TORAKOTOMİ SONRASI AĞRI TEDAVİSİNDE İNTRAVENÖZ HASTA KONTROLLÜ ANALJEZİ YÖNTEMİ İLE PETİDİN, FENTANİL VE TRAMADOLÜN KARŞILAŞTIRILMASI

Yıl 2019, Cilt: 52 Sayı: 1, 13 - 19, 14.03.2019

Sengül Özmert , Arif Osman Tokat , Ahmet Necati Çanakçı

Öz

Amaç: Torakotomi
sonrası petidin, fentanil ve tramadol’ün
intravenöz Hasta Kontrollü Analjezi (HKA)
yöntemi ile analjezik etkinliği, yan etkiler ve hemodinami üzerine olan etkilerini
karşılaştırmaktır.
Gereç ve Yöntem:
Etik Kurul onayı ile ASA I-II, 18-65 yaş arası torakotomi operasyonu geçiren 60
hasta rastgele üç gruba ayrılarak araştırmaya dahil edildi. Demografik veriler kaydedildi. Postoperatif dönemde
hastalara HKA cihazı intravenöz olarak takılıp ilaç uygulamasına başlandı. Petidin
grubunda; yükleme dozu 0.6 mg/kg, istem dozu 0.2 mg/kg, bazal infüzyon 0.1
mg/kg/saat, fentanil grubunda; yükleme dozu 0.8 mg/kg, istem dozu 0.4 mg/kg, bazal infüzyon 0.3 mg/kg/saat, tramadol grubunda; yükleme dozu 1 mg/kg, istem dozu 0.2
mg/kg, bazal infüzyon 0.1 mg/kg/saat ve üç gruptada kilitli kalma süresi 15
dakika olacak şekilde uygulandı. Başlangıç, 1, 2, 4, 6, 8, 12 ve 24. saatlerde
kan basıncı, kalp hızı, solunum sayısı, O₂ satürasyonu, Vizüel
Analog Skala (VAS) ve Verbal Ağrı Skala (VS) değerleri, yan etkiler, doktor ve
hasta memnuniyetleri kayıt edildi.
Bulgular:
Demografik veriler, sistolik kan basıncı, kalp hızı,
solunum sayısı ve yan etkiler açısından üç grup arasında istatistiksel açıdan
fark bulunmadı. Başlangıç
değerlerine göre tüm ölçüm zamanlarındaki VAS ve VS değerlerinde azalma her üç
grupta istatistiksel olarak anlamlıydı (p<0.05). Gruplar arası
karşılaştırmada; sadece 8. saatte tramadol grubunun VS değerleri Petidin
grubuna göre yüksekti (p<0.05) diğer zaman dilimlerinde benzerdi. Analjezi kalitesinin hasta ve doktor tarafından
değerlendirilmesinde; gruplar arasında anlamlı fark saptanmadı.

Sonuç: Posttorakotomi ağrısında HKA yöntemi ile üç ilacın kullanılan dozlarda
ağrı skorları ve yan etkiler bakımından farkı olmadığı, bu yöntemin hastanın
tedaviye aktif katılımını sağlayarak etkili bir ağrı kontrolü sağladığı
kanısına varılmıştır.

ABSTRACT

Conclusion: The results of the study showed no difference
between the 3 drugs used in the PCA method for post-thoracotomy pain relief,
and it was concluded that effective pain control was provided by the active
participation of the patient in this treatment method.

Results:
No statistically significant difference was determined between the 3 groups in
respect of demographic data, systolic blood pressure, heartrate, respiratory
count and side-effects. Compared to the baseline values, a statistically
significant decrease was determined in all 3 groups in the VAS and VPS values
at all the measured times (p<0.05). In the comparison between the groups,
the VPS values of the tramadol group were higher than those of the pethidine
group at 8 hours (p<0.05) and at all other times were similar. No
significant difference was determined between the groups in respect of the
quality of analgesia as evaluated by the patient and physician.

Material
and Method: With the approval of the Local Ethics Committee,
the study included a total of 60 patients undergoing a thoracotomy operation.
All patients were ASA I-II, aged 18-65 years, and were randomly separated into
3 groups. Demographic data were recorded. In the postoperative period,
intravenous analgesia was administered via a PCA device. The pethidine group
were administered a loading dose of 0.6mg/kg, and a request dose of 0.2mg/kg
with a basal infusion of 0.1 mg/kg/hour. In the fentanyl group, the loading
dose was 0.8mg/kg, the request dose was 0.4mg/kg and the basal infusion 0.3
mg/kg/hour. In the tramadol group, the loading dose was 1mg/kg, the request
dose was 0.2mg/kg and the basal infusion 0.1mg/kg/hour. In all 3 groups, the
locked out time was set as 15 mins. Blood pressure, heartrate, respiratory
count, O2 saturation, visual analog scale (VAS) and Verbal Pain Scale (VPS)
values were recorded at baseline, 1, 2, 4, 6, 8, 12 and 24 hours, together with
side-effects, and patient and physician satisfaction.

Aim:
To compare the analgesic efficacy, side-effects, and effects on haemodynamics
of pethidine, fentanyl and tramadol used with the intravenous Patient
Controlled Analgesia (PCA) method following thoracotomy.

Anahtar Kelimeler

TORAKOTOMİ, HASTA KONTROLLÜ ANALJEZİ, PETİDİN, FENTANİL, TRAMADOL

Kaynakça

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