The Comparison of Preemptive Oral Tramadol, Gabapentin Tramadol and Parasetamol Tramadol Combination on the Efficacy of Postoperative Pain Control in Breast Reduction Surgery

Year 2013, Volume: 38 Issue: 3, 417 - 425, 01.09.2013

Müge Can Zehra Hatipoğlu Cengiz Eser Yasemin Güneş

Abstract

Purpose: Application of tramadol by intravenous patient controlled analgesia (PCA) is a routine method for controlling postoperative pain in the breast reduction operations. It was aimed to compare the efficacy of preemptive oral gabapentin/tramadol and parasetamol/tramadol combination usage on the postoperatif tramadol consumption in patients undergoing breast reduction operation. Material and Methods: Our study was held on 54 patients (ASA I-III, aged between 18-65 yr) undergoing breast reduction operation. Patients randomly divided into three groups. Group I were received 600mg tablet gabapentin and 35mg drop tramadol one hour before the operation. Group II were received 500mg tablet parasetamol and 35mg drop tramadol one hour before the operation. Group III (Control group) were received 35mg drop tramadol one hour before the operation. 30 minutes before the end of operation, 1mg/kg i.v. tramadol and 10mg metoklopramid HCL three groups were administred. After the end of operation, three groups were started to receive tramadol infusion and intravenous patient controlled analgesia (PCA) application (300 mg diluated with 0,09% 100cc SF, 0,2 mg/kg PCA, 15 min locked in time). Peroperative SpO2, KH, SKB, DKB, extubation, disillusion, response time to the verbal stimuli, postoperative pain scores (VRS, VAS), total tramadol consumption, additional analgesic need and side effects (nausea and vomiting, diplopia, dizziness) were recorded and evaluated. Results: Peroperative SpO2, KH, SKB, DKB, extubation, disillusion, response time to the verbal stimuli, postoperative pain scores (VRS, VAS), total tramadol consumption, additional analgesic need and side effects of groups were similar to each other. Peroperative second hour DKB values and postoperative twelfth hour additional analgesic need of second group was found higher compared to other groups. There were no significantly differences in the groups except diplopia. It was found higher in favour of the first group. Conclusion: Application of tramadol/gabapentin, tramadol/parasetamol and low dose tramadol (35mg) in patients undergoing breast reduction operation did not affect intraoperative hemodinami. The tramadol combined with postoperatif HKA also does not cause any differences among postoperative pain scores, 24 hours total tramadol consumption and additional analgesia need except twelfth hour. It was concluded that the side effects in group applied gabapentin were similar except diplopia.

Keywords

Preemptive analgesia, gabapentin, tramadol drop, patient controlled analgesia

Meme Küçültme Cerrahisinde Postoperatif Ağrının Kontrolünde Preemptif Oral Tramadol İle Tramadol- Parasetamol ve Tramadol-Gabapentinin Etkinliğinin Araştırılması

Abstract

Amaç: Meme küçültme operasyonlarında postoperatif ağrı kontrolünde rutin uygulanan yöntemlerden birisi intravenöz yoldan hasta kontrollü analjezi (HKA) ile tramadol uygulamasıdır. Biz bu çalışmada meme küçültme operasyonu uygulanan hastalarda preemptif oral gabapentin/tramadol ile parasetamol/tramadol kullanımının postoperatif tramadol tüketimi üzerindeki etkilerinin karşılaştırılmasını amaçladık. Materyal ve Metod: Çalışma yaşları 18 - 65 arasında, ASA I-III grubu 54 hastada yapıldı. Hastalar rastgele üç gruba ayrıldı. I.Gruba; operasyondan bir saat önce gabapentin 600mg tablet ve tramadol 35mg damla, II. Gruba; operasyondan bir saat önce parasetamol 500mg tablet ve tramadol 35mg damla, III. Gruba (Kontrol grubu); operasyondan bir saat önce tramadol 35mg damla verildi. Her üç gruba da operasyon bitiminden 30 dakika önce 1mg/kg iv tramadol ve 10mg metoklopramid HCl, operasyon bitiminde postoperatif hasta kontrollü analjezi (HKA) uygulaması ile tramadol (100cc %0,09 serum fizyolojik içerisine 300mg konulup, 0,2mg/kg HKA doz, 15 dk kilitli kalma süresi) infüzyonuna başlandı. Grupların peroperatif SpO2, KH, SKB, DKB, ekstübasyon, göz açma, sözlü uyaranlara yanıt süreleri, postoperatif ağrı skorları(VRS, VAS), toplam tramadol tüketimi, ek analjezik ihtiyacı ve yan etkileri (bulantı, kusma, çift görme, sersemlik) not edilerek değerlendirildi. Bulgular: Grupların demografik özellikleri, operasyon süreleri, ekstübasyon, göz açma, sözlü uyaranlara yanıt süreleri, peroperatif SpO2, KH, SKB değerleri postoperatif ağrı skorları (VRS, VAS), toplam tramadol tüketimi birbirine benzerdi. Peroperatif 2. saatteki DKB değerlerinin ve postoperatif 12. saatteki ek analjezik gereksiniminin II. Grupta diğer gruplar ile karşılaştırıldığında daha yüksek olduğu bulundu. Yan etkiler karşılaştırıldığında gruplar arasında çift görme dışında anlamlı fark yoktu. Çift görme sıklığı I. Grupta daha yüksek bulundu. Sonuç: Meme küçültme operasyonlarında preemptif oral yoldan uygulanan tramadol/gabapentin, tramadol/parasetamol ve düşük doz tramadolün (35mg) intraoperatif hemodinamiyi etkilemediği, postoperatif HKA ile kombine edildiğinde postoperatif ağrı skorlarının ve 24 saatlik total tramadol tüketiminin ve 12. saat dışında ek analjezik gereksiniminin fark göstermediği, gabapentin grubundaki çift görme dışında yan etkilerin benzer olduğu kanısına varılmıştır. Anahtar Kelimeler:

