Comparison of the Effectiveness of Preemptive and Postoperative Single Dose Tenoxicam in Postoperative Pain Control

Öz

mastectomy. 75 patients with mastectomy between June 2009-September 2010 were included to the study. In preemptive tenoxicam group (Group CÖ-T, n=25) tenoxicam 20 mg (2 ml) iv was given to patients 30 minutes before beginning of the surgery and saline (SF) 2 ml was given iv at the end of the surgery. In postoperative tenoxicam group (Group CB-T, n=25) patients were administered SF 2 ml iv 30 minutes before beginning of surgery and tenoxicam 20 mg at the end of the surgery. In the control group (Group Control, n=25) SF 2 ml iv was applied to patients 30 minutes before beginning of the surgery and at the end of the surgery. Postoperative patient-controlled analgesia was started. Postoperative Visual Analogue Scale (VAS) values, severity of nausea-vomiting and the amount of morphine usage, postoperative first analgesic requirement and mobilization times, hospital stays, 24-hour morphine consumption, postoperative complications, patient and nurse satisfaction were recorded. VAS values at 0th hour were found similar in Group CÖ-T and Group CB-T, but high in Group Control (p <0.05). There was no difference between the groups in VAS values at the other hours. The first analgesic requirement time of the patients was longest in Group CÖ-T and shortest in Group Control (p <0.001). Postoperative hourly and 24-hour morphine consumption were lowest in Group CÖ-T. Postoperative nausea and vomiting were observed mostly in Group Control. Patient satisfaction was higher in the tenoxicam groups than in Group Control (p<0.05). Postoperative first mobilization times, hospital stays and nurses satisfaction level were similar between the groups. We are of the opinion that preemptive tenoxicam usage is effective in postoperative pain control in patients undergoing mastectomy due to prolonging the initial analgesic requirement time and reducing the consumption of postoperative morphine.

Anahtar Kelimeler

• tenoxicam
• preemptive
• postoperative pain

Postoperatif Ağrı Kontrolünde Preemptif ve Postoperatif Tek Doz Tenoksikam Uygulamasının Etkinliğinin Karşılaştırılması

Öz

Çalışmamızda mastektomi uygulanan hastalarda preemptif ve postoperatif tenoksikam kullanımının postoperatif ağrı üzerine etkilerinin karşılaştırılması amaçlandı. Haziran 2009-Eylül 2010 tarihleri arasında mastektomi uygulanan 75 hasta çalışmaya dahil edildi. Preemptif tenoksikam grubundaki (Grup CÖ-T, n=25) hastalara cerrahi başlangıcından 30 dk önce tenoksikam 20 mg iv (2 ml), cerrahi bitiminde serum fizyolojik (SF) 2 ml iv verildi. Cerrahi sonrası tenoksikam uygulanan gruptaki (Grup CB-T, n=25) hastalara ise cerrahi başlangıcından 30 dk önce SF, cerrahi bitiminde tenoksikam uygulandı. Kontrol grubundaki (Grup Kontrol, n=25) hastalara ise cerrahi başlangıcından 30 dk önce ve cerrahi bitiminde SF uygulandı. Postoperatif hasta kontrollü analjezi başlandı. Postoperatif Görsel Analog Skala (VAS) değerleri, bulantı- kusma şiddeti ve morfin kullanım miktarları ile postoperatif ilk analjezik gereksinim ve mobilizasyon zamanları, hastanede kalış süreleri, 24 saatlik morfin tüketimleri, postoperatif komplikasyonlar, hasta ve hemşire memnuniyetleri kaydedildi. Postoperatif derlenme ünitesinde yapılan ilk değerlendirme (0. saat) VAS değeri Grup CÖ-T ve Grup CB-T’de benzer, Grup-Kontrol’de yüksek bulundu. (p<0,05). Diğer saatlerde VAS değerlerinde gruplar arasında fark yoktu. Hastaların ilk analjezik gereksinim zamanı Grup CÖ-T’de en uzun, Grup Kontrol’de en kısaydı (p<0,001). Postoperatif saatlik morfin tüketimleri ve 24 saatlik toplam morfin tüketimi Grup CÖ-T’de en düşüktü. Postoperatif bulantı-kusma en fazla Grup Kontrolde gözlendi. Hasta memnuniyeti tenoksikam kullanılan gruplarda yüksek bulunurken kontrol grubunda düşüktü (p<0,05). Postoperatif ilk mobilizasyon zamanları, hastanede kalış süreleri ile hemşirelerin memnuniyet düzeyleri gruplar arasında benzer bulundu. Preemptif tenoksikam uygulamasının ilk analjezik gereksinim zamanını uzatması, postoperatif morfin tüketimini azaltması sebebiyle mastektomi uygulanan hastalarda postoperatif ağrı kontrolünde etkin olduğu kanısındayız.

Anahtar Kelimeler

• tenoksikam
• preemptif
• postoperatif ağrı

Kaynakça

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