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Preemptı̇f oral tramadol-pregabalı̇n ı̇le tramadol-parasetamol kombinasyonunun postoperatı̇f tramadol tüketı̇mı̇ üzerı̇ne etkı̇lerı̇nin karşılaştırılması

Yıl 2019, Cilt: 44 Sayı: Ek 1, 181 - 189, 29.12.2019
https://doi.org/10.17826/cumj.585656

Öz

Amaç: Çalışmamızda preemptif oral tramadol-plasebo, tramadol-pregabalin ve tramadol–parasetamol kombinasyonlarının postoperatif tramadol tüketimi üzerine etkilerini karşılaştırmayı amaçladık. 

Gereç ve Yöntem: Çalışmaya meme küçültme ameliyatı yapılacak, 18-65 yaş aralığında, 60 hasta alındı. Hastalar rastgele üç gruba ayrıldı. Operasyondan bir saat önce her üç gruba tramadol 35 mg oral damla ile grup I’e (n=20) pregabalin 75 mg tablet, grup II’ye (n=20) parasetamol 500 mg tablet, grup III’e (n=20) ise plasebo tablet verildi.Grupların postoperatif 24 saatlik ağrı skorları, total tramadol tüketimleri, ek analjezi ihtiyaçları, ekstübasyon ve derlenme zamanları ve yan etkiler kaydedildi.  

Bulgular: Vizüel Analog Skala (VAS) 10. ve 60. dakika değerleri grup II’de diğer gruplardan daha düşük saptandı. Tramadol tüketiminde gruplar arasında istatiksel olarak anlamlı farklılık saptanmamış olmakla birlikte tüketilen toplam tramadol miktarı 120 mg  ve 120 mg  olarak gruplandırıldığında grup I’de tramadol tüketimi diğer iki gruptan daha düşük saptandı.

Sonuç: Meme küçültme cerrahisinde preoperatif oral yoldan uygulanan pregabalin ve tramadol kombinasyonu ile parasetamol ve tramadol kombinasyonu tek başına tramadole göre postoperatif ağrı skorları, 24 saatlik total tramadol tüketimi ve yan etkiler açısından farklılığa yol açmamıştır.


