TORAKOTOMİ SONRASI AĞRI TEDAVİSİNDE İNTRAVENÖZ HASTA KONTROLLÜ ANALJEZİ YÖNTEMİ İLE PETİDİN, FENTANİL VE TRAMADOLÜN KARŞILAŞTIRILMASI
Abstract
Amaç: Torakotomi
sonrası petidin, fentanil ve tramadol’ün
intravenöz Hasta Kontrollü Analjezi (HKA)
yöntemi ile analjezik etkinliği, yan etkiler ve hemodinami üzerine olan etkilerini
karşılaştırmaktır.
Gereç ve Yöntem:
Etik Kurul onayı ile ASA I-II, 18-65 yaş arası torakotomi operasyonu geçiren 60
hasta rastgele üç gruba ayrılarak araştırmaya dahil edildi. Demografik veriler kaydedildi. Postoperatif dönemde
hastalara HKA cihazı intravenöz olarak takılıp ilaç uygulamasına başlandı. Petidin
grubunda; yükleme dozu 0.6 mg/kg, istem dozu 0.2 mg/kg, bazal infüzyon 0.1
mg/kg/saat, fentanil grubunda; yükleme dozu 0.8 mg/kg, istem dozu 0.4 mg/kg, bazal infüzyon 0.3 mg/kg/saat, tramadol grubunda; yükleme dozu 1 mg/kg, istem dozu 0.2
mg/kg, bazal infüzyon 0.1 mg/kg/saat ve üç gruptada kilitli kalma süresi 15
dakika olacak şekilde uygulandı. Başlangıç, 1, 2, 4, 6, 8, 12 ve 24. saatlerde
kan basıncı, kalp hızı, solunum sayısı, O2 satürasyonu, Vizüel
Analog Skala (VAS) ve Verbal Ağrı Skala (VS) değerleri, yan etkiler, doktor ve
hasta memnuniyetleri kayıt edildi.
Bulgular:
Demografik veriler, sistolik kan basıncı, kalp hızı,
solunum sayısı ve yan etkiler açısından üç grup arasında istatistiksel açıdan
fark bulunmadı. Başlangıç
değerlerine göre tüm ölçüm zamanlarındaki VAS ve VS değerlerinde azalma her üç
grupta istatistiksel olarak anlamlıydı (p<0.05). Gruplar arası
karşılaştırmada; sadece 8. saatte tramadol grubunun VS değerleri Petidin
grubuna göre yüksekti (p<0.05) diğer zaman dilimlerinde benzerdi. Analjezi kalitesinin hasta ve doktor tarafından
değerlendirilmesinde; gruplar arasında anlamlı fark saptanmadı.
Sonuç: Posttorakotomi ağrısında HKA yöntemi ile üç ilacın kullanılan dozlarda
ağrı skorları ve yan etkiler bakımından farkı olmadığı, bu yöntemin hastanın
tedaviye aktif katılımını sağlayarak etkili bir ağrı kontrolü sağladığı
kanısına varılmıştır.
ABSTRACT
Conclusion: The results of the study showed no difference
between the 3 drugs used in the PCA method for post-thoracotomy pain relief,
and it was concluded that effective pain control was provided by the active
participation of the patient in this treatment method.
Results:
No statistically significant difference was determined between the 3 groups in
respect of demographic data, systolic blood pressure, heartrate, respiratory
count and side-effects. Compared to the baseline values, a statistically
significant decrease was determined in all 3 groups in the VAS and VPS values
at all the measured times (p<0.05). In the comparison between the groups,
the VPS values of the tramadol group were higher than those of the pethidine
group at 8 hours (p<0.05) and at all other times were similar. No
significant difference was determined between the groups in respect of the
quality of analgesia as evaluated by the patient and physician.
Material
and Method: With the approval of the Local Ethics Committee,
the study included a total of 60 patients undergoing a thoracotomy operation.
