Laparoskopik kolesistektomi uygulanan olgularda lornoksikam ile lornoksikam-gabapentin kombinasyonunun postoperatif analjezi üzerine etkilerinin karşılaştırılması
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Date
2012
Authors
Orhan, Gültekin
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Preemptif analjezi, nosiseptif afferent ağrı yollarının periferik ve santral sinir sisteminde bloke edilmesi ile santral sensitizasyon ve postoperatif ağrı oluşumunu engellemeyi amaçlar. Çalışmamızda, elektif laparoskopik kolesistektomi operasyonu planlanan olgularda, operasyondan önce peroral uygulanan lornoksikam ile lornoksikam-gabapentin kombinasyonunun postoperatif analjezi üzerine etkilerini karşılaştırmayı amaçladık.Etik kurul onayı ve hastaların yazılı onamları alındıktan sonra, randomize olarak planlanan çalışmaya ASA I-II grubu, 18-75 yaş aralığında elektif laparoskopik kolesistektomi planlanan 50 olgu dahil edilerek iki gruba ayrıldı. Lornoksikam grubuna (n=25) operasyondan 1 saat önce, peroral 8 mg lornoksikam, Lornoksikam-Gabapentin grubuna (n=25) peroral 8 mg lornoksikam ile 800 mg gabapentin verildi. İntraoperatif dönemde hemodinamik parametreler, postoperatif dönemde ise ilk analjezik gereksinim zamanı, ek analjezik gereksinimleri, ağrı ve sedasyon skorları, morfin tüketim miktarları, yan etkiler ve hasta memnuniyeti takip edilerek kayıt edildi.Demografik veriler, anestezi ve cerrahi süreleri, intraoperatif hemodinamik parametreler, postoperatif sedasyon skorları ve hasta memnuniyeti her iki grupta benzer bulundu. Grup Lornoksikam-Gabapentin' de 24 saatlik morfin tüketiminin daha az olduğu görüldü (p<0.001). Postoperatif 18. saatte ağrı skorları Lornoksikam-Gabapentin grubunda daha düşük bulundu (p=0.036). Postoperatif dönemde ek analjezik gereksinimi olan hasta sayısı Grup Lornoksikam'da daha fazla olarak saptandı (p=0.002). Yine postoperatif dönemde ilk analjezik gereksinim zamanları Grup Lornoksikam'da daha kısa bulundu (p<0.001).Preemptif 8 mg lornoksikam - 800 mg gabapentin kombinasyonu ile yalnızca 8 mg lornoksikam uygulanan olguları karşılaştırdığımızda, Lornoksikam-Gabapentin grubunda postoperatif ağrı skorları ve morfin tüketimlerinin daha düşük olduğunu, ilk analjezik gereksinim zamanlarının daha uzun olduğunu, ek analjezik gereksinimlerinin daha az olduğunu saptadık. Lornoksikam-gabapentin kombinasyonunun, lornoksikama göre daha etkin postoperatif analjezi sağladığı kanısındayız.
The purpose of preemptive analgesia is blockage of nociceptive afferent pain pathways in peripheral and central nervous system and preventing the establishment of central sensitization and postoperative pain. The aim of our study was to investigate the effects of preoperative administered peroral lornoxicam and lornoxicam-gabapentine combination on postoperative pain scores.After approval from ethical committee, randomized study, ASA I-II, aged 18-75 years who were undergo elective laparoscopic cholecystectomy 50 cases were enrolled and divided into two groups. In group lornoxicam (n=25), 8 mg lornoxicam were given 1 hour prior to surgical incision, in group lornoxicam-gabapentine (n=25) 800 mg gabapentine added with 8 mg lornoxicam. Intraoperative hemodynamic parameters and postoperative first analgesic requirement, additional analgesic requirement, pain and sedation scores, morphine consumption, adverse effects and patient satisfaction scores were recorded.There were no significant differences in demographic data, duration of anesthesia and surgery, intraoperative hemodynamic parameters, postoperative sedation scores, and patient satisfaction scores between the groups. Total morphine consumption in postoperative 24 hours was lower in group lornoxicam-gabapentine when compared with other group (p<0.001). Postoperative 18. hour pain scores were lower in Group Lornoxicam-Gabapentine (p=0.036). Postoperative additional analgesic requirement was higher in Group Lornoxicam (p=0.002). Also first analgesic requirement time was lower in Group Lornoxicam (p<0.001).When we compare preemptive administration of 8 mg lornoxicam- 800 mg gabapentine combination with 8 mg lornoxicam; we found that the administration of lornoxicam-gabapentine provides effective analgesia with decreasing postoperative opioid consumption, prolonged first analgesic requirement and additional analgesic requirement was also lower. Lornoxicam-gabapentine combination can provide effective postoperative analgesia, than lornoxicam alone.
The purpose of preemptive analgesia is blockage of nociceptive afferent pain pathways in peripheral and central nervous system and preventing the establishment of central sensitization and postoperative pain. The aim of our study was to investigate the effects of preoperative administered peroral lornoxicam and lornoxicam-gabapentine combination on postoperative pain scores.After approval from ethical committee, randomized study, ASA I-II, aged 18-75 years who were undergo elective laparoscopic cholecystectomy 50 cases were enrolled and divided into two groups. In group lornoxicam (n=25), 8 mg lornoxicam were given 1 hour prior to surgical incision, in group lornoxicam-gabapentine (n=25) 800 mg gabapentine added with 8 mg lornoxicam. Intraoperative hemodynamic parameters and postoperative first analgesic requirement, additional analgesic requirement, pain and sedation scores, morphine consumption, adverse effects and patient satisfaction scores were recorded.There were no significant differences in demographic data, duration of anesthesia and surgery, intraoperative hemodynamic parameters, postoperative sedation scores, and patient satisfaction scores between the groups. Total morphine consumption in postoperative 24 hours was lower in group lornoxicam-gabapentine when compared with other group (p<0.001). Postoperative 18. hour pain scores were lower in Group Lornoxicam-Gabapentine (p=0.036). Postoperative additional analgesic requirement was higher in Group Lornoxicam (p=0.002). Also first analgesic requirement time was lower in Group Lornoxicam (p<0.001).When we compare preemptive administration of 8 mg lornoxicam- 800 mg gabapentine combination with 8 mg lornoxicam; we found that the administration of lornoxicam-gabapentine provides effective analgesia with decreasing postoperative opioid consumption, prolonged first analgesic requirement and additional analgesic requirement was also lower. Lornoxicam-gabapentine combination can provide effective postoperative analgesia, than lornoxicam alone.
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Keywords
Laparoskopik kolesistektomi, Gabapentin, Lornoksikam, Postoperatif, Analjezi, Laparoscopic cholecystectomy, Gabapentine, Lornoxicam, Postoperative, Analgesia
Citation
Orhan, G. (2012). Laparoskopik kolesistektomi uygulanan olgularda lornoksikam ile lornoksikam-gabapentin kombinasyonunun postoperatif analjezi üzerine etkilerinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.