Keywords

Preemptif analjezi, gabapentin, tramadol damla, hasta kontrollü analjezi

References

• Mitchell RW, Smith G. The Control of acute postoperative pain. Br J Anaesth. 1989; 63: 147-58
• Keskin A. Operatif stratejide ağrının rolü, Ağrı. 2004; 16: 42-3.
• Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet. 2004; 43: 879 923.
• Scott LJ, Perry CM. Tramadol: a review of its use in perioperative pain. Drugs. 2000; 60: 139-76
• Katz J. Pre-emptive analgesia: importance of timing. Can J Anaesth. 2001; 48: 105-14
• Carlsson KH. Depression by morphine and the nonopioid analgesic agents, metamizol (dipyrone), lysine acetlysalicylate, and paracetamol, of activity in rat thalamus neurones evoked by electrical stimulation of nociceptive afferents. Pain. 1988; 32: 313-26.
• Bannwarth B. Plasma and cerebrospinal fluid concentrations of paracetamol after a single intravenous dose of propacetamol. Br J Clin Pharmacol. 1992; 34:79-81.
• Tang R, Evans H, Chaput A, Kim C. Multimodal analgesia for hip arthroplasty. Orthop Clin North Am. 2009; 40:377-87.
• Casali R, Lepri A, Cantini Q, Landi S, Novelli GP. Comparative study of the effects of morphine and tramadol in the treatment of postoperative pain. Minerva Anestesio. 2000; 66: 147-52.
• Wang F, Shen X, Xu S, Liu Y. Preoperative tramadol combined with postoperative small-dose tramadol infusion after total abdominal hysterectomy: a doubleblind, randomized, controlled trial. Pharmacol Rep. 2009; 61: 1198-20.
• 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
• Avellaneda C, Gómez A, Martos F, Rubio M, Sarmiento J, S. de la Cuesta F, The effect of a single intravenous dose of metamizol 2g, ketorolac 30 mg and propacetamol 1g on haedmodynamic parameters and postoperative pain after heart surgery. Eur J Anaesthesiol. 2000; 17: 85-90.
• Filitz J, Ihmsen H, Günther W, Tröster A, Schwilden H, Schüttler J, Koppert W. Supra-additive effects of tramadol and acetaminophen in a human pain model. Pain. 2008; 136: 262-70.
• 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: 308-15.
• Stephan A. Schug. Combination analgesia in 2005— a rational approach: focus on paracetamol–tramadol.
• Clin Rheumatol 2006; 25: 16–S21.
• Medve RA, Wang J, Karim R. Tramadol and acetaminophen tablets for dental pain. Anesth Prog. 2001; 48: 79-81.
• 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: 711-38.
• Rose MA, Kam PC. Gabapentin: pharmacology and its use in pain management. Anaesthesia. 2002; 57:451-62.
• Rowbothm DJ. Gabapentin: a new drug for postoperative pain? Editorial II. Br J Anaesth. 2006; 96: 152–5.
• Pandey CK, Navkar DV, Giri PJ, Raza M, Behari S, Singh RB, Singh U, Singh PK. Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy: a randomized, double-blind, placebo-controlled study. J Neurosurg Anesthesiol. 2005; 17: 65-8.
• Grover VK, Mathew PJ, Yaddanapudi S, Sehgal S. A single dose of preoperative gabapentin for pain reduction and requirement of morphine after total mastectomy and axillary dissection: randomized placebo-controlled double-blind trial. J Postgrad Med. 2009; 55: 257-60.
• Ko SH, Kwon HS, Yu JM, Baik SH, Park IB, Lee JH, Ko KS, Noh JH, Kim DS, Kim CH, Mok JO, Park TS, Son HS, Cha BY. Comparison of the efficacy and safety of tramadol/acetaminophen combination therapy and gabapentin in the treatment of painful diabetic neuropathy. Diabet Med. 2010; 27: 1033-40.
• Guttuso T Jr, Roscoe J, Griggs J. Effect of gabapentin on nausea induced by chemotherapy in patients with breast cancer. Lancet. 2003; 361: 1703–5.
• Pandey CK, Priye S, Ambesh SP, Singh S, Singh U, Singh PK. Prophylactic gabapentin for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. J Postgrad Med. 2006; 52: 97-100.
• Khademi S, Ghaffarpasand F, Heiran HR, Asefi A. Effects of Preoperative Gabapentin on Postoperative Nausea and Vomiting after Open Cholecystectomy: A Prospective Randomized Double-Blind PlaceboControlled Study. Med Princ Pract. 2010; 19: 57–60.
• Ali M, Khan FA. Comparison of analgesic effect of tramadol alone and a combination of tramadol and paracetamol in day-care laparoscopic surgery. Eur J Anaesthesiol. 2009; 26: 475-9
• Yazışma Adresi / Address for Correspondence: Dr. Yasemin Güneş Çukurova Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı 01330 Balcalı-ADANA e-mail: [e-mail] geliş tarihi/received :11.01.2013 kabul tarihi/accepted:04.02.2013