All patients were ASA I-II, aged 18-65 years, and were randomly separated into
3 groups. Demographic data were recorded. In the postoperative period,
intravenous analgesia was administered via a PCA device. The pethidine group
were administered a loading dose of 0.6mg/kg, and a request dose of 0.2mg/kg
with a basal infusion of 0.1 mg/kg/hour. In the fentanyl group, the loading
dose was 0.8mg/kg, the request dose was 0.4mg/kg and the basal infusion 0.3
mg/kg/hour. In the tramadol group, the loading dose was 1mg/kg, the request
dose was 0.2mg/kg and the basal infusion 0.1mg/kg/hour. In all 3 groups, the
locked out time was set as 15 mins. Blood pressure, heartrate, respiratory
count, O2 saturation, visual analog scale (VAS) and Verbal Pain Scale (VPS)
values were recorded at baseline, 1, 2, 4, 6, 8, 12 and 24 hours, together with
side-effects, and patient and physician satisfaction.
Aim:
To compare the analgesic efficacy, side-effects, and effects on haemodynamics
of pethidine, fentanyl and tramadol used with the intravenous Patient
Controlled Analgesia (PCA) method following thoracotomy.
References
- KAYNAKLAR 1) Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. Anesthesiology 1994;81:737-59.2) Conacher ID. Pain relief after thoracotomy. Br J Anaesth 1990;65:806-12.3) Sechzer PH. Studies in pain with the analgesic-demand system. Anesth Analg 1971;50(1):1-10.4) Yücel A. Hasta Kontrollü Analjezi. Ufuk Matbaacılık, İstanbul,1997.5) Mather LE. Pharmacokinetics and patient controlled analgesiz. Acta Anaesth Belg 1992;43:5-20.6) Houmes RJ, Voets MA, Verkaaik A, Erdmann W, Lachmann B. Efficacy and safety of tramadol versus morphine for moderate and severe postoperative pain with special regard to respiratory depression. Anesth Analg. 1992 Apr;74(4):510-4.7) Ngan Kee WD, Lam KK, Chen PP, Gin T. Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia using pethidine or fentanyl. Anaesth Intensive Care. 1997 Apr;25(2):126-32.8) Yeğin A, Erdoğan A, Hadimioğlu N. Toraks Cerrahisinde Ameliyat Sonrası Analjezi. Turkish J Thorac Cardiovasc Surg 2005;13(4):418-25 9) Glass PSA, Estok P, Ginsberg B Goldberg JS, Sladen RN. Use of patient-controlled analgesia to compare the efficacy of epidural to intravenous fentanyl administration. Anesth Analg 1992;74:345-51.10) Boulanger A, Choiniere M, Roy D, Boure B, Chartrand D, Choquette R, Rousseau P. Comparison between patient-controlled analgesia and intramuscular meperidine after thoracotomy. Can J Anaesth 1993;40:409-15.11) Hagle ME, Lehr VT, Brubakken K, Shippee A. Respiratory depression in adult patients with intravenous patient-controlled analgesia. Orthop Nurs. 2004 Jan-Feb;23(1):18-27; quiz 28-9.12) Türk Anesteziyoloji ve Reanimasyon Derneği (TARD) Anestezi Uygulama Kılavuzları. Postoperatif Ağrı Tedavisi, Mart 2006.13) FerranteFM, Orav EJ, Rocco AG, Gallo J. A statistical model for pain in patient-controlled analgesia and conventional intramuscukar opioid regiments. Anesth Analg 1988;67:890-5.14) Peng PWH, Sandler AN. A review of the use ofb fentanyl anlgesia in the management of acute pain in adults. Anesthesiology 1999;90:576-9915) Kee WDN, Lam KK, Chen PP, Gın T. Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia using pethidine or fentanyl. Anaesth Intens Care 1997;25:126-32.16) Paech MJ, Moore JS, Evans SF, Meperidine for patient-controlled analgesia after cesarean section. Anesthesiology 1994;80:1268-76.17) Ginosar Y, Riley ET, Angst MS. The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration. Anesth Analg 2003;97(5):1428–38.18) White PF. Use of pat,i,net-controlled analgesia. An update on its use in the treatment of postoperative pain. Anesth Clin N Am 1989;7:63-78.19) Mitchell RWD, Smith G. The controll of acute postoperative pain. Br J