Lomber Diskektomi ve Laminektomi Operasyonlarında Preoperatif ve Postoperatif verilen Deksketoprofen Trometamolün Postoperatif Analjezi ve Meperidin Tüketimi Üzerine Etkisi

Öz

 Postoperatif ağrı morbiditeyi arttıran başlıca etkenlerdendir. Analjezi postopeatif morbiditenin azaltılmasında ve hastanede kalışın kısaltılmasında etkilidir. Lomber diskektomi ve laminektomi uygulanacak hastalarda hasta kontrollü analjezide kullanılan meperedin ile birlikte multimodal analjezi amacıyla preemptif ve postoperatif dönemde uygulanan deksketoprofenin etkinliğini ve yan etki profilini değerlendirmeyi amaçladık. Randomize, prospektif ve tek kör plasebo kontrollü çalışmada  lomber laminektomi ve diskektomi uygulanacak hastalar randomize olarak iki gruba ayrıldı.  Grup I kontrol-plasebo grubu, Grup II’ye indüksiyondan 30 dakika önce intravenöz 50 miligram deksketoprofen ve ikinci doz ilk dozdan 8 saat sonra  50 mg deksketoprofen verildi. VAS skorları, hasta memnuniyeti, analjezik ilişkili yan etkiler (bulantı, kusma, dispepsi, kanama, baş ağrısı, hipotansiyon, bradikardi, solunum sıkıntısı, kaşıntı) postoperatif dönemde 1,4,8,12 ve 24 saatlarde kaydedildi. Kanama cerrahi sırasında aspiratörde biriken kan, kullanılan spançlar ve postoperatif dönemde vakum drenlerden gelen kan olarak toplanarak kaydedildi. Gruplar arasında yaş,cinsiyet, ağırlık, ASA skorları, anestezi ve cerrahi sürelerinde farklılık bulunmadı. İntaroperatif ve postoperatif kanama miktarları benzerdi. Grup 1’ de PCA’dan analjezik kullanımı ihtiyacı daha erken oldu. Grup II’de; postopeartif 1, 4, 8, 12 ve 24. saat VAS değerleri daha düşük bulundu. Grup 2’de kullnaılan meperidin dozları 4,12 ve 24. saatlerde daha düşüktü.  Grup 2’ de analjezik kullanımına bağlı  gastrointestinal yan etkiler ve baş ağrısı oranları düşüktü ve hasta tatmin oranları daha yüksek bulundu. Çalışmamız lomber laminektomi ve diskektomi olgularında multimodal  analjezide deksketoprofen kullanımının kanama ve diğer yan etki oranlarında artma olmadan güvenli ve etkili bir seçenek olduğunu göstermiştir. 

Anahtar Kelimeler

• postoperatif ağrı,deksketoprofen,meperidin,laminektomi

Dexketoprofen Effectively Reduces Postoperative Pain and Meperidine Consumption After Lumbar Discectomy and Laminectomy

Öz

Postopeartive pain is a major contributor to increased morbidity. Analgesia is important in reducing postoperative morbidity and hospital stay. We aimed to determine the efficacy and side effect profile of preemptive and postoperative multimodal use of dexketoprofen added to meperidine patient-controlled analgesia  infusion in patients undergoing lumbar discectomy and laminectomy. In this randomised, prospective, single-blind placebo-controlled trial, 60 patients undergoing laminectomy and discectomy were randomly (1:1) divided into two: Group I received placebo whereas Group II received 50 milligrammes dexketoprofen intravenously 30 minutes before surgery and 8 hours after the first dose. VAS scores, overall patient satisfaction, analgesic related side effects (nausea, vomiting, dyspepsia, bleeding, headache, hypotension, bradycardia, respiratory distress, pruritus) at hours 1, 4, 8, 12 and 24 were collected after surgery.  Bleeding was recorded as the total value of aspirations during surgery, a number of sponges used during surgery and postoperative bleeding from vacuum drainage tubes. Groups were distributed similarly regarding age, sex, weight, ASA, anaesthesia and surgery time. Intraoperative and postoperative bleeding was similar. First time for PCA analgesic requirement was shorter in Group I.  Group II had lower VAS scores on postoperative hours 1, 4, 8, 12 and 24. The total dosage of meperidine was lower in Group II at the 4th, 12th and 24th hours.  Group II had lower rates of gastrointestinal side effects and headache related with analgesic use and had higher rates of satisfaction in regards of postoperative analgesia. Current study shows the multimodal use of dexketoprofen is a safe and effective analgesia option in patients undergoing lumbar discectomy and laminectomy. Dexketoprofen is not associated with increased frequency side effects or bleeding.

