Laparoskopik Kolesistektomilerde Preemptif ve İntraoperatif Tramadol ve Fentanil Kullanımının Karşılaştırılması

Yıl 2022, Cilt: 6 Sayı: 1, 78 - 87, 28.04.2022

Rahşan Dilek Okyay , Pınar Durak Uluer , Selda Muslu , Ertay Boran , Ali Demirbağ , Özcan Erdemli

https://doi.org/10.29058/mjwbs.899807

Öz

Amaç: Bu çalışmada preemptif ve intraoperatif analjezi amaçlı tramadol ve fentanil uygulamalarının
hemodinami, analjezik ve nöromüsküler bloke edici ajan tüketimi, uyanma süresi ve postoperatif ağrı
üzerine etkilerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntemler: Genel anestezi altında laparoskopik kolesistektomi planlanan 120 hasta dört
gruba ayrıldı. Fentanil bolus (Grup FB) ve fentanil infüzyon (Grup Fİ) gruplarına; 2 μgkg-1 fentanil,
tramadol bolus (Grup TB) ve tramadol infüzyon (Grup Tİ) gruplarına; 2 mgkg-1 tramadol intravenöz (iv)
uygulanmasını takiben, tüm gruplarda propofol ve rokuronium indüksiyonu yapıldı. Entübasyon sonrası,
Grup Fİ’ye 0.5μgkg-1saat-1 fentanil, Grup Tİ’ye 0.5 mgkg-1saat-1 tramadol uygulandı. İntraoperatif
ek analjezi ihtiyacında Grup FB ve Grup Fİ’ye; 0.5μgkg-1 fentanil, Grup Tİ ve Grup TB’ye 0.5 mg kg-1
tramadol yapıldı. Postoperatif vizüel analog skala (VAS) >5 olduğunda meperidin ve gerektiğinde
diklofenak uygulandı. Hemodinamik veriler, fentanil, tramadol tüketimleri, uyanma süresi, VAS değerleri,
analjezik ihtiyaçlar kaydedildi.
Bulgular: İndüksiyondan sonra ortalama arter basıncı (OAB) fentanil gruplarında daha düşük bulundu
(p<0.05) Entübasyon sonrası kalp atım hızı ve OAB tramadol gruplarında daha fazla yükseldi (p<0.05).
İntraoperatif analjezik tüketimleri infüzyon gruplarında bolus uygulananlara oranla fazlaydı (p<0.05).
Nöromüsküler ajan tüketimi tramadol gruplarında fazlaydı (p<0.05). Postoperatif 5. ve 60.dk’da Grup
FB’de; VAS değerleri ile ek analjezik ihtiyacı daha fazla iken OAB düşük seyretti (p<0.05).
Sonuç: Entübasyona hemodinamik yanıtların fentanil uygulananlarda daha iyi önlendiği, preemptif ve
intraoperatif fentanil bolus uygulamalarının postoperatif analjezi sağlamada yetersiz olduğu kanısına
varıldı.

Anahtar Kelimeler

Fentanil, Tramadol, Preemptif, İntraoperatif analjezi, Derlenme, Laparoskopik Kolesistektomi

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Comparison of Preemptive and Intraoperative Use of Tramadol and Fentanyl in Laparoscopic Cholecystectomies

Öz

Aim: It was aimed to compare the effects of tramadol and fentanyl for preemptive and intraoperative
analgesia on hemodynamics, consumption of analgesics and muscle relaxants, recovery time and
postoperative pain.
Material and Methods: 120 patients scheduled for laparoscopic cholecystectomy were divided into four groups. Fentanyl bolus (Group FB)
and infusion (Group FI) groups received 2 μgkg-1 fentanyl, and tramadol bolus (Group TB) and infusion (Group TI) groups received 2 mgkg-
1 tramadol intravenously, followed by induction of propofol and rocuronium. After intubation, 0.5 μg kg-1 hour-1 of fentanyl and 0.5 mg kg-1
hour-1 of tramadol were administered to the Groups FI and TI, respectively. If additional intraoperative analgesia was required, in Groups
FB and FI 0.5 μgkg-1 fentanyl, in Groups TI and TB 0.5 mgkg-1 tramadol were administered. Meperidine and, if necessary, diclofenac were
administered with a postoperative visual analog scale (VAS) score of >5 points. Hemodynamic data, fentanyl and tramadol consumption,
postoperative recovery time, VAS scores and analgesic drugs recuirement were recorded.
Results: After induction, mean arterial pressure (MAP) was lower in fentanyl groups (p <0.05). After intubation, heart rate and MAP increased
more in tramadol groups (p <0.05). Intraoperative analgesics consumption was higher in infusion groups (p <0.05). Consumption of muscle
relaxants was higher in tramadol groups (p <0.05). At the postoperative 5th and 60th minutes, Group FB had a higher VAS score and
analgesics requirement and lower MAPs (p <0.05).
Conclusion: It was concluded that post-intubation hemodynamic responses were better-maintained in fentanyl groups. and that preemptive
and intraoperative bolus administrations of fentanyl were insufficient to provide analgesia in the postoperative period.