Destekleyen Kurum

Çukurova Üniversitesi Tıp Fakültesi Bilimsel Araştırmalar Proje Daire Başkanlığı

Kaynakça

  • KAYNAKLAR1. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be under managed. Anesth Analg 2003; 97(2): 534-40.
  • 2. Recart A, Duchene D, White PF, Thomas T, Johnson DB, Cadeddu JA. Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy. J Endourol 2005; 19(10):1165-9.
  • 3. Kehlet H, Dahl JB. The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg 1993; 77:1048-56.
  • 4. Dahl JB, Møiniche J. Pre-emptive analgesia. Br Med Bull 2004; 71:13-27.
  • 5. Katz J. Pre-emptive analgesia: importance of timing. Can J Anaesth 2000; 84(3):169-73.
  • 6. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004; 43:879-923.
  • 7. Scott LJ, Perry CM. Tramadol: a review of its use in perioperative pain. Drugs 2000; 60:139-76.
  • 8. Kavoussi R. Pregabalin: from molecule to medicine. Euro Neuropsychopharmacol 2006; 16:128-33.
  • 9. Shneker BF, McAuley JW. Pregabalin: a new neuromodulator with broad therapeutic indications. Ann Pharmacother 2005; 39:2029–37.
  • 10. Imani F, Rahimzadeh P. Gabapentinoids: gabapentin and pregabalin for postoperative pain management. Anesth Pain Med 2012; 2(2):52–3.
  • 11. Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg 2007; 104(6):1545–56.
  • 12. Kohli M, Murali T, Gupta R, Khan P, Bogra J. Optimization of subarachanoid block by oral pregabalin for hysterectomy. J Anaesthesiol Clin Pharmacol 2011; 27(1):101–5.
  • 13. Ghai A, Gupta M, Hooda S, Singla D, Wadhera R. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy. Saudi J Anaesth 2011; 5(3):252–7.
  • 14. Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Curr Opin Anaesthesiol 2006; 19(5):562-5.
  • 15. Goodman LS, Gilman A, Brunton LL. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 11.Ed., New York: McGraw-Hill, 2006. 16. Lascelles BD, Waterman AE, Cripps PJ, Livingston A, Henderson G. Central sensitization as a result of surgical pain: Investigation of the pre-emptive value of pethidine for ovariohysterectomy in the rat. Pain 1995; 62:201-12.
  • 17. Marks K, Nelson C, Lautenschlayer P. Antibiotic impregrated acrylic bone cement. J Bone and Joint Surg 1976; 58-A:358-64.
  • 18. Tang R, Evans H, Chaput A, Kim C. Multimodal analgesia for hip arthroplasty. Orthop Clin North Am 2009; 40(3):377-87.
  • 19. Poisson-salomon AS, Brasseur L, Lory C C M, Durieux P. Audit de la prise en charge de la douleur postopertoire. La Presse Medikale 1996; 25(22):1013-7.
  • 20. McHugh GA. The management of pain foolowing day-case surgery. Anaesthesiol 2002; 57:2705.
  • 21. Budd K. The role of tramadol in acute pain management. Acute Pain 1999; 2(4):189-96.
  • 22. Zavareh SM, Kashefi P, Saghaei M, Emami H. Pre emptive analgesia for reducing pain after cholecystectomy: Oral tramadol vs. acetaminophen codeine. Adv biomed Res 2013; 2:12.
  • 23. Kumar KP, Kulkarni DK, Gurajala, I, Gopinath R. Pregabalin versus tramadol for postoperative pain management in patients undergoing lumbar laminectomy: a randomized, double-blinded, placebo-controlled study. J Pain Res 2013; 6:471-8.
  • 24. Wang F, Shen X, Xu S, Liu Y. Preoperative tramadol combined with postoperative small-dose tramadol infusion after total abdominal hysterectomy: a double-blind, randomized, controlled trial. Pharmacol Rep 2009; 61(6):1198-205.
  • 25. Fahim, M., Abbasi, S. I., Malik, N. A., Khan, J. S., Hassan, H., & Khan, M. M. (2016). Preemptive analgesia with intravenous tramadol for postoperative pain management in patients undergoing inguinal hernioplasty: a randomized controlled trial. Journal of The Society of Surgeons of Pakistan, 32(3), 143-149.
  • 26. Lintz W, Becker R, Gerloff J, Terlinden R. Pharmacokinetics of tramadol and bioavailability of enteral tramadol formulations. 4th communication: drops (without ethanol). Arzneimittelforschung 2000; 50 (2): 99-108.
  • 27. Mattia C, Coluzzi F, Sarzi Puttini P, Vigano R. Paracetamol/ tramadol association: the easy solution for mild-moderate pain. Minerva Med 2008; 99(4): 369-90.