Anaesth 1989;63:147-58.20) Parker RK, Haltman B, White PF. Pstient-controlled analgesia: failure of opioid infusion to improve pain management after surgery. JAMA 1991;266:1947-52.21) Özyalçın S, Yücel A, Erdine S. Postoperatif analjezide tramadol, petidin, morfin ve fentanil ile intravenöz PCA. Turk Anest Rean Cem Mecmuası 1997;25:207-13.22) Owen H, Mather LE, Rowley K. The development and clinical use of patient-controllled analgesia. Anaesth Intens Care 1988;16:437-4723) Plummer JL, Owen H, Ilsley AH, Inglis S. Morphine patinet-controlled analgesia is superior to meperidine patient controlled analgesia for postoperative pin. Anesth Analg 1997;84:794-9.24) Pang WW, Mok MS, Lin CH, Yang TF, Huang MH. Comparison of patient controlled analgesia (PCA) with tramadol or morphine. Can J Anesth 1999;46:1030-5.25) Hackl W, Fitzal S, Lackner F, Weindmary-Goettel M. Vergleich von fentanyl und tramadol zur schmerzbehandlung mittels on demand-analgesie-computer in der frühen postoperativen phase. Anaesthesist 1986;35:665-71.26) Vickers MD, O’Flaherty D, Szekeley SM, Read M, Yoshizumi J.Tramadol: Pain relief by an opioid without depression of respiration. Anaesthesia 1992;47:291-6.27) Woodhouse A, Hobbes AFT, Mather LE, Gibson M. A comparison of morphine, pethidine and fentanyl in the postsurgical patient-controlled analgesia environment. Pain 1996;64:115-21.28) Cade L, Ashley J. Towards optimal analgesia after caesarean section: Comparison of epidural and intravenous patient-controlled opioid analgesia. Anaesth Intens Care 1993;21:416-9.29) Woodhouse A, Ward ME, Mather LE, Intra-subject variability in postoperative patient-controlled analgesia (PCA): is the patient equally satisfied with morphine, pethidine and fentanyl. Pain 1999;80:545-53.30) Kim S, Jeon Y, Lee H, Lim JA, Park S, Kim SO. The evaluation of implementingsmartpatient controlled analgesic pump with a different infusion rate for different time duration on postoperative pain management. J Dent Anesth Pain Med. 2016 Dec;16(4):289-294.31) Hutchison RW, Chon H, Tucker WF, Gilder R Moss J, Daniel P. A Comparison of a Fentanyl, Morphine, and Hydromorphone Patient-Controlled Intravenous Delivery for Acute Postoperative Analgesia: A Multicenter Study of Opioid-Induced Adverse Reactions. Hosp Pharm Vol 41, Issue 7, 2006;41:659-63.
Abstract
References
- KAYNAKLAR 1) Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. Anesthesiology 1994;81:737-59.2) Conacher ID. Pain relief after thoracotomy. Br J Anaesth 1990;65:806-12.3) Sechzer PH. Studies in pain with the analgesic-demand system. Anesth Analg 1971;50(1):1-10.4) Yücel A. Hasta Kontrollü Analjezi. Ufuk Matbaacılık, İstanbul,1997.5) Mather LE. Pharmacokinetics and patient controlled analgesiz. Acta Anaesth Belg 1992;43:5-20.6) Houmes RJ, Voets MA, Verkaaik A, Erdmann W, Lachmann B. Efficacy and safety of tramadol versus morphine for moderate and severe postoperative pain with special regard to respiratory depression. Anesth Analg. 1992 Apr;74(4):510-4.7) Ngan Kee WD, Lam KK, Chen PP, Gin T. Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia using pethidine or fentanyl. Anaesth Intensive Care. 1997 Apr;25(2):126-32.8) Yeğin A, Erdoğan A, Hadimioğlu N. Toraks Cerrahisinde Ameliyat Sonrası Analjezi. Turkish J Thorac Cardiovasc Surg 2005;13(4):418-25 9) Glass PSA, Estok P, Ginsberg B Goldberg JS, Sladen RN. Use of patient-controlled analgesia to compare the efficacy of epidural to intravenous fentanyl administration. Anesth Analg 1992;74:345-51.10) Boulanger A, Choiniere M, Roy D, Boure B, Chartrand D, Choquette R, Rousseau P. Comparison between patient-controlled analgesia and intramuscular meperidine after thoracotomy. Can J Anaesth 1993;40:409-15.11) Hagle ME, Lehr VT, Brubakken K, Shippee