Depolama semptomlarının transüretral prostat rezeksiyonu sonrasında erken postopratif ağrıya etkisi

Abstract

Amaç: Bu çalışmada, TUR-P sonrasında gelişen ağrı üzerine, depolama semptomlarının etkisi araştırıldı. Gereç ve Yöntemler: Ekim 2012-Şubat 2013 tarihleri arasında TUR-P yapılmasına karar verilen hastalar IPSS’lamasında International Prostate Symptom Score 2, 4, ve 7. sorulara verdiği yanıta göre 2 gruba ayrıldı. Grup 1’e 3 ve daha üzerini işaretleyen hastalar, grup 2’ye 3’ün aşağısını işaretleyen hastalar dahil edildi. Her iki gruba toplam 30 hasta alındı. Hastaların total IPSS ve depolama IPSS skorları ayrı ayrı kayıt edildi. Her iki gruba spinal analjezi etkisi ortadan kalktıktan sonra, Diklofenak Na 75 mg paranteral yapıldı. Analjezik yapıldıktan 4 saat sonra, her iki grupta kateter ilişkili rahatsızlık ve genel ağrı, VAS Visual Analog Scale skorlaması kullanılarak değerlendirildi. Bulgular: Her iki grupta da çalışma dışı bırakılan hasta olmadı. Her iki hasta grubunun yaş, PSA, prostat hacmi, maksimum idrar akım hızı, rezidüel idrar hacmi, operasyon süresi ve rezeke edilen prostat doku hacmi arasında istatistiksel fark saptanmadı. Depolama semptomları ön planda olan hastaların kateter ilişkili mesane rahatsızlık VAS skorlarının ve total VAS skorlarının diğer gruptan yüksek olduğu görüldü. Sonuç: TUR-P sonrasında postoperatif dönemde analjezik tedavi yapılırken, depolama semptomlarının yoğunluğunun gözönünde bulundurulması faydalı olabilir

Keywords

• TURP,analjezi,depolama semptomları

The effect of storage symptoms on early postoperative pain after transurethral resection of the prostate. Do the storage symptoms persist after transurethral resection of the prostate?

Abstract

effects of preoperative storage symptoms on post Transurethral Resection of the Prostate TUR-P pain. Materıal and Methods: The patients undergoing TUR- P between October 2012 and February 2013 were grouped into two based on the severity of the symptoms they described in the 2nd, 4th and 7th questions of International Prostate Symptom Score IPSS . Group 1 patients were those who scored 3 and more and Group 2 patients were those who scored less than 3. Thirty patients were allocated to each of the groups. The total IPSS and storage IPSS syptoms of the patients were recorded separately. At postoperative follow up when the effect of spinal anesthesia wore off each patient received parenteral injection of 75 mg of Diclofenac sodium. Four hours after the analgesic administration, catheter related discomfort suprapubic pain, urgency, etc and general pain were evaluated with the use of Visual Analog Scale VAS scoring. Results: There were no excluded patients in both groups. There were no statistically significant differences between groups in terms of age, PSA, prostate volume, maximum flow rate, residual urine volume, duration of the operation and volume of resected prostate. The catheter related bother and total VAS scores of the patients in the group of predominant storage symptoms were found to be higher compared to the other group. Conclusıon: Adapting the administration of analgesic therapy in the postoperative period after TUR-P according to the dominance of storage symptoms may provide a better analgesia.

Keywords

• TUR-P,analgesia,storage symptoms

References

1. Ghandi R, Jage J, Fichtner J, Hohenfeliner R. The use of questionnaire for improvement of postoperative analgesia after transurethral resection of the the prostate. Acute Pain 2003;5:17-24.
2. Gordon DB, Dahl JL, Miaskowski C, et al. American pain society recommendations for improving the quality of acu- te and cancer pain management: American Pain Society Quality of Care Task Force Arch Intern Med 2005;25:1574- 80.
3. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534-40.
4. Turk DC, Sist TC, Okifuji A, et al. Adaptation to metasta- tic cancer pain, regional/local cancer pain and non-cancer pain: role of psychological and behavioral factors. Pain 1998;74:247-56.
5. Wu CL, Hurley RW, Anderson GF et al. Effect of postope- rative epidural analgesia on morbidity and mortality follo- wing surgery in Medicare patients. Reg Anesth Pain Med 2004;29:525-533.
6. Brennan TJ, Kehlet H. Preventive analgesia to reduce wo- und hyperalgesia and persistent postsurgical pain: Not an easy path. Anesthesiology 2005; 103:681–3.
7. Macrae WA Chronic post-surgical pain: 10 years on Br J Anaesth 2008;101:77-86.
8. Brodner G, van Aken H. Does the choice of anaesthetic technique influence outcome? Eur J Anaesth 1998;15:740-7.

9. Beattie WS, Buckley DN, Forrest JB. Epidural morphi- ne reduces the risk of postoperative myocardial ische- mia in patients with cardiac riskfactors. Can J Anaesth 1993;40:532-41.
10. Andersson KE. Advances in the pharmacological control of the bladder. Exp Physiol 1999;14:195–213.
11. Andersson KE. Advances in the pharmacological control of the bladder. Exp Physiol 1999;84:195–213.
12. Woolf CJ, Chong MS. Preemptive analgesia-treating pos- toperative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77:362-79.
13. Agarwal A, Dhiraaj S, Singhal V, Kapoor R, Tandon M. Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter bladder discomfort: a prospective, randomized, placebo controlled double-blind study. Br J Anaesth 2006; 96: 377–80.
14. Agarwal A, Raza M, Singhal V, et al. Evaluation of efficacy of tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled double blind study. Anesth Analg 2005;101:1065–7.
15. McMahon SB, Dmitrieva N, Koltzenburg M. Visceral pain. Br J Anaesth 1995;75:132–44.
16. Battaglia J. Pharmacological management of acute agitati- on. Drugs 2005;65: 1207–22.
17. Tauzin-Fin P, Sesay M, Svartz L, Krol-Houdek MC, Mau- rette P. Sublingual oxybutynin reduces postoperative pain related to indwelling bladder catheter after radical retropu- bic prostatectomy. Br J Anaesth 2007; 99: 572–5.