  • 28. Hernandez-Palazon J, Tortosa José A, Juan F, Martínez-L, Domingo PF. Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery. Anesth Analg 2001; 92:1473-6.
  • 29. Avellaneda C, Gómez A, Martos F, Rubio M, Sarmiento J, S. de la Cuesta F. The effect of a single intravenous dose of metamizol 2 g, ketorolac 30 mg and propacetamol 1 g on haedmodynamic parameters and postoperative pain after heart surgery. Eur J Anaesthesiol 2000; 17:85-90.
  • 30. Filitz J, Ihmsen H, Günther W, Tröster A, Schwilden H, Schüttler J, Koppert W. Supraadditive effects of tramadol and acetaminophen in a human pain model. Pain 2008; 136(3):262-70.
  • 31. Emir E, Serin S, Erbay RH, Sungurtekin H, Tomatir E. Tramadol versus low dose tramadol paracetamol for patient controlled analgesia during spinal vertebral surgery. Kaohsiung J Med Sci 2010; 26(6):308-15.
  • 32. Stephan A. Schug. Combination analgesia in 2005—a rational approach: focus on paracetamol– tramadol. Clin Rheumatol 2006; 25(1): S16–S21.
  • 33. Dhillon S. Tramadol/paracetamol fixed-dose combination: a review of its use in the management of moderate to severe pain. Clin Drug Investig 2010; 30(10):711-38.
  • 34. Dworkin RH, O’Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007; 132:237–51.
  • 35. Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen Hosp Psychiatry 2009; 31:206–19.
  • 36. Durkin B, Page C, Glass P. Pregabalin for the treatment of postsurgical pain. Expert Opin Pharmacother 2010; 11:2751–8.
  • 37. Guay DR. Pregabalin in neuropathic pain: a more “pharmaceutically elegant” gabapentin? Am J Geriatr Pharmacother 2005; 3:274–87.
  • 38. Dahl JB, Mathiesen O, Moiniche S. Protective premedication: an option with gabapentin and related Drugs? A review of gabapentin and pregabalin in the treatment of post-operative pain. Acta Anaesthesiol Scand 2004; 48:1130-6.
  • 39. Werner FM, Frederick M, Perkins K, Holte K, Pedersen JL, Kehlet H. Effects of gabapentin in acute inflammatory pain in humans. Reg Anesth Pain Med 2001; 26:322-8.
  • 40. Freedman BM, O›Hara E. Pregabalin has opioid sparing effects following augmentation mammaplasty. Aesthet Surg J 2008; 28:421-4.
  • 41. Gajraj NM. Pregabalin: Its pharmacology and use in pain management. Anesth Analg 2007; 105:1805-15.
  • 42. Ben-Menachem E. Pregabalin pharmacology and its relevance to clinical practice. Epilepsia 2004; 45(6):13-8.
  • 43. Keyhanfar F, Meymandi MS, Sepehri G, Rastegaryanzadeh R, Heravi G. Evaluation of antinociceptive effect of pregabalin in mice and its combination with tramadol using tail flick test. Iran J Pharm Res 2013; 12(3):483-93.
  • 44. Meymandi MS, Keyhanfar F. Pregabalin antinociception and its interaction with tramadol in acute model of pain. Pharmacol Rep 2012; 64(3):576-85.
  • 45. Bornemann-Cimenti H, Lederer AJ, Wejbora M, et al. Preoperative pregabalin administration significantly reduces postoperative opioid consumption and mechanical hyperalgesia after transperitoneal nephrectomy, Br J Anaesth 2012 ;108(5):845-9.
  • 46. Kim SY, Jeong JJ, Chung WY, Kim HJ, Nam KH, Shim YH. Perioperative administration of pregabalin for pain after robot-assisted endoscopic thyroidectomy: A randomized clinical trial. Surg Endosc 2010; 24:2776-81.
  • 47. Agarwal A, Gautam S, Gupta D, Agarwal S, Signh PK, Singh U. Evaluation of single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth 2008; 1001:700-4.
  • 48. Spreng UJ, Dahl V, Raeder J. Effect of a single dose of pregabalin on post-operative pain and preoperative anxiety in patients undergoing discectomy. Acta Anaesthesiol Scand. 2011; 55(5):571-6.
  • 49. Frampton JE, Foster RH. Pregabalin: in the treatment of postherpetic neuralgia. Drugs 2005; 65:111– 8.
  • 50. Rajappa GC, Vig S, Bevanaguddaiah Y, Anadaswamy TC. Efficacy of pregabalin as premedication for post-operative analgesia in vaginal hysterectomy. Anesth Pain Med 2016; 6(3):e3491.
  • 51. Paech MJ, Goy R, Chua S, Scott K, Christmas T, Doherty A. Randomized, placebo-controlled trial of preoperative oral pregabalin for postoperative pain relief after minör gynecological surgery. Anesth Analg 2007; 105:1449-3.