A. Respiratory depression in adult patients with intravenous patient-controlled analgesia. Orthop Nurs. 2004 Jan-Feb;23(1):18-27; quiz 28-9.12) Türk Anesteziyoloji ve Reanimasyon Derneği (TARD) Anestezi Uygulama Kılavuzları. Postoperatif Ağrı Tedavisi, Mart 2006.13) FerranteFM, Orav EJ, Rocco AG, Gallo J. A statistical model for pain in patient-controlled analgesia and conventional intramuscukar opioid regiments. Anesth Analg 1988;67:890-5.14) Peng PWH, Sandler AN. A review of the use ofb fentanyl anlgesia in the management of acute pain in adults. Anesthesiology 1999;90:576-9915) Kee WDN, Lam KK, Chen PP, Gın T. Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia using pethidine or fentanyl. Anaesth Intens Care 1997;25:126-32.16) Paech MJ, Moore JS, Evans SF, Meperidine for patient-controlled analgesia after cesarean section. Anesthesiology 1994;80:1268-76.17) Ginosar Y, Riley ET, Angst MS. The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration. Anesth Analg 2003;97(5):1428–38.18) White PF. Use of pat,i,net-controlled analgesia. An update on its use in the treatment of postoperative pain. Anesth Clin N Am 1989;7:63-78.19) Mitchell RWD, Smith G. The controll of acute postoperative pain. Br J Anaesth 1989;63:147-58.20) Parker RK, Haltman B, White PF. Pstient-controlled analgesia: failure of opioid infusion to improve pain management after surgery. JAMA 1991;266:1947-52.21) Özyalçın S, Yücel A, Erdine S. Postoperatif analjezide tramadol, petidin, morfin ve fentanil ile intravenöz PCA. Turk Anest Rean Cem Mecmuası 1997;25:207-13.22) Owen H, Mather LE, Rowley K. The development and clinical use of patient-controllled analgesia. Anaesth Intens Care 1988;16:437-4723) Plummer JL, Owen H, Ilsley AH, Inglis S. Morphine patinet-controlled analgesia is superior to meperidine patient controlled analgesia for postoperative pin. Anesth Analg 1997;84:794-9.24) Pang WW, Mok MS, Lin CH, Yang TF, Huang MH. Comparison of patient controlled analgesia (PCA) with tramadol or morphine. Can J Anesth 1999;46:1030-5.25) Hackl W, Fitzal S, Lackner F, Weindmary-Goettel M. Vergleich von fentanyl und tramadol zur schmerzbehandlung mittels on demand-analgesie-computer in der frühen postoperativen phase. Anaesthesist 1986;35:665-71.26) Vickers MD, O’Flaherty D, Szekeley SM, Read M, Yoshizumi J.Tramadol: Pain relief by an opioid without depression of respiration. Anaesthesia 1992;47:291-6.27) Woodhouse A, Hobbes AFT, Mather LE, Gibson M. A comparison of morphine, pethidine and fentanyl in the postsurgical patient-controlled analgesia environment. Pain 1996;64:115-21.28) Cade L, Ashley J. Towards optimal analgesia after caesarean section: Comparison of epidural and intravenous patient-controlled opioid analgesia. Anaesth Intens Care 1993;21:416-9.29) Woodhouse A, Ward ME, Mather LE, Intra-subject variability in postoperative patient-controlled analgesia (PCA): is the patient equally satisfied with morphine, pethidine and fentanyl. Pain 1999;80:545-53.30) Kim S, Jeon Y, Lee H, Lim JA, Park S, Kim SO. The evaluation of implementingsmartpatient controlled analgesic pump with a different infusion rate for different time duration on postoperative pain management. J Dent Anesth Pain Med. 2016 Dec;16(4):289-294.31) Hutchison RW, Chon H, Tucker WF, Gilder R Moss J, Daniel P. A Comparison of a Fentanyl, Morphine, and Hydromorphone Patient-Controlled Intravenous Delivery for Acute Postoperative Analgesia: A Multicenter Study of Opioid-Induced Adverse Reactions. Hosp Pharm Vol 41, Issue 7, 2006;41:659-63.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Original research article |
| Authors | |
| Publication Date | March 14, 2019 |
| Submission Date | November 14, 2018 |
| Published in Issue | Year 2019 Volume: 52 Issue: 1 |