Araştırma Makalesi
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Artroskopik diz cerrahisinde intraartiküler uygulanan levobupivakain, fentanil-levobupivakain ve tramadol-levobupivakain’in postoperatif ağrı kontrolüne etkileri

Yıl 2015, Cilt: 49 Sayı: 3, 267 - 273, 17.07.2015
https://doi.org/10.3944/AOTT.2015.14.0107

Öz

Amaç: Bu çalışmanın amacı diz cerrahisinde levobupivakain, levobupivakain-fentanil ve levobupivakain-tramadol eklem içi enjeksiyonlarının postoperatif ağrı kontrolündeki etkinliğini karşılaştırmaktır.

Çalışma planı: Elektif diz artroskopisi için başvuran 80 hasta çalışmaya dahil edildi. Hastalar 20’şerli gruplara ayrıldı. Grup 1’deki hastalara eklem içi serum fizyolojik verildi ve kontrol grubu olarak planlandı. Grup 2’deki hastalara levobupivakain 2,5 mg/ml, Grup 3’teki hastalara levobupivakain 2.5 mg/ml içine 50 mg tramadol ve Grup 4’teki hastalara levobupivakain 2.5 mg/ml içine 50 mcg fentanil kombinasyonu verildi. Tüm hastalar genel anestezi altında opere edildi ve total 20 ml çalışma solüsyonu enjekte edildi; bu dozun 7 ml’si cerrahi öncesi cilde, 13 ml’si ameliyat sonrası eklem içi enjekte edildi. Postoperatif ağrı için cerrahi sonrası Vizuel analog skala (VAS) 1., 2., 4., 8., 12. ve 24. saatlerde uygulandı. VAS skoru 5’ten fazla olan hastalara diklofenak sodyum verildi ve analjezik ihtiyaçları not edildi.

Bulgular: Postoperatif 1., 2., 4., 8., 12. ve 24. saatlerde Grup 3 ve Grup 4 postoperatif ağrı açısından istatistiksel anlamlı düşük VAS skorlarına sahipti. Postoperatif analjezik ihtiyaçları da gruplar arasında anlamlılık gösterdi. Postoperatif 1. saatte analjezik ihtiyaçları Grup 3 ve Grup 4’te istatistiksel olarak anlamlı derecede düşüktü (p<0.01). Postoperatif iki ve dördüncü saatte analjezik ihtiyaçları Grup 3’te diğer gruplara göre istatistiksel olarak anlamlı derecede düşüktü (p<0.01). Postoperatif sekizinci saatte analjezik ihtiyaçları Grup 3 ve Grup 4’te istatistiksel olarak anlamlı derecede düşüktü (p<0.01). Postoperatif 12. ve 24. saatte analjezik ihtiyaçları arasında anlamlı farklılık yoktu (p>0.05).

Çıkarımlar: Bu bulgular levobupivakain’in fentanil veya tramadol ile kombinasyonunun tek başına kullanımına göre ağrı kontrolünde daha etkin olduğu, operasyon sonrası ağrı skorlarını ve analjezik ihtiyaçlarını azalttığının göstermektedir.

 

