Postoperatif ağrı kontrolünde preemptif tek doz uygulanan deksketoprofen trometamol ile deksmedetomidinin etkinliklerinin karşılaştrılması

Yıl 2015, Cilt: 5 Sayı: 2, 0 - 0, 01.06.2015

Selda Kayaaltı , Fatih Uğur , Mehmet Dolanbay , Recep Aksu Seher Orbay Yaşlı

Öz

Amaç: Bu çalışmada; abdominal histerektomi uygulanacak hastalarda postoperatif ağrı tedavisinde preemptif intravenöz (ıv) deksketorofen trometamol ile deksmedetomidinin analjezik etkilerininin karşılaştırılması amaçlanmıştır.

Materyal ve Metod: Kurumsal onay ve izin alındıktan sonra yaşları 18-65 yaş arasında, ASA I-II, abdominal histerektomi uygulanacak olan 60 hasta randomize olarak 30’arlı iki eşit gruba ayrılmıştır. Hastalara anestezi indüksiyonundan sonra, cerrahi insizyondan 10 dk önce deksketoprofen 50 mg (Grup I) veya deksmedetomidin 1µg/kg (Group II) iv uygulandı. Postoperatif dönemde morfin kullanılarak Hasta Kontrollü Analjezi (HKA) sağlandı. Hemodinamik parametreler, Visüel Analog Skala (VAS) ile ağrı ölçümü, sedayon skoru, morfin tüketimi ve olası yan etkiler postoperatif 2, 6, 12 ve 24. saatlerde kaydedildi.

Bulgular: Postoperatif 24 saatlik dönemde; ağrı skorları VAS ile değerlendirilen gruplar arasında VAS ağrı skorları benzer olarak bulunmuştur (p>0.05). Toplam 24 saatlik morfin tüketimi Grup I ve II için sırasıyla 21,9 ± 13,9 ve 19,6 ± 12,2 mg dı (p>0.05). Yan etkiler açısından da gruplar arasında anlamlı farklılık bulunmadı (p>0.05).

Sonuç: Bu çalışma ile deksketoprofen trometamol ve deksmedetomidinin preemptif analjezik etkinlikleri benzer bulunmuştur. Aynı zamanda yan etki açısından da deksketoprofen trometamol ile deksmedetomidin arasında anlamlı bir farklılık bulunmamıştır.