Comparison of effects of preemptive oral pregabalin-tramadol combination and paracetamol-tramadol combination administration on postoperative tramadol consumption

Yıl 2019, Cilt: 44 Sayı: Ek 1, 181 - 189, 29.12.2019
https://doi.org/10.17826/cumj.585656

Öz

Purpose: We aimed to evaluate the efficacy of preemptive oral tramadol-placebo, tramadol-pregabalin and tramadol-paracetamol combination on postoperatif tramadol consumption in patients undergoing breast reduction operation. 

Materials and Methods: Sixty adult patients between 18-65 years of age, undergoing breast reduction surgery were included in this study, randomly divided into three groups. Each of groups were received 35 mg drop tramadol one hour before surgery. Additionally Group I (n=20) patients received 75 mg pregabalin tablet and Group II (n=20) patients received 500 mg paracetamol tablet preoperatively, and Group III (n=20) patients accepted as control group. 30 minutes before the end of operation Postoperative 24 hour pain scores, total tramadol consumption, supplement analgesic requirement, extubation, recovery time and side effects were recorded. 

Results: Postoperative 10th and 60th min Visual Analogue Scale scores were lower in group II compared to others. The consumption of tramadol in Group I was lower than the others when the total amount of tramadol consumtion was grouped as 120 mg≥ and 120mg <. 

Conclusion: The combinations of pregabalin and tramadol and paracetamol and tramadol did not cause any difference in terms of postoperative pain scores, 24-hour total tramadol consumption compared with tramadol alone.


