The Effects of Tramadol and Levobupivacaine Infiltration on Postoperative Analgesia in Functional Endoscopic Sinus Surgery and Septorhinoplasty

Yıl 2012, , 391 - 394, 01.04.2012

Muhammet Hilmi Koputan Alparslan Apan Gökşen Öz Emine Arzu Köse

https://doi.org/10.5152/balkanmedj.2012.027

Öz

Objective: The aim of this prospective, randomized, double-blind study was to investigate the postoperative analgesic effects of levobupivacaine or tramadol infiltration administered prior to surgery in septorhinoplasty (SRP) or endoscopic sinus surgery (ESS). Material and Methods: Sixty ASA class I-III adult patients electively undergoing SRP or ESC were included the study. Induction of anesthesia was performed with propofol 2-2.5 mg/kg, rocuronium bromide 0.6 mg/kg and fentanyl 1 μg/kg i.v. Sevoflurane 2% with an N2O/O2 mixture (FiO2: 35%) was used for maintenance. Tramadol 0.5 mg/kg (Group T: n=20), levobupivacaine 0.25% (Group L: n=20) and lidocaine 1% (Group C: n=20) in a 1/200,000 adrenaline solution was infiltrated into the surgical area 10 min before the operation (5 mL for ESS and 10 mL for SRP). All patients received fentanyl (bolus dose: 15 μg and lockout interval: 10 min) with a patient-controlled analgesia device during the postoperative period. Pain was assessed using an 11-point visual analogue scale (VAS) every 4 h for the first 24 h. Analgesic requirements, opioid consumption and side effects in the postoperative period were recorded. Results: There was a statistically significant decrease in postoperative fentanyl demand and consumption in patients receiving tramadol. Fentanyl doses in the 24 h period were 345.2±168.8 μg, 221.1±120.6 μg and 184.1±130.3 μg (p=0.002) for the Groups C, L and T, respectively. There were statistically significant differences in fentanyl requirements between the tramadol and control groups at the 16, 20 and 24 h time points (p=0.012, p=0.004 and p=0.002, respectively). The side effect profiles were similar. Conclusions: Our study indicates that the preemptive tramadol infiltration technique is an efficient, practical and safe alternative to levobupivacaine in ESS or SRP operations. Turkish Başlık: Endoskopik Sinüs Cerrahisi ve Septorinoplastide Tramadol ve Levobupivakain İnfiltrasyonunun Postoperatif Analjezi üzerine Etkileri Anahtar Kelimeler: İnfiltrasyon, levobupivakain, tramadol, postoperatif analjezi, hasta kontrollü analjezi Amaç: Prospektif, randomize ve çilf kör çalışmada septorinoplasti (SRP) ve endoskopik sinus cerrahisi (ESC) ameliyatlarından sonra levobupivakain ve tramadol infiltrasyonunun postoperatif analjezik etkilerinin araştırılması amaçlandı. Gereç ve Yöntemler: Çalışmaya elektif olarak ESC ve SRP operasyonları gerirecek ASA I-III sınıfı altmış erişkin hasta alındı. Anestezi indüksiyonu intravenöz propofol 2-2.5 mg/kg-1, roküronyum bromid 0.6 mg/kg-1, and fentanil 1 μg/kg-1 ile gerçekleştirildi. İdame %2 sevofluran ile N2O/O2 karışımı (FiO2: 35%) ile sağlandı. Operasyondan 10 dakika önce cerrahi sahaya tramadol 0.5 mg/kg-1(Group T: n= 20), levobupivakain %0.25(Group L: n= 20), ve lidokainin %1(Group C: n= 20) adrenaline solüsyonu 1/200000 infiltre edildi (ESC için 5 mL ve SRP için10 mL). Postoperatif dönemde hastaların tümüne hasta kontrollü analjezi cihazı ile fentanil uygulandı (bolus doz: 15 μg ve kilit aralığı:10 dak). Ağrı postoperative ilk 24 saatte 11 dereceli vizüel analog skala (VAS) ile 4 saat ara ile değerlendirildi. Postoperatif dönemde analjezik gereksinim, opioid tüketimi ve yan etkiler belirlenerek kaydedildi. Bulgular: Tramadol verilen grubun fentanil gereksinim ve tüketimi istatistiksel açıdan farklı bulundu. 24 saatlik fentanyl dozları Grup C, L ve T için sırası ile 345.2 ± 168.8,6 μg, 221.1 ± 120.6 μg; and 184.1 ± 130,3 μg (p= 0.002) olarak belirlendi. Tramadol ve kontrol grubunun fentanil gereksinimlerinde 16, 20 ve 24. saat peryotlarda (p= 0.012, p= 0.004. ve p= 0.002) farklılık saptandı. Yan etki profili benzerdi. Sonuç: Bulgularımız ESC ve SRP operasyonlarından önce preemptif tramadol infiltrasyonunun levobupivakainin etkili, pratik ve güvenli bir alternatifi olduğunu düşündürmektedir.

Anahtar Kelimeler

Infiltration, levobupivacaine, tramadol, postoperative analgesia, patient-controlled analgesia

The Effects of Tramadol and Levobupivacaine Infiltration on Postoperative Analgesia in Functional Endoscopic Sinus Surgery and Septorhinoplasty

Öz

Kaynakça

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