Laparoskopik kolesistektomide ağrı yönetiminin derlenme parametreleri üzerine etkisi

Abstract

Amaç: Laparoskopik kolesistektomi ameliyatı geçiren hastalarda intraoperatif kullanılan analjeziklerin postoperatif ağrı ve derlenme üzerine etkilerini gözlemlemeyi amaçladık.

 

Gereç ve Yöntemler: ASA I-III risk grubunda, 20-85 yaş arası, LK geçiren hastalar çalışmaya dahil edildi. Kullanılan analjeziklerin isimlerine göre gruplar adlandırıldı: İntraoperatif analjezi uygulanmayan hastalar kontrol grubu (Grup C); tramadol (Grup T); metamizol (Grup M); diklofenak (Grup D); parasetamol (Grup P); tramadol + metamizol (Grup TM); tramadol + diklofenak (Grup TD); tramadol + parasetamol (Grup TP). Görsel analog skala (VAS) ≤  4 sağlayabilen analjezikler etkili olarak kabul edildi. Derlenme odasında VAS 4’den büyük  olan hastalara ek analjezikler uygulandı. Hastaların derlenmesi Aldrete Skoru ile belirlendi.

 

Bulgular: Kontrol grubunda 31 hasta, tramadol grubunda 35 hasta, metamizol grubunda 36 hastada, diklofenak grubunda 32 hasta, parasetamol grubunda 31 hasta, Tramadol + metamizol grubunda 56 hasta,  tramadol + diklofenak grubunda 31 hasta  ve tramadol + parasetamol grubunda  32 hasta bulunmaktaydı. Analjezik kullanan tüm gruplarda, intraoperatif analjezikler ile ilk saatte VAS≤4 sağlanamadı. Hastalarda tek analjezik veya iki analjezik birlikte kullanıldığında ilk bir saat içinde, en düşük ek analjezik gereksinimi GP ve GTP grubunda  idi. İntraoperatif analjezik uygulanmayanlarda Aldrete skorları  en düşük düzeyde gözlendi.

 

Sonuç: Laparoskopik kolesistektomide ağrının erken postoperatif dönemde yapılması gerektiğini düşünüyoruz. Tüm analjezikler, farmakokinetik profillerinin bilgisi temelinde uygulanmalıdır.   

Keywords

• laparoskopik kolesistektomi,postoperatif ağrı,non-steroid analjezikler

The effect of pain management in laparoscopic cholecystectomy on recovery parameters

Abstract

Aim: We aimed to observe the effects of analgesics used intraoperatively on the postoperative pain and recovery in patients underwent LC .

 

Material and Methods: ASA I-III group, aged 20-85 patients, who underwent LC surgery were included in the study. We denominated as groups the distribution of analgesics used in eight groups: control group(Group C) for patients without intraoperative analgesia; tramadol (Group T); metamizole (Group M); diclofenac (Group D); paracetamol (Group P); tramadol+metamizol (Group TM); tramadol+diclofenac (Group TD); tramadol+paracetamol (Group TP).   Analgesics that can provide visual analog scale (VAS) ≤ 4 was considered effective. Additional analgesics were administered to the patients whom VAS was above 4 in recovery room.  Recoveries of patients was determined with Aldrete Score.

 

Results:  31 patients control group, in 35 patients tramadol, in 36 patients, metamizole, in 32 patients diclofenac and in 31 patients paracetamol,  in 56 patients tramadol+metamizol, in 31 patients  tramadol+diclofenac  and in 32 patients  tramadol+paracetamol were used. In all groups used analgesics, VAS≤ 4 could not be provided in first hour. In the patients used one analgesic alone and two analgesics together, lowest need for additional analgesics was in GP and GTP group  within the first one hour. Aldrete scores were lowest in whom did not receive analgesics intraoperatively.

 

Conclusion: We consider that the management of pain in laparoscopic cholecystectomy should be done early postoperative period. All analgesics should be administered on the basis of the knowledge of their pharmacokinetic profiles.

Keywords

• laparoscopic cholecystectomy,postoperative pain,non-steroid analgesics

References

1. 1. Paul F. White. The Changing Role of Non-opioid Analgesic Techniques in the Management of Postoperative Pain. Anesth Analg 2005; 101: 5-22
2. 2. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative Dexamethasone İmproves Surgical Outcome After Laparoscopic Cholecystectomy: A Randomized Double-Blind Placebo-Controlled Trial. Ann Surg 2003; 238: 651-60
3. 3. Alexander JI. Pain after Laparoscopy. Br J Anaesth 1997; 79: 369-78
4. 4. Kaba A, Joris J. Anaesthesia for laparoscopic surgery. Curr Anaesth Crit Care 2001; 12: 159-65
5. 5. Pang WW, Wu HS, Tung CC. Tramadol 2,5mg * kg -1 appears to be the optimal intraoperativeloading dose before patient-controlled analgesia. Can J Anaesth 2003; 50: 48-51
6. 6. J De Witte, GW Rietman, G Vandenbroucke. Post-operative effects of tramadol administered at wound closure. Eur J Anaesthesiol 1998; 15: 190-95
7. 7. Vickers MD, O’Flaherty D, Szekely SM, Read M, Yoshizum J. Tramadol:Pain relief by an opioid without depression of respiration. Anesthesia 1992; 47: 291-96
8. 8. M Naguib, M Attia, AH Samarkandi. Wound closure tramadol administration has a short-lived analgesic effect. Canadian Journal of Anesthesia 2000; 47: 815-18

9. 9. Kehlet H, Werner UM. Role of paracetamol in acute pain management. Drugs 2003; 63: 15-21
10. 10. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 2006; 104: 835-46
11. 11. Alexander JI. Pain after Laparoscopy. Br J Anaesth 1997; 79: 369-78
12. 12. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 2006; 104: 835-46
13. 13. Barczynski M, Herman RM. A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc 2003; 17: 533–53
14. 14. Bisgaard T, Klarskov B, Kehlet H et al: Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: A randomized double-blind placebo-controlled trial. Ann Surg 2003; 238: 651