Lomber Diskektomi ve Laminektomi Operasyonlarında Preoperatif ve Postoperatif verilen Deksketoprofen Trometamolün Postoperatif Analjezi ve Meperidin Tüketimi Üzerine Etkisi

Year 2018, Volume: 40 Issue: 3, 79 - 85, 01.09.2018

İsmail Yıldız İlkay Ceylan Ebru Karakoç Birgül Yelken

https://doi.org/10.20515/otd.415188

Abstract

 Postoperatif ağrı morbiditeyi arttıran
başlıca etkenlerdendir. Analjezi postopeatif morbiditenin azaltılmasında ve
hastanede kalışın kısaltılmasında etkilidir.
Lomber diskektomi ve laminektomi uygulanacak hastalarda hasta kontrollü
analjezide kullanılan meperedin ile birlikte multimodal analjezi amacıyla
preemptif ve postoperatif dönemde uygulanan deksketoprofenin etkinliğini ve yan
etki profilini değerlendirmeyi amaçladık. Randomize, prospektif ve tek kör
plasebo kontrollü çalışmada  lomber
laminektomi ve diskektomi uygulanacak hastalar randomize olarak iki gruba
ayrıldı.  Grup I kontrol-plasebo grubu,
Grup II’ye indüksiyondan 30 dakika önce intravenöz 50 miligram deksketoprofen
ve ikinci doz ilk dozdan 8 saat sonra  50
mg deksketoprofen verildi. VAS skorları, hasta memnuniyeti, analjezik ilişkili
yan etkiler (bulantı, kusma, dispepsi, kanama, baş ağrısı, hipotansiyon,
bradikardi, solunum sıkıntısı, kaşıntı) postoperatif dönemde 1,4,8,12 ve 24
saatlarde kaydedildi. Kanama cerrahi sırasında aspiratörde biriken kan,
kullanılan spançlar ve postoperatif dönemde vakum drenlerden gelen kan olarak
toplanarak kaydedildi. Gruplar
arasında yaş,cinsiyet, ağırlık, ASA skorları, anestezi ve cerrahi sürelerinde
farklılık bulunmadı. İntaroperatif ve postoperatif kanama miktarları benzerdi.
Grup 1’ de PCA’dan analjezik kullanımı ihtiyacı daha erken oldu. Grup
II’de; postopeartif 1, 4, 8, 12 ve 24. saat VAS değerleri daha düşük bulundu.
Grup 2’de kullnaılan meperidin dozları 4,12 ve 24. saatlerde daha düşüktü.  Grup 2’ de analjezik kullanımına bağlı  gastrointestinal yan etkiler ve baş ağrısı
oranları düşüktü ve hasta tatmin oranları daha yüksek bulundu. Çalışmamız
lomber laminektomi ve diskektomi olgularında multimodal  analjezide deksketoprofen kullanımının kanama
ve diğer yan etki oranlarında artma olmadan güvenli ve etkili bir seçenek
olduğunu göstermiştir. 

Keywords

postoperatif ağrı, deksketoprofen, meperidin, laminektomi

Dexketoprofen Effectively Reduces Postoperative Pain and Meperidine Consumption After Lumbar Discectomy and Laminectomy

Abstract

Postopeartive pain is a major
contributor to increased morbidity. Analgesia is important in reducing
postoperative morbidity and hospital stay.
We aimed to determine the efficacy and side effect profile of preemptive
and postoperative multimodal use of dexketoprofen added to meperidine
patient-controlled analgesia  infusion in
patients undergoing lumbar discectomy and laminectomy. In this randomised, prospective,
single-blind placebo-controlled trial, 60 patients undergoing laminectomy and
discectomy were randomly (1:1) divided into two: Group I received placebo
whereas Group II received 50 milligrammes dexketoprofen intravenously 30 minutes
before surgery and 8 hours after the first dose. VAS scores, overall patient
satisfaction, analgesic related side effects (nausea, vomiting, dyspepsia,
bleeding, headache, hypotension, bradycardia, respiratory distress, pruritus)
at hours 1, 4, 8, 12 and 24 were collected after surgery.  Bleeding was recorded as the total value of
aspirations during surgery, a number of sponges used during surgery and
postoperative bleeding from vacuum drainage tubes. Groups were distributed
similarly regarding age, sex, weight, ASA, anaesthesia and surgery time.
Intraoperative and postoperative bleeding was similar. First time for PCA
analgesic requirement was shorter in Group I. 
Group II had lower VAS scores on postoperative hours 1, 4, 8, 12 and 24.
The total dosage of meperidine was lower in Group II at the 4th, 12th and 24th
hours.  Group II had lower rates of
gastrointestinal side effects and headache related with analgesic use and had
higher rates of satisfaction in regards of postoperative analgesia. Current
study shows the multimodal use of dexketoprofen is a safe and effective
analgesia option in patients undergoing lumbar discectomy and laminectomy.
Dexketoprofen is not associated with increased frequency side effects or
bleeding.

Keywords

postoperative pain, dexketoprofen, meperidine, laminectomy

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