DOI: 10.3944/AOTT.2015.14.0107

Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Kaynakça

  • Eren M, Koltka K, Köknel Talu G, Aşık M, Özyalçın S. Comparison of analgesic activity of intraarticular lornoxi- cam, bupivacaine and saline after knee arthroscopy. Agri 2008;20:17-22.
  • De Andrés J, Valía JC, Barrera L, Colomina R. Intra- articular analgesia after arthroscopic knee surgery: com- parison of three different regimens. Eur J Anaesthesiol 1998;15:10–5.
  • In Morgan GE, Mikhail MS, Murray MJ. Lokal Anes- tezikler (Local Anesthetic), Tulunay M, Cuhruk H. ed. Klinik Anesteziyoloji (Clinical Anesthesiology), 3. Türkçe Baskı, Ankara, Güneş Kitabevi 2004;233–52.
  • Gristwood RW. Cardiac and CNS toxicity of levobupi- vacaine: strengths of evidence for advantage over bupiva- caine. Drug Saf 2002;25:153–63.
  • Geutjens G, Hambidge JE. Analgesic effects of intraartic- ular bupivacaine after day-case arthroscopy. Arthroscopy 1994;10:299–300.
  • Brill S, Plaza M. Non-narcotic adjuvants may improve the duration and quality of analgesia after knee arthroscopy: a brief review. Can J Anaesth 2004;51:975–8.
  • Tverskoy M, Braslavsky A, Mazor A, Ferman R, Kissin I. The peripheral effect of fentanyl on postoperative pain. Anesth Analg 1998;87:1121–4.
  • Jawish D, Antakly MC, Dagher F, Nasser E, Geahchan N. Intra-articular analgesia after arthroscopy of the knee. [Article in French] Cah Anesthesiol 1996;44:415–7.
  • Mandal P, Saudagar AH. Intra-articular fentanyl for anal- gesia following artroscopic knee surgery. Indian Journal of Anesthesia 2002;46:107–10
  • Varkel V, Volpin G, Ben-David B, Said R, Grimberg B, Si- mon K, et al. Intraarticular fentanyl compared with mor- phine for pain relief following arthroscopic knee surgery. Can J Anaesth 1999;46:867–71.
  • Beyzadeoglu T, Yilmaz C, Bekler H, Gokce A, Sayin MM. Intraarticular tramadol plus pericapsular incisional bupi- vacaine provides better analgesia than intraarticular plus pericapsular incisional bupivacaine after outpatient ar- throscopic partial meniscectomy. Knee Surg Sports Trau- matol Arthrosc 2007;15:564–8.
  • Zeidan A, Kassem R, Nahleh N, Maaliki H, El-Khatib M, Struys MM, et al. Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative anal- gesia after outpatient arthroscopic knee surgery. Anesth Analg 2008;107:292–9.
  • Hosseini H, Abrisham SM, Jomeh H, Kermani-Algho- raishi M, Ghahramani R, Mozayan MR. The comparison of intraarticular morphine-bupivacaine and tramadol-bu- pivacaine in postoperative analgesia after arthroscopic an- terior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012;20:1839–44.
  • Jacobson E, Forssblad M, Rosenberg J, Westman L, Wei- denhielm L. Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia. Arthroscopy 2000;16:183–90.
  • Özok U, Kafalı H, Mimaroğlu C. Artroskopilerde post- operatif analjezi amacıyla morfin ve bupivakainin intraar- tiküler ve epidural uygulamasının karşılaştırılması. Tür- kiye Klinikleri Tıp Bilimleri Dergisi 1996;16:374–7.
  • Raj N, Sehgal A, Hall JE, Sharma A, Murrin KR, Groves ND. Comparison of the analgesic efficacy and plasma concentrations of high-dose intra-articular and intramus- cular morphine for knee arthroscopy. Eur J Anaesthesiol 2004;21:932–7.
  • Alagöl A, Calpur OU, Kaya G, Pamukçu Z, Turan FN. The use of intraarticular tramadol for postoperative an- algesia after arthroscopic knee surgery: a comparison of different intraarticular and intravenous doses. Knee Surg Sports Traumatol Arthrosc 2004;12:184–8.
  • Karaman Y, Kayali C, Ozturk H, Kaya A, Bor C. A com- parison of analgesic effect of intra-articular levobupiva- caine with bupivacaine following knee arthroscopy. Saudi Med J 2009;30:629–32.
  • Kazak Bengisun Z, Aysu Salviz E, Darcin K, Suer H, Ates Y. Intraarticular levobupivacaine or bupivacaine adminis- tration decreases pain scores and provides a better recov- ery after total knee arthroplasty. J Anesth 2010;24:694–9.
  • Ivani G, Borghi B, van Oven H. Levobupivacaine. Minerva Anestesiol 2001;67(9 Suppl 1):20–3.
  • Turk HS, Dobrucalı H, Totoz T, Sayın P, Oba S, Hancı A. Artroskopik diz cerrahisinde intraartiküler uygulanan bu- pivakain ve levobupivakainin postoperatif analjezik etkile- rinin karşılaştırılması. Turkiye Klinikleri J Anest Reanim 2012;10:7–13
  • Jacobson E, Assareh H, Cannerfelt R, Anderson RE, Jako- bsson JG. The postoperative analgesic effects of intra-artic- ular levobupivacaine in elective day-case arthroscopy of the knee: a prospective, randomized, double-blind clinical study. Knee Surg Sports Traumatol Arthrosc 2006;14:120–4.
  • Lawrence AJ, Joshi GP, Michalkiewicz A, Blunnie WP, Moriarty DC. Evidence for analgesia mediated by periph- eral opioid receptors in inflamed synovial tissue. Eur J Clin Pharmacol 1992;43:351–5.
  • Stein C, Comisel K, Haimerl E, Yassouridis A, Lehr- berger K, Herz A, et al. Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 1991;325:1123–6.

