Postoperatif ağrı tedavisinde uygulanan hasta-kontrollü analjezi yöntemlerinin retrospektif incelemesi

Abstract

Amaç: Postoperatif ağrı tedavisinde hasta kontrollü anal­jezi (HKA) uygulamaları, konvansiyonel analjezi yöntem­lerinden daha etkindir. Daha az sedasyon ve postoperatif komplikasyonla yüksek hasta memnuniyeti sağlamaları ve hastaların iyileşme sürecine olan pozitif etkileri ne­deniyle günümüzde sıklıkla tercih edilmektedir. Bu çalış­mada kliniğimizde son iki yıllık süreç içerisinde uygula­dığımız HKA yöntemlerine ait verileri retrospektif olarak incelemeyi amaçladık. Yöntemler: Hastanemizde 01 Ocak 2010 ve 31 Aralık 2011 tarihleri arasında postoperatif analjezi amacıyla HKA uygulanan hastaların kayıtları incelendi. Hastaların cinsiyetleri, HKA protokolleri ve operasyonlara ait veriler değerlendirildi. Bulgular: Çalışmada 2010 yılında 1030 hastadan 580 (%56,3) hastaya İV tramadol HKA, 431 (%41,8) hastaya epidural HKA, 19 (%1,8) hastaya ise İV morfin HKA uy­gulandığı görülmüştür. 2011\'de ise 971 hastanın 737\'sine (%75,9) İV tramadol HKA, 234\'üne (%24,1) epidural HKA uygulandığı görülmüştür. 2011 yılında İV tramadol HKA kullanımı 2010 yılına göre anlamlı derecede artarken (p

Keywords

• Postoperatif ağrı; analjezi, has­ta-kontrollü; analjezi, epidural.

A retrospective investigation of the patient-controlled analgesia methods applied for postoperative pain management

Abstract

Objectives: Patient-controlled analgesia (PCA) in post­operative pain treatment is more effective than conven­tional analgesia methods. It is commonly preferred for the reasons of maintaining high patient satisfaction and posi­tive effects on patients\' recovery period with less sedation and postoperative complications. In this study we aimed to investigate the characteristics of PCA methods that have been applied at our clinic within the last two-year period retrospectively. Methods: The records of patients who were received PCA for postoperative analgesia at our hospital between 01 January 2010 and 31 December 2011 were investigat­ed. Patients\' genders, PCA protocols and the operations\' characteristics were evaluated. Results: In this study, it was seen that of the 1030 pa­tients, IV tramadol PCA was applied to 580 (56.3%) pa­tients, epidural PCA was applied to 431 (41.8%) patients and IV morphine PCA was applied to 19 (1.8%) patients. In 2011, it was seen that of the 971 patients, IV tramadol PCA was applied to 737 (75.9%) patients and epidural PCA was applied to 234 (24.1%) patients. When com­pared to 2010, it was detected that IV tramadol PCA use has significantly increased (p

Keywords

• Postoperative pain; analgesia, patient-con­trolled, analgesia; epidural.

References

1. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postopera- tive pain experience: results from a national survey suggest postoperative pain continues to be under- managed. Anesth Analg 2003;97:534–540.
2. Sommer M, de Rijke JM, van Kleef M, et al. The preva- lence of postoperative pain in a sample of 1490 surgi- cal inpatients. Eur J Anaesthesiol 2008;25:267–274.
3. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet 2011;25:2215-2225.
4. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001;87:62–72.
5. Liu SS, Wu CL. The effect of analgesic technique on postoperative patient-reported outcomes includ- ing analgesia: a systematic review. Anesth Analg 2007;105:789–808.
6. Momeni M, Crucitti M, De Kock M. Patient-controlled analgesia in the management of postoperative pain. Drugs 2006;66:2321–2337.
7. Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. J Am Med Assoc 2003;290:2455–2463.
8. Hudcova J, McNicol E, Quah C, et al. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev 2006;18;CD003348.