Kaynakça

• Grape S, Tramèr MR. Do we need preemptive analgesia for the treatment of postoperative pain? Best Practice & Research Clinical Anaesthesiology. 2007;21(1):51-63.
• Campiglia L, Consales G, De Gaudio AR. Pre-emptive analgesia for postoperative pain control. Clinical Drug Investigation. 2010;30(2):15-26.
• Dahl JB, Møiniche S. Pre-emptive analgesia. British Medical Bulletin. 2004;71(1):13-27.
• Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology. 2002;96(3):725-41.
• Mishra AK, Afzal M, Mookerjee SS, Bandyopadhyay KH, Paul A. Pre-emptive analgesia: Recent trends and evidences. Indian Journal of Pain. 2013;27(3):114.
• Blaudszun G, Lysakowski C, Elia N, Tramer M. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116(6):1312-22.
• Barden J, Derry S, McQuay HJ, Moore RA. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. The Cochrane Library. 2009 (4):CD007355. PubMed PMID: 19821407. Pubmed Central PMCID: PMC4171124. Epub 2009/10/13.
• Dahl JB, Kehlet H. The value of pre-emptive analgesia in the treatment of postoperative pain. British Journal of Anaesthesia. 1993;70(4):434-9.
• Barbanoj M-J, Antonijoan R-M, Gich I. Clinical pharmacokinetics of dexketoprofen. Clinical Pharmacokinetics. 2001;40(4):245-62.
• Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesthesia and Analgesia. 2004;98(1):153-8.
• Tüzüner F. Anestezi Yoğun Bakım Ağrı: Nobel Yayıncılık 2010.
• de Beer JdV, Winemaker MJ, Donnelly GA, Miceli PC, Reiz JL, Harsanyi Z, et al. Efficacy and safety of controlled-release oxycodone and standard therapies for postoperative pain after knee or hip replacement. Canadian Journal of Surgery. 2005;48(4):277.
• Kehlet H, Dahl JB. The value of" multimodal" or" balanced analgesia" in postoperative pain treatment. Anesthesia and Analgesia. 1993;77(5):1048-56.
• Werawatganon T, Charuluxananan S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra‐abdominal surgery. The Cochrane Library. 2013;3(CD004088).
• Katz J, Kavanagh BP, Sandler AN, Nierenberg H, Boylan J, Friedlander F, et al. Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology. 1992;77(3):439-46.
• Thomas V, Heath M, Rose D, Flory P. Psychological characteristics and the effectiveness of patient-controlled analgesia. British Journal of Anaesthesia. 1995;74(3):271-6.
• Nesek-Adam V, Grizelj-Stojcic E, Mršic V, Rašic Ž, Schwarz D. Preemptive use of diclofenac in combination with ketamine in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2012;22(3):232-8.
• Cobby TF, Crighton IM, Kyriakides K, Hobbs GJ. Rectal paracetamol has a significant morphine-sparing effect after hysterectomy. British Journal of Anaesthesia. 1999;83(2):253-6.
• Wang Y, Zhang H-b, Xia B, Wang G-m, Zhang M-y. Preemptive analgesic effects of flurbiprofen axetil in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach. Chinese Medical Journal. 2012;125(4):579-82.
• Mauleón D, Artigas R, García ML, Carganico G. Preclinical and clinical development of dexketoprofen. Drugs. 1996;52(5):24-46.
• Hanna MH, Elliott KM, Stuart‐Taylor M, Roberts D, Buggy D, Arthurs G. Comparative study of analgesic efficacy and morphine‐sparing effect of intramuscular dexketoprofen trometamol with ketoprofen or placebo after major orthopaedic surgery. British Journal of Clinical Pharmacology. 2003;55
• (2):126-33.
• Tuncer S, Reisli R, Keçecioğlu M, Erol A. The effects of intravenous dexketoprofen on postoperative analgesia and morphine consumption in patients undergoing abdominal hysterectomy. The journal of the Turkish Society of Algology. 2010;22(3):98-102.
• Kara İ, Tuncer S, Erol A, Reisli R. Preemptif deksketoprofen kullanımının postoperatif ağrı ve tramadol tüketimine etkisi. Ağrı. 2011;23(1):18-21.
• Yazar MA, Inan N, Ceyhan A, Sut E, Dikmen B. Postoperative analgesic efficacy of intravenous dexketoprofen in lumbar disc surgery. Journal of Neurosurgical Anesthesiology. 2011;23(3):193-7.
• İnan N, Takmaz SA, İltar S, Yazıcı I, Başar H. Total kalça protezi operasyonlarında iki multimodal analjezi yönteminin etkinliği. Ağrı. 2009;21:69-74.
• Koçum A, Şener M, İzmirli H, Haydardedeoğlu B, Arıboğan A. Günübirlik operatif histeroskopi sonrası intravenöz parasetamol ve deksketoprofen trometamol'ün analjezik etkinliklerinin karşılaştırılması: Randomize, çift kör, plasebo kontrollü çalışma. Ağrı. 2014;26(1):15-22.
