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

Yıl 2021, Cilt: 47 Sayı: 1, 97 - 104, 01.04.2021

Ayşe Neslihan Balkaya , Fatma Nur Kaya , Filiz Ata , Ümran Karaca

https://doi.org/10.32708/uutfd.873439

Cited By: 1

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

• 1. Karamanoğlu A, Özer FG. Mastektomili hastalarda evde bakım. Meme Sağlığı Dergisi 2008;4:3-8.
• 2. Björkman B, Arner S, Hyden LC. Phantom breast and other syndromes after mastectomy: eight breast cancer patients desc-ribe their experiences over time: a 2-year follow-up study. J Pain. 2008;9(11):1018-25.
• 3. Dahl JB, Kehlet H. The value of pre-emptive analgesia in the treatment of postoperative pain. Br J Anaesth 1993;70:434-9.
• 4. Hebl JR, Dilger JA, Byer DE, et al. A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperati-ve outcomes after major orthopedic surgery. Reg Anesth Pain Med 2008;33:510-7.
• 5. Wall PD. The prevention of postoperative pain. Pain; 1988;33:289-90.
• 6. Grape S, Tramer MR. Do we need preemptive analgesia for the treatment of postoperative pain. Best Pract Res Clin Anaesthe-siol 2007; 21:51-63.
• 7. Katz J, McCartney CJ. Current status of pre-emptive analgesia. Curr Opin Anesthesiol 2004;15:435–41.
• 8. Moote C. Efficacy of non steroidal antiinflamatory drugs in the management of postoperative pain. Drugs 1992;44(5):14-29.
• 9. Nilsen OG. Clinical pharmocokineties of tenoksikam. Clin Pharmacokinet 1994;26:16-43.
• 10. Merry FA, Webstar SC, Holland RL, et al. Clinical tolerability of perioperative tenoxicam in 1001 patients–a prospective, controlled, double-blind, multi-centre study. Pain 2004;111: 313-22.
• 11. Morgan GE, Mikhail MS. Ağrı tedavisi. In: Lüleci N, eds. Klinik Anesteziyoloji. 4. Baskı. İstanbul: Nobel Kitabevi; 2008:359-412.
• 12. Merry AF, Sidebotham DA, Middleton NG, Calder MV, Webs-ter CS. Tenoxicam 20 mg or 40 mg after thoracotomy: a pros-pective, randomized, double-blind, placebo-controlled study. Anaesth Intensive Care 2002;30:160-6.
• 13. Talbot H, Hutchinson SP, Edbrooke DL, Wrench I, Kohlhardt SR. Evaluation of a local anaesthesia regimen following mas-tectomy. Anaesthesia 2004;59:664–7.
• 14. Huang TT, Parks DH, Lewis SR. Outpatient breast surgery under intercostal block anesthesia. Plast Reconstr Surg 1979;63:299–303.
• 15. Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ. Thoracic epidural anesthesia improves outcome after breast surgery. Ann Surg 1995;222:663–9.
• 16. Coveney E, Weltz CR, Greengrass R, Iglehart JD, Leight GS, Steele SM, et al. Use of paravertebral block anesthesia in the surgical management of breast cancer: Experience in 156 ca-ses. Ann Surg 1998;227:496–501.
• 17. Prashanth Gowtham Raj SK, Bhagyashree A. Efficacy of Preemptive oral pregabalin for prolonging post-operative anal-gesia in modified radical mastectomies. Indian Journal of Clini-cal Anaesthesia 2016;3(3): 374-9
• 18. Bharti N, Bala I, Narayan V, et al. Effect of gabapentin pretre-atment on propofol consumption, hemodynamic variables, and postoperative pain relief in breast cancer surgery. Acta Anaest-hesiol Taiwan 2013;51:10-13.
• 19. Akca T, Colak T, Kanik A, Yaylak F, Caglikulekci M, Aydın S. The effect of preoperative intravenous use of tenoxicam: a prospective, double-blind, placebo-controlled study. J Invest Surg 2004; 17:333-8.
• 20. Yazkan FO, Unsal EE. Tenoxicam Pain Effect after Tonsillec-tomy. SDU Journal of Health Science Institute 2017;8(1):124-30.
• 21. Danou F, Paraskeva A, Vassilakopoulos T, Fassoulaki A. The analgesic efficacy of intravenous tenoxicam as an adjunct to pa-tient-controlled analgesia in total abdominal hysterectomy. Anesth Analg 2000;90:672-6.
• 22. Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of pre-emptive analgesia for acute postoperative pain management: A meta-analysis, Anesth Analg 2005;100:757-73.
• 23. Yagar S, Turan SK, Ayık I, et al. Comparative study of pre-emptive and postoperative iv tenoxiam in laparoscopic cho-lecystectomy. Türk Anest Rean Der Dergisi 2011;39:19-24.
• 24. Moiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 2002;96:725-41.
• 25. Klein SM, Greengraas RA, Steele SM, et al. A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block. Anesth Analg 1998;87:1316-9.
• 26. De Decker K, Vercauteren M, Hoffmann V, Lasters B, Adria-ensen H. Piroxicam versus tenoxicam in spine surgery: a place-bo controlled study. Acta Anaesthesiol Belg 2001; 52: 265–69.
• 27. Vandermeulen EP, Van Aken H, Scholtes JL, Singelyn F, Buelens A, Haazen L. 1Intravenous administration of tenoxi-cam 40 mg for post-operative analgesia: a double-blind, place-bo-controlled multicentre study. Eur J Anaesthesiol 1997; 14: 250–57.
• 28. O’Hanlon DM, Thambipillai T, Colbert ST, Keane PW, Given HF. Timing of pre-emptive tenoxicam is important for postope-rative analgesia. Can J Anaesth 2001;48:162-6.
• 29. Colbert ST, O’Hanlon DM, McDonnell C, Given HF, Keane PW. Analgesia in day case breast biopsy- the value of pre-emptive tenoxicam. Can J Anaesth 1998;45: 217-22.
• 30. Shalaby HS, Hemada HM, Faris MA. Efficacy of Intravenous Tenoxicam as an Analgesic during the First Stage of Labor: A Randomized Controlled Trial. The Egyptian Journal of Hospital Medicine 2018;70(4): 601-9.
• 31. Arslan M, Çiçek R, Celep B, Yılmaz H, ÜSTÜN KH . Tiroi-dektomi sonrası postoperatif ağrıda intravenöz parasetamol ve lornoksikamın analjezik etkilerinin karşılaştırılması. Ağ-rı 2011;23:160-66.
• 32. Ozkan S, Yavaşcaoğlu B, Kaya FN, et al. Comparing efficacy of preemptively used dexketoprofen and tramadol for postope-rative pain in patients underwent laparoscopic cholecystectomy. JCEI 2015; 6 (1): 44-51
• 33. Jamison RN, Ross MJ, Hoopman P, et al. Assessment of posto-perative pain management: patient satisfaction and perceived helpfulness. Clin J Pain 1997;13:229-36.