9. Yücel A. Hasta Kontrollü Analjezi (Patient Controlled An- algesia) PCA, 1. Baskı. İstanbul: Ufuk R & M;1997;3.
10. Viscusi ER. Patient-controlled drug delivery for acute postoperative pain management: a review of current and emerging technologies. Reg Anesth Pain Med 2008;33:146-158.
11. Yücel A. PCA’de Alternatif Yollar. Hasta Kontrollü Analjezi (Patient Controlled Analgesia) PCA, 1. Baskı. İstanbul: Ufuk R & M;1997:82.
12. Miaskowski C. Patient-controlled modalities for acute postoperative pain management. J Perianesth Nurs 2005;20:255-267.
13. Türk Anesteziyoloji ve Reanimasyon Derneği (TARD) Anestezi Uygulama Kılavuzları. Postoperatif Ağrı Te- davisi, Mart 2006.
14. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anes- thesiologists Task Force on Acute Pain Management. Anesthesiology 2004;100:1573-1581.
15. Yücel A. PCA (Patient Controlled Analgesia). 2. Baskı. İstanbul: Ufuk R & M;1998;31-3,101-102.
16. Herr KA, Spratt K, Mobily PR, Richardson G. Pain intensity assessment in older adults: use of experi- mental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain 2004;20:207-219.
17. Liu SS, Wu CL. The effect of analgesic technique on postoperative patient-reported outcomes includ- ing analgesia: a systematic review. Anesth Analg 2007;105:789-808.
18. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL. Efficacy of postoperative epidural an- algesia: a meta-analysis. JAMA 2003;290:2455-2463.
19. Wu CL, Cohen SR, Richman JM, et al. Efficacy of postoperative patient-controlled and continuous infu- sion epidural analgesia versus intravenous patient- controlled analgesia with opioids: a meta-analysis. Anesthesiology 2005;103:1079-1088.
20. Pöpping DM, Zahn PK, Van Aken HK, Dasch B, Boche R, Pogatzki-Zahn EM. Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anesth 2008;101:832-840.
21. Sam WJ, MacKey SC, Lötsch J, Drover DR. Morphine and its metabolites after patient-controlled analge- sia: considerations for respiratory depression. J Clin Anesth 2011;23:102-106.
22. Catley DM, Thornton C, Jordan C, et al. Pronounced, episodic oxygen desaturation in the postoperative pe- riod: its association with ventilatory pattern and anal- gesic regimen. Anesthesiology 1985;63:20–28.
23. Ray DC, Drummond GB. Continuous intravenous morphine for pain relief after abdominal surgery. Ann R Coll Surg Engl 1988;70:317–321.
24. Baird MB, Schug SA. Safety aspects of postoperative pain relief. Pain Digest 1996;6:219–225.
25. Grass JA. Patient-controlled analgesia. Anesth Analg 2005;101:44-61.
26. Yarkan Uysal H, İnan N, Akın Takmaz S, Akdemir C, Başar H. Ağrı ünitemizde akut postoperatif ağrı te- davisinde hasta kontrollü analjezi uygulamalarının retrospektif değerlendirilmesi. 10. Ulusal Ağrı, 9. Ulu- sal Rejyonel Anestezi Kongresi Bildiri Özetleri Kitabı 2008;86.
27. Özyuvacı E, Altan A, Uluç A, ve ark. Hasta Kontrollü Analjezi Uygulamasının “Ağrı Tedavisinde Toplam Ka- lite Yönetimi Programı” ile Prospektif Olarak Değer- lendirilmesi. Türkiye Klinikleri J Med Sci 2005;25:530- 537.
28. Powell AE, Davies HT, Bannister J, Macrae WA. Chal- lenge of improving postoperative pain management: case studies of three acute pain services in the UK National Health Service. Br J Anaesth 2009;102:824– 831.
29. Lee A, Chan SK, Chen PP, et al. The costs and ben- efits of extending the role of the acute pain service on clinical outcomes after major elective surgery. Anesth Analg 2010;111:1042-1050.
30. Nasir D, Howard JE, Joshi GP, Hill GE. A survey of acute pain service structure and function in United States hospitals. Pain Res Treat 2011;934-932.