Comparison of Analgesic Effects of Intraperitoneal Lornoxicam and Ropivacaine Administration in Laparoscopic Cholecystectomy

Abstract

Objectives: In this randomized prospective study, we investigated the effects of lornoxicam vs. ropivacaine for the management of postoperative pain in patients undergoing elective laparoscopic cholecystectomy. Patients and Methods: Patients were randomized into three groups and received 150 mg (80 mL) ropivacaine or 16 mg lornoxicam (80 mL) or placebo (80 mL saline) via multi-regional intraperitoneal instillation and port sites infiltration. Patient-controlled analgesia (PCA) device was used. Tramadol 50 mg tolerable dose, 5 mg/hour basal infusion, bolus dose 20 mg, locked 30 min, 4 hour limit were applied as 200 mg. Postoperative pain was assessed with 100-mm visual analog scale (VAS) at rest, while coughing, and during mobilization. Pain scores were recorded in the post-anesthesia care unit, and at 2, 4, 8, 12,18 and 24 h after the surgery. Results: At 24 h, VAS scores at rest and while coughing were found significantly lower in ropivacaine and lornoxicam group when compared with control group (p=0.047). The percentage of patients needing tramadol was significantly lower with ropivacaine and lornoxicam compared with control (p<0.001, p=0.018). There was no statistically significant difference between ropivacaine and lornoxicam group. Conclusion: Multi-regional, intraperitoneal instillation and port site infiltration of ropivacaine and lornoxicam during laparoscopic cholecystectomy reduces the postoperative pain. Amaç: Prospektif randomize olarak yapılan bu çalışmada laparoskopik kolesistektomi sonrası ağrı tedavisinde lornoksikam ve ropivakainin etkisi araştırılmıştır. Hastalar ve Yöntemler: Çalışmaya dahil edilen 45 hasta üç gruba randomize edildi. Hastalara 150 mg (80 mL) ropivakain, 16 mg lornoksikam (80 mL) ve plasebo (80 mL saline) intraperitoneal olarak püskürtüldü ve port bölgelerine infiltre edildi. Ameliyat bitiminde hasta kontrollü analjezi cihazı ile tramadol 50 mg yükleme dozu, 5 mg bazal infüzyon, bolus doz 20 mg, kilitli kalma süresi 30 dk, 4 saatlik limit 200 mg olarak planlandı. Hastaların ağrısı görsel analog skala (VAS) ile 0-100 olacak şekilde istirahat, öksürük sonrası ve mobilizasyon sırasında değerlendirildi. Ağrı skorları ilk saatte anestezi derlenme odasında ve 2., 4., 8., 12., 18., 24. saatlerde serviste değerlendirildi. Bulgular: Ropivakain ve lornoksikam grubunda istirahat ve öksürük sonrası VAS değerleri kontrol grubuna göre daha düşük bulundu (p=0.047). Tramadol tüketimi açısından, ropivakain ve lornoksikam grupları arasında fark bulunmazken (p>0.05), kontrol grubuna göre bu iki grupta anlamlı düşük olarak bulundu (p<0.001, p=0.018). Ropivakain ve lornoksikam grubu arasında ise istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Ropivakain ve lornoksikamın port bölgelerine, intraperitoneal çoklu bölgeye laparoskopik kolesistektomi sonrası infiltrasyonu ameliyat sonrası ağrı tedavisinde etkin olarak bulunmuştur.

Keywords

• Laparoscopic cholecystectomy; ropivacaine; lornoxicam; postoperative pain

Laparoskopik Kolesistektomi Sonrası Ağrı Tedavisinde İntraperitoneal Uygulanan Lornoksikam ve Ropivakainin Etkisinin Karşılaştırılması

Öz

Amaç: Prospektif randomize olarak yapılan bu çalışmada laparoskopik kolesistektomi sonrası ağrı tedavisinde lornoksikam ve ropivakainin etkisi araştırılmıştır. Hastalar ve Yöntemler: Çalışmaya dahil edilen 45 hasta üç gruba randomize edildi. Hastalara 150 mg (80 mL) ropivakain, 16 mg lornoksikam (80 mL) ve plasebo (80 mL saline) intraperitoneal olarak püskürtüldü ve port bölgelerine infiltre edildi. Ameliyat bitiminde hasta kontrollü analjezi cihazı ile tramadol 50 mg yükleme dozu, 5 mg bazal infüzyon, bolus doz 20 mg, kilitli kalma süresi 30 dk, 4 saatlik limit 200 mg olarak planlandı. Hastaların ağrısı görsel analog skala (VAS) ile 0-100 olacak şekilde istirahat, öksürük sonrası ve mobilizasyon sırasında değerlendirildi. Ağrı skorları ilk saatte anestezi derlenme odasında ve 2., 4., 8., 12., 18., 24. saatlerde serviste değerlendirildi. Bulgular: Ropivakain ve lornoksikam grubunda istirahat ve öksürük sonrası VAS değerleri kontrol grubuna göre daha düşük bulundu (p=0.047). Tramadol tüketimi açısından, ropivakain ve lornoksikam grupları arasında fark bulunmazken (p > 0.05), kontrol grubuna göre bu iki grupta anlamlı düşük olarak bulundu (p < 0.001, p=0.018). Ropivakain ve lornoksikam grubu arasında ise istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Ropivakain ve lornoksikamın port bölgelerine, intraperitoneal çoklu bölgeye laparoskopik kolesistektomi sonrası infiltrasyonu ameliyat sonrası ağrı tedavisinde etkin olarak bulunmuştur.

Anahtar Kelimeler

• Laparoskopik kolesistektomi, ropivakain, lornoksikam, ameliyat sonrası ağrı

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