Kaynakça

  • KAYNAKLAR1. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be under managed. Anesth Analg 2003; 97(2): 534-40.
  • 2. Recart A, Duchene D, White PF, Thomas T, Johnson DB, Cadeddu JA. Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy. J Endourol 2005; 19(10):1165-9.
  • 3. Kehlet H, Dahl JB. The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg 1993; 77:1048-56.
  • 4. Dahl JB, Møiniche J. Pre-emptive analgesia. Br Med Bull 2004; 71:13-27.
  • 5. Katz J. Pre-emptive analgesia: importance of timing. Can J Anaesth 2000; 84(3):169-73.
  • 6. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004; 43:879-923.
  • 7. Scott LJ, Perry CM. Tramadol: a review of its use in perioperative pain. Drugs 2000; 60:139-76.
  • 8. Kavoussi R. Pregabalin: from molecule to medicine. Euro Neuropsychopharmacol 2006; 16:128-33.
  • 9. Shneker BF, McAuley JW. Pregabalin: a new neuromodulator with broad therapeutic indications. Ann Pharmacother 2005; 39:2029–37.
  • 10. Imani F, Rahimzadeh P. Gabapentinoids: gabapentin and pregabalin for postoperative pain management. Anesth Pain Med 2012; 2(2):52–3.
  • 11. Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg 2007; 104(6):1545–56.
  • 12. Kohli M, Murali T, Gupta R, Khan P, Bogra J. Optimization of subarachanoid block by oral pregabalin for hysterectomy. J Anaesthesiol Clin Pharmacol 2011; 27(1):101–5.
  • 13. Ghai A, Gupta M, Hooda S, Singla D, Wadhera R. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy. Saudi J Anaesth 2011; 5(3):252–7.
  • 14. Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Curr Opin Anaesthesiol 2006; 19(5):562-5.
  • 15. Goodman LS, Gilman A, Brunton LL. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 11.Ed., New York: McGraw-Hill, 2006. 16. Lascelles BD, Waterman AE, Cripps PJ, Livingston A, Henderson G. Central sensitization as a result of surgical pain: Investigation of the pre-emptive value of pethidine for ovariohysterectomy in the rat. Pain 1995; 62:201-12.
  • 17. Marks K, Nelson C, Lautenschlayer P. Antibiotic impregrated acrylic bone cement. J Bone and Joint Surg 1976; 58-A:358-64.
  • 18. Tang R, Evans H, Chaput A, Kim C. Multimodal analgesia for hip arthroplasty. Orthop Clin North Am 2009; 40(3):377-87.
  • 19. Poisson-salomon AS, Brasseur L, Lory C C M, Durieux P. Audit de la prise en charge de la douleur postopertoire. La Presse Medikale 1996; 25(22):1013-7.
  • 20. McHugh GA. The management of pain foolowing day-case surgery. Anaesthesiol 2002; 57:2705.
  • 21. Budd K. The role of tramadol in acute pain management. Acute Pain 1999; 2(4):189-96.
  • 22. Zavareh SM, Kashefi P, Saghaei M, Emami H. Pre emptive analgesia for reducing pain after cholecystectomy: Oral tramadol vs. acetaminophen codeine. Adv biomed Res 2013; 2:12.
  • 23. Kumar KP, Kulkarni DK, Gurajala, I, Gopinath R. Pregabalin versus tramadol for postoperative pain management in patients undergoing lumbar laminectomy: a randomized, double-blinded, placebo-controlled study. J Pain Res 2013; 6:471-8.
  • 24. Wang F, Shen X, Xu S, Liu Y. Preoperative tramadol combined with postoperative small-dose tramadol infusion after total abdominal hysterectomy: a double-blind, randomized, controlled trial. Pharmacol Rep 2009; 61(6):1198-205.
  • 25. Fahim, M., Abbasi, S. I., Malik, N. A., Khan, J. S., Hassan, H., & Khan, M. M. (2016). Preemptive analgesia with intravenous tramadol for postoperative pain management in patients undergoing inguinal hernioplasty: a randomized controlled trial. Journal of The Society of Surgeons of Pakistan, 32(3), 143-149.
  • 26. Lintz W, Becker R, Gerloff J, Terlinden R. Pharmacokinetics of tramadol and bioavailability of enteral tramadol formulations. 4th communication: drops (without ethanol). Arzneimittelforschung 2000; 50 (2): 99-108.
  • 27. Mattia C, Coluzzi F, Sarzi Puttini P, Vigano R. Paracetamol/ tramadol association: the easy solution for mild-moderate pain. Minerva Med 2008; 99(4): 369-90.
  • 28. Hernandez-Palazon J, Tortosa José A, Juan F, Martínez-L, Domingo PF. Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery. Anesth Analg 2001; 92:1473-6.
  • 29. Avellaneda C, Gómez A, Martos F, Rubio M, Sarmiento J, S. de la Cuesta F. The effect of a single intravenous dose of metamizol 2 g, ketorolac 30 mg and propacetamol 1 g on haedmodynamic parameters and postoperative pain after heart surgery. Eur J Anaesthesiol 2000; 17:85-90.
