Laparoskopik Kolesistektomilerde Preemptif ve İntraoperatif Tramadol ve Fentanil Kullanımının Karşılaştırılması

Year 2022, , 78 - 87, 28.04.2022

Rahşan Dilek Okyay , Pınar Durak Uluer , Selda Muslu , Ertay Boran , Ali Demirbağ , Özcan Erdemli

https://doi.org/10.29058/mjwbs.899807

Abstract

Amaç: Bu çalışmada preemptif ve intraoperatif analjezi amaçlı tramadol ve fentanil uygulamalarının
hemodinami, analjezik ve nöromüsküler bloke edici ajan tüketimi, uyanma süresi ve postoperatif ağrı
üzerine etkilerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntemler: Genel anestezi altında laparoskopik kolesistektomi planlanan 120 hasta dört
gruba ayrıldı. Fentanil bolus (Grup FB) ve fentanil infüzyon (Grup Fİ) gruplarına; 2 μgkg-1 fentanil,
tramadol bolus (Grup TB) ve tramadol infüzyon (Grup Tİ) gruplarına; 2 mgkg-1 tramadol intravenöz (iv)
uygulanmasını takiben, tüm gruplarda propofol ve rokuronium indüksiyonu yapıldı. Entübasyon sonrası,
Grup Fİ’ye 0.5μgkg-1saat-1 fentanil, Grup Tİ’ye 0.5 mgkg-1saat-1 tramadol uygulandı. İntraoperatif
ek analjezi ihtiyacında Grup FB ve Grup Fİ’ye; 0.5μgkg-1 fentanil, Grup Tİ ve Grup TB’ye 0.5 mg kg-1
tramadol yapıldı. Postoperatif vizüel analog skala (VAS) >5 olduğunda meperidin ve gerektiğinde
diklofenak uygulandı. Hemodinamik veriler, fentanil, tramadol tüketimleri, uyanma süresi, VAS değerleri,
analjezik ihtiyaçlar kaydedildi.
Bulgular: İndüksiyondan sonra ortalama arter basıncı (OAB) fentanil gruplarında daha düşük bulundu
(p<0.05) Entübasyon sonrası kalp atım hızı ve OAB tramadol gruplarında daha fazla yükseldi (p<0.05).
İntraoperatif analjezik tüketimleri infüzyon gruplarında bolus uygulananlara oranla fazlaydı (p<0.05).
Nöromüsküler ajan tüketimi tramadol gruplarında fazlaydı (p<0.05). Postoperatif 5. ve 60.dk’da Grup
FB’de; VAS değerleri ile ek analjezik ihtiyacı daha fazla iken OAB düşük seyretti (p<0.05).
Sonuç: Entübasyona hemodinamik yanıtların fentanil uygulananlarda daha iyi önlendiği, preemptif ve
intraoperatif fentanil bolus uygulamalarının postoperatif analjezi sağlamada yetersiz olduğu kanısına
varıldı.

Keywords

Fentanil, Tramadol, Preemptif, İntraoperatif analjezi, Derlenme, Laparoskopik Kolesistektomi

Supporting Institution

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Project Number

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Thanks

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Comparison of Preemptive and Intraoperative Use of Tramadol and Fentanyl in Laparoscopic Cholecystectomies

Abstract

Aim: It was aimed to compare the effects of tramadol and fentanyl for preemptive and intraoperative
analgesia on hemodynamics, consumption of analgesics and muscle relaxants, recovery time and
postoperative pain.
Material and Methods: 120 patients scheduled for laparoscopic cholecystectomy were divided into four groups. Fentanyl bolus (Group FB)
and infusion (Group FI) groups received 2 μgkg-1 fentanyl, and tramadol bolus (Group TB) and infusion (Group TI) groups received 2 mgkg-
1 tramadol intravenously, followed by induction of propofol and rocuronium. After intubation, 0.5 μg kg-1 hour-1 of fentanyl and 0.5 mg kg-1
hour-1 of tramadol were administered to the Groups FI and TI, respectively. If additional intraoperative analgesia was required, in Groups
FB and FI 0.5 μgkg-1 fentanyl, in Groups TI and TB 0.5 mgkg-1 tramadol were administered. Meperidine and, if necessary, diclofenac were
administered with a postoperative visual analog scale (VAS) score of >5 points. Hemodynamic data, fentanyl and tramadol consumption,
postoperative recovery time, VAS scores and analgesic drugs recuirement were recorded.
Results: After induction, mean arterial pressure (MAP) was lower in fentanyl groups (p <0.05). After intubation, heart rate and MAP increased
more in tramadol groups (p <0.05). Intraoperative analgesics consumption was higher in infusion groups (p <0.05). Consumption of muscle
relaxants was higher in tramadol groups (p <0.05). At the postoperative 5th and 60th minutes, Group FB had a higher VAS score and
analgesics requirement and lower MAPs (p <0.05).
Conclusion: It was concluded that post-intubation hemodynamic responses were better-maintained in fentanyl groups. and that preemptive
and intraoperative bolus administrations of fentanyl were insufficient to provide analgesia in the postoperative period.

Keywords

Fentanyl, Tramadol, Preemptive, Intraoperative Analgesia, Recovery, Laparoscopic Cholecystectomy

Project Number

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