Effects of intra-articular levobupivacaine, fentanyllevobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery

Yıl 2015, Cilt: 49 Sayı: 3, 267 - 273, 17.07.2015
https://doi.org/10.3944/AOTT.2015.14.0107

Öz

Objective: The aim of this study was to compare the postoperative analgesic efficacy of intra-articularly injected levobupivacaine, levobupivacaine-fentanyl, and levobupivacaine-tramadol combinations.
Methods: Eighty patients scheduled for elective knee arthroscopy were divided randomly into 4 groups of 20 patients each. Group 1 (the control group) received intra-articular saline, Group 2 received levobupivacaine 2.5 mg/ml, Group 3 received levobupivacaine 2.5 mg/ml + tramadol 50 mg, and Group 4 received levobupivacaine 2.5 mg/ml + fentanyl l50 mcg. All patients were operated on under general anesthesia, and a total of 20 ml study solution was injected: 7 ml subcutaneously before surgery and 13 ml intra-articularly upon completion of surgery. For postoperative, pain visual analogue scale (VAS) was assessed at the 1st, 2nd, 4th, 8th, 12th, and 24th hours postoperatively. Patients with a VAS score over 5 received diclofenac sodium, and the need for rescue analgesics was recorded.
Results: At the 1st, 2nd, 4th, 8th, 12th, and 24th postoperative hours, Group 3 and Group 4 had statistically significant lower VAS scores of pain (p<0.01). Postoperative rescue analgesic requirements were different among the groups. The postoperative 1st hour analgesic requirement was statistically significantly lower in Group 3 and Group 4 when compared to the other groups (p<0.01). At the postoperative 2nd and 4th hours, analgesic requirements were statistically significantly lower in Group 3 than in the other groups (p<0.01). Analgesic requirements were statistically significantly lower in Group 3 and Group 4 than in the other groups (p<0.01). Analgesic requirements at the 12th and 24th postoperative hours did not show any statistically significant difference (p>0.05).
Conclusion: The results indicated that levobupivacaine combined with either fentanyl or tramadol decreased rescue analgesic requirements when compared to levobupivacaine alone.

