Laparoskopik kolesistektomi uygulanan hastalarda nöromüsküler blokaj derinliği, artık CO2 miktarı ve uzamış asiste ventilasyonun postoperatif ağrıya etkisi; prospektif, randomize, kontrollü çift kör klinik araştırma

Öz

Amaç Laparoskopik cerrahi güncel pratikte sıkça uygulanan bir yöntemdir. Laparoskopik cerrahi sonrası ağrı yönetimi büyük önem taşımaktadır. Bu çalışmada nöromüsküler blokaj derinliğinin, remnant karbondioksit gazı atılımı ve uzamış asiste ventilasyonun, laparoskopik kolesistektomi geçiren hastalarda postoperatif ağrıya olan etkisi değerlendirildi. Metot ve Bulgular Laparoskopik kolesistektomi ameliyatı olacak toplam 80 hasta alındı. Hastalar 4 gruba ayrıldı. Grup 1: Standart laparoskopik kolesistektomi yapılan Kontrol grubu, Grup 2: Cerrahi bitiminde ek olarak trendelenburg pozisyonunda beş dakika asiste ventilasyon yapılan grup, Grup 3: Cerrahi süre boyunca derin kas gevşemesi yapılan grup, Grup 4: Cerrahi süre boyunca derin kas gevşemesi yapılan ve cerrahi bitiminde beş dakika boyunca asiste ventilasyon yapılan grup olarak belirlendi. Postoperatif 24 saat süre boyunca ağrı değerlendirilmesi visual analog scale (VAS) ile yapıldı. Buna ilaveten postoperatif bulantı kusma, omuz ağrısı varlığı ve cerrahi memnuniyet değerlendirildi. Hastaların %77.5 si kadın (n:62) cinsiyet, ortalama yaş 51.912.5 yıl (25-86) olarak bulundu. Vücut kitle indexi, anestezi risk skalası, bulantı kusma açısından gruplar arasında istatistiksel olarak fark saptanmadı. Cerrahi süresi ve ameliyat sonrası omuz ağrısı açısından yapılan karşılaştırmalarda, Grup 3 ve Grup 4’te ameliyat süresinin anlamlı derecede düşük olduğu (41.3±11.3 and 40.6±18.5 dakika) ayrıca omuz ağrısının (%75 ve %80) anlamlı derecede düşük olduğu görüldü sırasıyla P=0.035, P=0.002). Cerrahi memnuniyet grup 3ve 4’te anlamlı derecede yüksek bulundu (P=0.001). Sonuçlar Cerrahi koşulları iyileştirmek için derin kas gevşemesi yapmak postoperatif omuz ağrısını azaltmıştır ve cerrahi süre bitiminde Trendelenburg pozisyonunda yapılan beş dakika süre boyunca asiste ventilasyonun postoperatif ağrıyı azalttığı bulunmuştur.

Anahtar Kelimeler

• Ağrı,laparoskopi,omuz ağrısı,bulantı,kusma,kolesistektomi

The effect of neuromuscular blockade depth, remnant CO2 excretion and prolonged assisted ventilation on postoperative pain in patients undergoing laparoscopic cholecystectomy; a prospective randomized, double-blind, clinical study

Abstract

Aim Laparoscopic cholecystectomy (LC) is a frequently applied in current practice. Pain management after LC is of great importance. In this study, the effect of neuromuscular blockade depth, remnant CO2 excretion and prolonged assisted ventilation on postoperative pain in patients undergoing LC were evaluated. Methods and Results A total of 80 patients were taken to the study and divided into 4 groups. Group1: Control with standard LC, Group2: Receiving assisted ventilation in the Trendelenburg position for five minutes at the end of LC, Group3: Receiving deep muscle relaxation during the LC, Group4: Receiving deep muscle relaxation during the LC and taking assisted ventilation for five minutes at the end of LC. Postoperative period of 24 hours, the evaluation of pain was done with visual analogue scale (VAS). In addition, nausea, vomiting, shoulder pain and surgical satisfaction were assessed. As a result, 77.5% of the patients were female, the mean age was 51.9 12.5 (25-86) years. There was no statistically significant difference between the groups in terms of demographic data, nausea, and vomiting. The surgical duration (41.3±11.3 and 40.6±18.5min) and shoulder pain (75% and 80%) was found statistically significantly lower in Group 3 and 4 (P=0.035, P=0.002 respectively). In terms of comparing surgical satisfaction, it was found very high in Group 3 and 4 (P=0.001) Conclusions Deep muscle relaxation decreased postoperative shoulder pain, and it was found that assisted ventilation made for five minutes in the Trendelenburg position at the end of the LC reduced postoperative pain.

Keywords

• : Pain,laparoscopy,Cholecystectomy,Shoulder pain,Nausea,Vomiting

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