Anahtar Kelimeler

• postoperative pain,dexketoprofen,meperidine,laminectomy

Kaynakça

1. 1.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. Agri. 2011 Oct;23(4):153-9.2.Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001; 87: 62-72. 3.Thomas V, Heath M, Rose D, Flory P. Psychological characteristics and the effectiveness of patient-controlled analgesia. Br J Anaesth 1995; 74: 271-6.4.Bekker A, Cooper PR, Frempong-Boadu A, Babu R, Errico T, Lebovits A. Evaluation of preoperative administration of the cyclooxygenase-2 inhibitor rofecoxib for the treatment of postoperative pain after lumbar disc surgery. Neurosurgery 2002;50(5):1053-8.5.Ceyhan D, Bilir A, Güleç MS. Evaluation of the Analgesic Efficacy of Dexketoprofen Added to Paracetamol. Turk J Anaesthesiol Reanim. 2016 Dec;44(6):312-316. 6.Tuncer S, Pirbudak L, Balat O, Capar M. Adding ketoprofen to intravenous patient-controlled analgesia with tramadol after majorgynecological cancer surgery: A double- blinded, randomized, placebo-controlled clinical trial. Eur J Gynaec Oncol 2003; 24: 181-184.7.Bilir A, Gulec S, Turgut M, Cetinkaya D, Erkan A, Kurt I. Lornoxicam in extracorporeal shock-wave lithotripsy; comparison with tenoxicam and placebo in terms of anal¬gesic consumption. Scand J Urol Nephrol 2008; 42: 143-7.8.Gilron I, Milne B, Hong M. Cyclooxgenase-2 inhibitors in postoperative pain management: current evidence and future directions. Anesthesiology 2003; 99: 1198-208.9.Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001; 87: 62-72. 10.Yazar MA, Inan N, Ceyhan A, Sut E, Dikmen B. Postoperative analgesic efficacy of intravenous dexketoprofen in lumbar disc surgery. J Neurosurg Anesthesiol. 2011 Jul;23(3):193-7.11.Wheatley RG, Schug SA, Watson D. Safety and efficacy of postoperative epidural analgesia. BJA 2001; 87: 47-61.12.Wilson RJT, Leith S, Jackson IJB. Pre-emptive analgesia from intravenous administration of opioids. Anaesthesia, 1994;49: 591–593.13.Barbanoj MJ, Antanijoan RM, Gich I: Clinical pharmacokinetics of dexketoprofen. Clin Pharmacokinet 2001; 40: 245-262.14.Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Clin Pharmacol 2008 Oct 31;8:11.15.Tamsen A. Patient-controlled analgesia: A review of the current state of knowlodge. Anaesth, 1986;2: 100–107.16.Tunali Y, Akçil EF, Dilmen OK, Tutuncu AC, Koksal GM, Akbas S, Vehid H, YenturE. Efficacy of intravenous paracetamol and dexketoprofen on postoperative painand morphine consumption after a lumbar disk surgery. J Neurosurg Anesthesiol.2013;25(2):143-7. 17.Kelsaka E, Güldoğuş F, Cetinoğlu E. [Effect of intravenous dexketoprofen use on postoperative analgesic consumption in patients with lumbar disc surgery].Agri. 2014;26(2):82-6.18.Gelir İK, Güleç S, Ceyhan D. Preventive effect of dexketoprofen on postoperative pain. Agri. 2016 Apr;28(2):67-71.