Total diz artroplastisi uygulanan hastalarda postoperatif tramadol etkinliğinin CYP2D6*17 genomu ilişkisi

Öz

Amaç: Geriatrik hastalarda tramadol idamesinin VAS skoruna etkisini incelediğimiz çalışmamızda ameliyat sonrası 60. dakikaya kadar gözlem yaptık. Çalışmada diz artroplastisi uygulanan hastalarda ağrı insidansını araştırdık. Ameliyat sonrası tramadol etkinliğine CYP2D6 genomunun *17 alelinin etkisini incelemeyi amaçladık. Gereç ve yöntem: Bu çalışmaya Pamukkale Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı’nda servisimize total diz antroplastisi uygulanan 110 hasta ve kontrol grubu olarak şikâyeti olmayan sağlıklı 100 kişi dahil edildi. Her hastaya intravenöz yoldan 100 mg Tramadol (contramal) uygulandı. Hastaların post-op 0-15-30-45-60. dk VAS skorları kaydedildi. Bulgular: Hastalar ortalama 62,36 yaşındaydı. Çalışmamızdaki hastaların %86,4’ü kadınken kontrol grubunda bu oran %46 olarak bulundu. *17 alelinin varlığı hasta (n=7) ve kontrol grubunda (n=7) toplamda %3,65 oranında (n=14) *17 taşıyıcısına rastladık. VAS postoperartive 0. dakikada *1/*1 grubundaki hastaların VAS skoru 91,07 ve *1/*17 genomunun VAS skoru 95,0 şeklindeydi ve genomlar arasında istatistiksel olarak anlamlı bir farklılık yoktu (p>0,050). Benzer şekilde ameliyat sonrası 15., 30., 45. ve 60. dakikada da genomlar arasında istatistiksel olarak anlamlı bir farklılık yoktu (p>0,050). Zamana bağlı değişimde her iki gruptada post-op VAS skorunun 0-60 dakika arasında istatistiksel olarak anlamlı şekilde düştüğünü gördük (p=0,000). Sonuç: Tramadolun *17 aleli ile ilişkisinde IM veya EM olarak sınıflandırıldığı literatürdeki farklı sonuçlar alınmış çalışmaları incelediğimizde bizim çalışmamızın sonuçlarına göre: *17 aleli EM ile NM şeklinde değerlendirilmesi gerektiğini düşünüyoruz.

Anahtar Kelimeler

• Total diz artroplastisi
• CYP2D6
• Tramadol
• CYP2D6*1/*17
• ameliyat sonrası ağrı

The relationship of postoperative tramadol activity with the CYP2D6*17 genome in total knee artroplasty patients

Abstract

Purpose: In our study, we examined the effect of tramadol maintenance on the VAS score in geriatric patients. We observed them until the postoperative 60th minute. We investigated the incidence of pain in patients who underwent knee arthroplasty in the study. Our aim was to examine the effect of the *17 allele of the CYP2D6 genome on postoperative tramadol activity. Materials and methods: In our study we examined 110 patients who underwent total knee arthroplasty in the Department of Orthopedics and Traumatology at our facility, along with 100 healthy individuals without complaints who served as the control group. Each patient received a 100 mg dose of intravenous tramadol (Contramal). The postoperative VAS scores of the patients were recorded at 0-15-30-45-60 minutes. Results: The average age of the patients was 62.36 years. In our study, 86.4% of the patients were female, while this rate was 46% in the control group. We found that 3.65% of individuals (*17 carriers) possessed the *17 allele in both the patient group (n=7) and the control group (n=7). At the postoperative 0th minute, the VAS score for patients in the *1/*1 group was 91.07, while for the *1/*17 group, it measured 95.0. There was no statistically significant difference between the genomes (p>0.050). Likewise, no statistically significant difference was found between the genomes at the postoperative 15th, 30th, 45th, and 60th minutes (p>0.050). However, we observed a statistically significant decrease in the postoperative VAS score between 0-60 minutes in both groups, indicating time-dependent variation (p=0.000). Conclusion: When examining diverse literature on tramadol classification as intermediate metabolizer (IM) or extensive metabolizer (EM) concerning the *17 allele, our study indicates that the *17 allele should be regarded as both extensive metabolizer (EM) and normal metabolizer (NM).

Keywords

• Total knee arthroplasty CYP2D6
• Tramadol
• CYP2D6*1/*17
• postoperartive pain

Kaynakça

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