Effects of postoperative intravenous infusion of tramadol and addition of dexmedetomidine to tramadol on analgesia and hemodynamic parameters in gynecologic surgery: A prospective (double blind) randomised controlled trial

Yıl 2018, Cilt: 3 Sayı: 2, 88 - 93, 20.07.2018

Hakan Emirkadı Hüseyin Şen Güner Dağlı Bulat Aytek Şık , Yaşam Kemal Akpak

https://doi.org/10.25000/acem.422550

Öz

Aim: We designed this
double-blind study to test and compare the effects of intravenous tramadol and
intravenous tramadol plus dexmedetomidine on analgesia and hemodynamic
parameters for treatment of postoperative pain in gynecologic surgeries with
Pfannenstiel incision.

Methods: Sixty patients undergoing total abdominal
hysterectomy with Pfannenstiel incision under general anesthesia were randomly
allocated into two groups. Group C (Tramadol) and Group D (Tramadol + Dexmedetomidin).
The anesthetic technique was standardized. Postoperatively, the patients in both
groups received patient controlled analgesia during 24 hours after surgery
(tramadol 20 mg bolus for Group C, tramadol 20 mg+dexmedetomidine 10 mg first
four hours, then tramadol 20 mg for Group D with a lock-out time of 15 minutes).
Postoperative assessment included verbal pain score, sedation score, nausea and
vomiting score, consumption of tramadol, hemodynamic parameters and patient’s
satisfaction.

Results: Postoperative pain
scores were significantly lower in Group D compared with Group C and patient-controlled analgesia
tramadol use was
significantly reduced in Group D. Total PCA tramadol use was decreased by 27% in Group D compared with Group C (p=0.001).
Patient satisfaction with pain treatment was significantly improved in Group D compared with Group C (p=0.001).
A significant increase in sedation scores at
the 1^st, 2^nd and 4^th
hours were observed in Group D. Heart rate was lower in Group D at the 1st, 2^nd
and 4^th hours postoperatively (p=0.001, p=0.001 and p=0.01, respectively). Nausea and vomiting score was lower in Group D (p<0.05 for all).

Conclusion: The addition of dexmedetomidine to tramadol by patient controlled
analgesia method significantly reduces tramadol consumption and increases
analgesia level and patient satisfaction in gynecological operations.

Anahtar Kelimeler

Dexmedetomidine, gynecological operations, patient controlled analgesia, postoperative pain, tramadol

Jinekolojik cerrahide postoperatif uygulanan intravenöz tramadolün ve tramadole deksmedetomidin ilavesinin analjezi ve hemodinamik parametreler üzerine etkileri: Prospektif (çift kör) randomize kontrollü çalışma

Öz

Amaç: Bu çalışmada Pfannenstiel kesisi yapılan jinekolojik prosedürlerde
postoperatif ağrı tedavisinde intravenöz tramadol ile intravenöz tramadole
ilave deksmedetomidinin analjezi ve hemodinamik parametreler üzerine etkilerinin
karşılaştırılması amaçlanmıştır.

Yöntemler: Genel anestezi altında elektif Pfannenstiel kesisi uygulanarak
jinekolojik operasyon planlanan ASA I-II grubuna dahil 60 hasta randomize
olarak iki gruba ayrıldı (Grup C (Tramadol grubu) ve Grup D Tramadol +
Deksmedetomidin). Operasyon sonrası derlenme odasına alınan her iki gruptaki
hastalara ameliyat sonrası 24 saat boyunca hasta
kontrollu analjezi (HKA)  uygulandı (Grup C için 20 dk kilitli
kalma süresi ile 20 mg tramadol bolus doz, Grup D için ilk 4 saat 20 mg
tramadol+10mcg deksmedetomidin bolus doz, daha sonra 20 mg tramadol bolus doz).
Postoperatif değerlendirmede, sözel ağrı skoru, sedasyon skoru, bulantı ve
kusma skoru, tramadol kullanımı ile hemodinamik parametreler ve hasta
memnuniyeti kaydedildi.

Bulgular:
Postoperatif ağrı skorları Grup D'de, Grup C'ye göre anlamlı olarak düşüktü ve
hasta kontrollü analjezi tramadol kullanımı Grup D'de anlamlı olarak azaldı.
Toplam PCA tramadol kullanımı Grup D'de Grup C ile karşılaştırıldığında % 27
azaldı (p=0,001). Ağrı tedavisi ile hasta memnuniyeti Grup D'de Grup C'ye göre
anlamlı olarak yükseldi (p=0,001). Grup D'de 1, 2 ve 4 saatte sedasyon
skorlarında anlamlı bir artış gözlendi. Kalp hızı, Grup D'de postoperatif 1, 2
ve 4 saatte daha düşüktü (sırası ile p=0,001, p=0,001 and p=0,01, respectively). Bulantı ve kusma skoru Grup D'de daha düşüktü (hepsi için p<0,05).

Sonuç: Deksmedetomidinin PCA yöntemiyle tramadole eklenmesi, tramadol
tüketimini önemli ölçüde azaltmakta ve jinekolojik operasyonlarda analjezi
düzeyini ve hasta memnuniyetini artırmaktadır.

Anahtar Kelimeler

Deksmedetomidin, jinekolojik ameliyatlar, hasta kontrollü analjezi, postoperative ağrı, tramadol

Kaynakça

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