• Kesimci E, Gümüş T, Izdeş S, Sen P, Kanbak O. Comparison of efficacy of dexketoprofen versus paracetamol on postoperative pain and morphine consumption in laminectomy patients. Ağrı. 2011;23(4):153-9.
• Tunali Y, Akcil EF, Dilmen OK, Tutuncu AC, Koksal GM, Akbas S, et al. Efficacy of intravenous paracetamol and dexketoprofen on postoperative pain and morphine consumption after a lumbar disk surgery. Journal of Neurosurgical Anesthesiology. 2013;25(2):143-7.
• Weinbroum AA, Ben‐Abraham R. Dextromethorphan and dexmedetomidine: new agents for the control of perioperative pain. European Journal of Surgery. 2001;167(8):563-9.
• Schnabel A, Meyer-Frießem CH, Reichl SU, Zahn PK, Pogatzki-Zahn EM. Is intraoperative dexmedetomidine a new option for postoperative pain treatment? A meta-analysis of randomized controlled trials. Pain. 2013;154(7):1140-9.
• Demuro JP, Botros D, Nedeau E, Hanna AF. Use of dexmedetomidine for postoperative analgesia in spine patients. Journal of Neurosurgical Sciences. 2013;57(2):171-4.
• Ohtani N, Yasui Y, Watanabe D, Kitamura M, Shoji K, Masaki E. Perioperative infusion of dexmedetomidine at a high dose reduces postoperative analgesic requirements: a randomized control trial. Journal of Anesthesia. 2011;25(6):872-8.
• Şitilci AT, Özyuvacı E, Alkan Z, Demirgan S, Yiğit Ö. Mastoidektomi operasyonlarında perioperatif verilen deksmedetomidinin postoperatif analjezik tüketimine etkisi. Ağrı. 2010;22(3):109-16.
• Angst MS, Ramaswamy B, Davies MF, Maze M. Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans. Anesthesiology. 2004;101(3):744-52.
• Kida K, Ohtani N, Shoji K, Yasui Y, Masaki E. Postoperative pain status after intraoperative systemic dexmedetomidine and epidural neostigmine in patients undergoing lower abdominal surgery. European Journal of Anaesthesiology. 2008;25(11):869-75.
• Anttila M, Penttilä J, Helminen A, Vuorilehto L, Scheinin H. Bioavailability of dexmedetomidine after extravascular doses in healthy subjects. British Journal of Clinical Pharmacology. 2003;56(6):691-3.
• Venn R, Bradshaw C, Spencer R, Brealey D, Caudwell E, Naughton C, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54(12):1136-42.
• Unlugenc H, Gunduz M, Guler T, Yagmur O, Isik G. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. European Journal of Anaesthesiology. 2005;22(05):386-91.
• Schmidt AP, Valinetti EA, Bandeira D, Bertacchi MF, Simoes CM, Auler JOC. Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. Pediatric Anesthesia. 2007;17(7):667-74.
• Olutoye O, Kim T, Giannoni C, Stayer S. Dexmedetomidine as an analgesic for pediatric tonsillectomy and adenoidectomy. Pediatric Anesthesia. 2007;17(10):1007-8.
• Olutoye OA, Glover CD, Diefenderfer JW, McGilberry M, Wyatt MM, Larrier DR, et al. The effect of intraoperative dexmedetomidine on postoperative analgesia and sedation in pediatric patients undergoing tonsillectomy and adenoidectomy. Anesthesia and Analgesia. 2010;111(2):490-5.
• Pestieau SR, Quezado ZM, Johnson YJ, Anderson JL, Cheng YI, McCarter RJ, et al. High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children. Canadian Journal of Anesthesia/Journal Canadien d'anesthésie. 2011;58(6):540-50.
• Abdelmageed WM, Elquesny KM, Shabana RI, Abushama HM, Nassar AM. Analgesic properties of a dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Saudi Journal of Anaesthesia. 2011;5(2):150.
• Snapir A, Posti J, Kentala E, Koskenvuo J, Sundell J, Tuunanen H, et al. Effects of low and high plasma concentrations of dexmedetomidine on myocardial perfusion and cardiac function in healthy male subjects. Anesthesiology. 2006;105(5):902.
• Macintyre PE. Safety and efficacy of patient-controlled analgesia. British Journal of Anaesthesia. 2001;87(1):36-46.
• Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Pharmacology and Toxicology. 2008;8(1):11.
• Laporte J-R, Ibañez L, Vidal X, Vendrell L, Leone R. Upper gastrointestinal bleeding associated with the use of NSAIDs. Drug Safety. 2004;27(6):411-20.
• Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Medicine. 2010;11(12):1859-71.