Anahtar Kelimeler

Fentanyl, Tramadol, Preemptive, Intraoperative Analgesia, Recovery, Laparoscopic Cholecystectomy

Proje Numarası

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Kaynakça

• 1. Smith I, Skues M, Philip BK. Ambulatory (outpatient anesthesia). In: Miller RD, editor. Miller’s anesthesia. 8th ed. Philadelphia, Elsevier, Saunders; 2015. 2612-2645.
• 2. Rosero EB, Joshi GP. Preemptive, preventive, multimodal analgesia: what do they really mean? Plast Reconstr Surg 2014;134:85S-93S.
• 3. İnal MA, Baran İ, Polat R, Özlü O. Laparoskopik kolesistektomi cerrahisinde anestezi indüksiyonu sonrası verilen deksketoprofen trometamol ve tenoksikamın postoperatif tramadol tüketimi üzerine etkilerinin karşılaştırılması. Türkiye Klinikleri J Anest Reanim 2016;14:7-13.
• 4. Murshed H, Lateef KA, Alam MR. Review on ambulatory anaesthesia. Bangladesh Armed Forces Med J 2012;45:61-66.
• 5. Gupta A. Strategies for outpatient anaesthesia. Best Pract Res Clin Anaesthesiol 2004;18:675-692.
• 6. Afanso AM, Tokita HK, McCormic PJ, Twersky RS. Enhanced recovery programs in outpatient surgery. Anesthesiol Clin 2019;37:225-238.
• 7. Comer SD, Cahill CM. Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neurosci Biobehav Rev 2019;106:49-57.
• 8. Fukuda K. Opioid Analgesics. In: Miller RD, editor. Miller’s anesthesia. 8th ed. Philadelphia, Elsevier, Saunders; 2015. 2612-2645.
• 9. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clinical Pharmacokinetics 2004;43:879-923.
• 10. Lee CR, McTavish D. Tramadol a preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in acute and chronic pain states. Drugs 1993;46:313-340.
• 11. Bigat Z, Kayacan N, Akbaş M, Karslı B, Erman M. Tramadol entübasyon ve ekstübasyonda oluşan hemodinamik yanıtı önler mi? Türk Anest Rean Der Dergisi 2003;31:214-218.
• 12. Morgan E, Murray M. Airway management. In: Butterworth JF, Mackey DC, Wasnick JD, editors. Clinical anesthesiology. 6th ed. New York, Mc Graw Hill; 2018. 528-591.
• 13. Kayhan Z. Klinik anestezi. 3. baskı. Ankara, Logos; 2004
• 14. Hagberg CA, Artime CA. Airway management. In: Miller RD editor. Miller’s anesthesia. 8th ed. Philadelphia, Elsevier, Saunders; 2015. 1647-1684.
• 15. Pang WW, Lei CH, Chang DP, Tung CC, Huang MH. The effects of tramadol versus fentanyl in attenuating hemodynamic response following tracheal intubation. Acta Anaesthesiol Sin 1999;37:191-196.
• 16. van den Berg AA, Halliday EM, Soomro NA, Rasheed A, Baloch M. Reducing cardiovascular responses to laryngoscopy and tracheal intubation: A comparison of equipotent doses of tramadol, nalbuphine and pethidine, with placebo. Middle East J Anaesthesiol 2004;17(6):1023-1036.
• 17. Pang WW, Wu HS, Lin CH, Chang DP, Huang MH. Metoclopramide decreases emesis but increases sedation in tramadol patient-controlled analgesia. Can J Anaesth 2002;49(10):1029-1033.
• 18. Grape S, Tramèr MR. Do we need preemptive analgesia for the treatment of postoperative pain? Best Pract Res Clin Anaesthesiology 2007;21:51-63.
• 19. Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77:362-379.
• 20. Mathew P, Aggarwal N, Kumari K, Gupta A, Panda N, Bagga R. Quality of recovery and analgesia after total abdominal hysterectomy under general anesthesia: A randomized controlled trial of TAP block vs epidural analgesia vs parenteral medications. J Anaesth Clin Pharmac 2019;35:170-175.
• 21. Farzi F, Naderi Nabi B, Mirmansouri A, Fakoor F, Atrkar Roshan Z, Biazar G, Zarei T. Postoperative pain after abdominal hysterectomy: A randomized, double-blind, controlled trial comparing the effects of tramadol and gabapentin as premedication. Anesth Pain Med 2016;6:e32360.
• 22. Yaksh T, Wallace M. Opioids, Analgesia, Pain Management. In: Brunton LL, Dandan RH Knollmann BC (eds). Goodman & Gilman’s the pharmacological basis of therapeutics.13th edition. New YorkMc Graw Hill; 2018, 355-386.
• 23. Wordliczek J, Banach M, Garlicki J, Jakowicka-Wordliczek J, Dobrogowski J. Influence of pre- or intraoperational use of tramadol (preemptive or preventive analgesia) on tramadol requirement in the early postoperative period. Pol J Pharmacol 2002;54(6):693-697.
• 24. Koçak ZÖ, Atıcı Ş, Cinel İ, Altunkan AA, Oral U. Laparoskopik kolesistektomi uygulanan olgularda tramadolün postoperatif ağrı üzerine etkisi. MEÜ Tıp Fak Derg 2001;2:61-66.