin botus dozu yapıldı. VAS ağrı skorları, sedasyon, solunum sayısı, kalp hızı, kan basıncı, Sp02, total morfin tüketimi ve yan etkiler takip edildi. Demografik özellikler her iki grupta benzerdi. Grup P'de morfin tüketimi %40 daha az bulundu (p< 0.001). istenilen ve verilen bolus sayısı Grup S'de anlamlı olarak daha fazlaydı (p< 0.001). VAS skorları parasetamoi uygulanan grupta daha düşüktü (p< 0.008). Bulantı, kusma, idrar retansiyonu ve kaşıntı gibi yan etkiler Grup S'de daha fazla görülmekle birlikte istatistiksel olarak anlamlı değildi. Bu çalışmada, postoperatif ağrı tedavisinde kullanılan IV parasetamolün etkin bir analjezi sağlarken morfin tüketimi ve istatistiksel olarak anlamlı olmamakla beraber yan etki insidansını azalttığı gösterildi.

Keywords

Mastektomi, postoperatif analjezi, morfin, parasetamoi.

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