Kaynakça

  • Eren M, Koltka K, Köknel Talu G, Aşık M, Özyalçın S. Comparison of analgesic activity of intraarticular lornoxi- cam, bupivacaine and saline after knee arthroscopy. Agri 2008;20:17-22.
  • De Andrés J, Valía JC, Barrera L, Colomina R. Intra- articular analgesia after arthroscopic knee surgery: com- parison of three different regimens. Eur J Anaesthesiol 1998;15:10–5.
  • In Morgan GE, Mikhail MS, Murray MJ. Lokal Anes- tezikler (Local Anesthetic), Tulunay M, Cuhruk H. ed. Klinik Anesteziyoloji (Clinical Anesthesiology), 3. Türkçe Baskı, Ankara, Güneş Kitabevi 2004;233–52.
  • Gristwood RW. Cardiac and CNS toxicity of levobupi- vacaine: strengths of evidence for advantage over bupiva- caine. Drug Saf 2002;25:153–63.
  • Geutjens G, Hambidge JE. Analgesic effects of intraartic- ular bupivacaine after day-case arthroscopy. Arthroscopy 1994;10:299–300.
  • Brill S, Plaza M. Non-narcotic adjuvants may improve the duration and quality of analgesia after knee arthroscopy: a brief review. Can J Anaesth 2004;51:975–8.
  • Tverskoy M, Braslavsky A, Mazor A, Ferman R, Kissin I. The peripheral effect of fentanyl on postoperative pain. Anesth Analg 1998;87:1121–4.
  • Jawish D, Antakly MC, Dagher F, Nasser E, Geahchan N. Intra-articular analgesia after arthroscopy of the knee. [Article in French] Cah Anesthesiol 1996;44:415–7.
  • Mandal P, Saudagar AH. Intra-articular fentanyl for anal- gesia following artroscopic knee surgery. Indian Journal of Anesthesia 2002;46:107–10
  • Varkel V, Volpin G, Ben-David B, Said R, Grimberg B, Si- mon K, et al. Intraarticular fentanyl compared with mor- phine for pain relief following arthroscopic knee surgery. Can J Anaesth 1999;46:867–71.
  • Beyzadeoglu T, Yilmaz C, Bekler H, Gokce A, Sayin MM. Intraarticular tramadol plus pericapsular incisional bupi- vacaine provides better analgesia than intraarticular plus pericapsular incisional bupivacaine after outpatient ar- throscopic partial meniscectomy. Knee Surg Sports Trau- matol Arthrosc 2007;15:564–8.
  • Zeidan A, Kassem R, Nahleh N, Maaliki H, El-Khatib M, Struys MM, et al. Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative anal- gesia after outpatient arthroscopic knee surgery. Anesth Analg 2008;107:292–9.
  • Hosseini H, Abrisham SM, Jomeh H, Kermani-Algho- raishi M, Ghahramani R, Mozayan MR. The comparison of intraarticular morphine-bupivacaine and tramadol-bu- pivacaine in postoperative analgesia after arthroscopic an- terior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012;20:1839–44.
  • Jacobson E, Forssblad M, Rosenberg J, Westman L, Wei- denhielm L. Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia. Arthroscopy 2000;16:183–90.
  • Özok U, Kafalı H, Mimaroğlu C. Artroskopilerde post- operatif analjezi amacıyla morfin ve bupivakainin intraar- tiküler ve epidural uygulamasının karşılaştırılması. Tür- kiye Klinikleri Tıp Bilimleri Dergisi 1996;16:374–7.
  • Raj N, Sehgal A, Hall JE, Sharma A, Murrin KR, Groves ND. Comparison of the analgesic efficacy and plasma concentrations of high-dose intra-articular and intramus- cular morphine for knee arthroscopy. Eur J Anaesthesiol 2004;21:932–7.
  • Alagöl A, Calpur OU, Kaya G, Pamukçu Z, Turan FN. The use of intraarticular tramadol for postoperative an- algesia after arthroscopic knee surgery: a comparison of different intraarticular and intravenous doses. Knee Surg Sports Traumatol Arthrosc 2004;12:184–8.
  • Karaman Y, Kayali C, Ozturk H, Kaya A, Bor C. A com- parison of analgesic effect of intra-articular levobupiva- caine with bupivacaine following knee arthroscopy. Saudi Med J 2009;30:629–32.
  • Kazak Bengisun Z, Aysu Salviz E, Darcin K, Suer H, Ates Y. Intraarticular levobupivacaine or bupivacaine adminis- tration decreases pain scores and provides a better recov- ery after total knee arthroplasty. J Anesth 2010;24:694–9.
  • Ivani G, Borghi B, van Oven H. Levobupivacaine. Minerva Anestesiol 2001;67(9 Suppl 1):20–3.
  • Turk HS, Dobrucalı H, Totoz T, Sayın P, Oba S, Hancı A. Artroskopik diz cerrahisinde intraartiküler uygulanan bu- pivakain ve levobupivakainin postoperatif analjezik etkile- rinin karşılaştırılması. Turkiye Klinikleri J Anest Reanim 2012;10:7–13
  • Jacobson E, Assareh H, Cannerfelt R, Anderson RE, Jako- bsson JG. The postoperative analgesic effects of intra-artic- ular levobupivacaine in elective day-case arthroscopy of the knee: a prospective, randomized, double-blind clinical study. Knee Surg Sports Traumatol Arthrosc 2006;14:120–4.
  • Lawrence AJ, Joshi GP, Michalkiewicz A, Blunnie WP, Moriarty DC. Evidence for analgesia mediated by periph- eral opioid receptors in inflamed synovial tissue. Eur J Clin Pharmacol 1992;43:351–5.
  • Stein C, Comisel K, Haimerl E, Yassouridis A, Lehr- berger K, Herz A, et al. Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 1991;325:1123–6.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orijinal Makale
Yazarlar