  • 30. Filitz J, Ihmsen H, Günther W, Tröster A, Schwilden H, Schüttler J, Koppert W. Supraadditive effects of tramadol and acetaminophen in a human pain model. Pain 2008; 136(3):262-70.
  • 31. Emir E, Serin S, Erbay RH, Sungurtekin H, Tomatir E. Tramadol versus low dose tramadol paracetamol for patient controlled analgesia during spinal vertebral surgery. Kaohsiung J Med Sci 2010; 26(6):308-15.
  • 32. Stephan A. Schug. Combination analgesia in 2005—a rational approach: focus on paracetamol– tramadol. Clin Rheumatol 2006; 25(1): S16–S21.
  • 33. Dhillon S. Tramadol/paracetamol fixed-dose combination: a review of its use in the management of moderate to severe pain. Clin Drug Investig 2010; 30(10):711-38.
  • 34. Dworkin RH, O’Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007; 132:237–51.
  • 35. Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen Hosp Psychiatry 2009; 31:206–19.
  • 36. Durkin B, Page C, Glass P. Pregabalin for the treatment of postsurgical pain. Expert Opin Pharmacother 2010; 11:2751–8.
  • 37. Guay DR. Pregabalin in neuropathic pain: a more “pharmaceutically elegant” gabapentin? Am J Geriatr Pharmacother 2005; 3:274–87.
  • 38. Dahl JB, Mathiesen O, Moiniche S. Protective premedication: an option with gabapentin and related Drugs? A review of gabapentin and pregabalin in the treatment of post-operative pain. Acta Anaesthesiol Scand 2004; 48:1130-6.
  • 39. Werner FM, Frederick M, Perkins K, Holte K, Pedersen JL, Kehlet H. Effects of gabapentin in acute inflammatory pain in humans. Reg Anesth Pain Med 2001; 26:322-8.
  • 40. Freedman BM, O›Hara E. Pregabalin has opioid sparing effects following augmentation mammaplasty. Aesthet Surg J 2008; 28:421-4.
  • 41. Gajraj NM. Pregabalin: Its pharmacology and use in pain management. Anesth Analg 2007; 105:1805-15.
  • 42. Ben-Menachem E. Pregabalin pharmacology and its relevance to clinical practice. Epilepsia 2004; 45(6):13-8.
  • 43. Keyhanfar F, Meymandi MS, Sepehri G, Rastegaryanzadeh R, Heravi G. Evaluation of antinociceptive effect of pregabalin in mice and its combination with tramadol using tail flick test. Iran J Pharm Res 2013; 12(3):483-93.
  • 44. Meymandi MS, Keyhanfar F. Pregabalin antinociception and its interaction with tramadol in acute model of pain. Pharmacol Rep 2012; 64(3):576-85.
  • 45. Bornemann-Cimenti H, Lederer AJ, Wejbora M, et al. Preoperative pregabalin administration significantly reduces postoperative opioid consumption and mechanical hyperalgesia after transperitoneal nephrectomy, Br J Anaesth 2012 ;108(5):845-9.
  • 46. Kim SY, Jeong JJ, Chung WY, Kim HJ, Nam KH, Shim YH. Perioperative administration of pregabalin for pain after robot-assisted endoscopic thyroidectomy: A randomized clinical trial. Surg Endosc 2010; 24:2776-81.
  • 47. Agarwal A, Gautam S, Gupta D, Agarwal S, Signh PK, Singh U. Evaluation of single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth 2008; 1001:700-4.
  • 48. Spreng UJ, Dahl V, Raeder J. Effect of a single dose of pregabalin on post-operative pain and preoperative anxiety in patients undergoing discectomy. Acta Anaesthesiol Scand. 2011; 55(5):571-6.
  • 49. Frampton JE, Foster RH. Pregabalin: in the treatment of postherpetic neuralgia. Drugs 2005; 65:111– 8.
  • 50. Rajappa GC, Vig S, Bevanaguddaiah Y, Anadaswamy TC. Efficacy of pregabalin as premedication for post-operative analgesia in vaginal hysterectomy. Anesth Pain Med 2016; 6(3):e3491.
  • 51. Paech MJ, Goy R, Chua S, Scott K, Christmas T, Doherty A. Randomized, placebo-controlled trial of preoperative oral pregabalin for postoperative pain relief after minör gynecological surgery. Anesth Analg 2007; 105:1449-3.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma
Yazarlar

Murat Türkeün ILGINEL 0000-0001-9183-9124

Demet LAFLI TUNAY 0000-0002-7984-1800

Yasemin GÜNEŞ 0000-0001-9148-3041

Feride KARACAER 0000-0002-1048-6505

Ebru BİRİCİK 0000-0002-3355-198X

Özge ILGINEL Bu kişi benim 0000-0002-1079-644X

Yayımlanma Tarihi 29 Aralık 2019
Kabul Tarihi 22 Temmuz 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 44 Sayı: Ek 1

Kaynak Göster

MLA ILGINEL, Murat Türkeün vd. “Preemptı̇f Oral Tramadol-pregabalı̇n ı̇le Tramadol-Parasetamol Kombinasyonunun postoperatı̇f Tramadol tüketı̇mı̇ üzerı̇ne etkı̇lerı̇nin karşılaştırılması”. Cukurova Medical Journal, c. 44, 2019, ss. 181-9, doi:10.17826/cumj.585656.