Pinar Sayin Bu kişi benim

Hale Dobrucali Bu kişi benim

Hacer Turk Bu kişi benim

Tolga Totoz Bu kişi benim

Canan Isil Bu kişi benim

Ayse Hanci Bu kişi benim

Yayımlanma Tarihi 17 Temmuz 2015
Yayımlandığı Sayı Yıl 2015 Cilt: 49 Sayı: 3

Kaynak Göster

APA Sayin, P., Dobrucali, H., Turk, H., Totoz, T., vd. (2015). Effects of intra-articular levobupivacaine, fentanyllevobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery. Acta Orthopaedica Et Traumatologica Turcica, 49(3), 267-273. https://doi.org/10.3944/AOTT.2015.14.0107
AMA Sayin P, Dobrucali H, Turk H, Totoz T, Isil C, Hanci A. Effects of intra-articular levobupivacaine, fentanyllevobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery. Acta Orthopaedica et Traumatologica Turcica. Temmuz 2015;49(3):267-273. doi:10.3944/AOTT.2015.14.0107
Chicago Sayin, Pinar, Hale Dobrucali, Hacer Turk, Tolga Totoz, Canan Isil, ve Ayse Hanci. “Effects of Intra-Articular Levobupivacaine, Fentanyllevobupivacaine and Tramadol-Levobupivacaine for Postoperative Pain in Arthroscopic Knee Surgery”. Acta Orthopaedica Et Traumatologica Turcica 49, sy. 3 (Temmuz 2015): 267-73. https://doi.org/10.3944/AOTT.2015.14.0107.
EndNote Sayin P, Dobrucali H, Turk H, Totoz T, Isil C, Hanci A (01 Temmuz 2015) Effects of intra-articular levobupivacaine, fentanyllevobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery. Acta Orthopaedica et Traumatologica Turcica 49 3 267–273.
IEEE P. Sayin, H. Dobrucali, H. Turk, T. Totoz, C. Isil, ve A. Hanci, “Effects of intra-articular levobupivacaine, fentanyllevobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery”, Acta Orthopaedica et Traumatologica Turcica, c. 49, sy. 3, ss. 267–273, 2015, doi: 10.3944/AOTT.2015.14.0107.
ISNAD Sayin, Pinar vd. “Effects of Intra-Articular Levobupivacaine, Fentanyllevobupivacaine and Tramadol-Levobupivacaine for Postoperative Pain in Arthroscopic Knee Surgery”. Acta Orthopaedica et Traumatologica Turcica 49/3 (Temmuz 2015), 267-273. https://doi.org/10.3944/AOTT.2015.14.0107.
JAMA Sayin P, Dobrucali H, Turk H, Totoz T, Isil C, Hanci A. Effects of intra-articular levobupivacaine, fentanyllevobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery. Acta Orthopaedica et Traumatologica Turcica. 2015;49:267–273.
MLA Sayin, Pinar vd. “Effects of Intra-Articular Levobupivacaine, Fentanyllevobupivacaine and Tramadol-Levobupivacaine for Postoperative Pain in Arthroscopic Knee Surgery”. Acta Orthopaedica Et Traumatologica Turcica, c. 49, sy. 3, 2015, ss. 267-73, doi:10.3944/AOTT.2015.14.0107.
Vancouver Sayin P, Dobrucali H, Turk H, Totoz T, Isil C, Hanci A. Effects of intra-articular levobupivacaine, fentanyllevobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery. Acta Orthopaedica et Traumatologica Turcica. 2015;49(3):267-73.