Publication: Gömülü üçüncü molar diş cerrahisinde Tramadol ve Fentanilin anksiyete ve postoperatif ağrı üzerine etkilerinin karşılaştırılması
Abstract
1. ÖZET Bu çalışmada amaç; gömülü 3. molar diş çekimi operasyonu endikasyonu bulunan ve korkan hastalarda anksiyete düzeyini düşürmek amacıyla uygulanan sedasyon işlemlerinde midazolam ile kombine edilen fentanil ve tramadolün anksiyete ve postoperatif ağrı üzerine etkisini araştırmaktır. Bu prospektif, randomize, çift kör ve plasebo kontrollü çalışmaya, horizontal gömülü üçüncü molar diş cerrahi çekimi gerçekleşecek APAIS verileri 10’un üzerinde olan 60 hasta dâhil edilmiştir. Hastalar, 0.03 mg/ kg iv midazolam bolus dozunun uygulanmasını takiben üç gruba ayrılıp Grup A sadece midazolam, Grup B midazolam ve 1µg/ kg fentanil, Grup C midazolam ve tramadol 1 mg/ kg uygulanmıştır. Tüm vital bulgular, intraoperatif PSI verileri kaydedilmiş; hastalar postoperatif ağrı, yan etkiler, hasta ve hekim memnuniyeti açısından değerlendirilmiştir. Sedasyon süresince kalp atım sayılarında istatistiksel olarak anlamlı bir fark tespit edilmemiştir (p>0.05). Ortalama arter basınçlarında 40. dakikaya kadar istatistiksel olarak anlamlı bir fark yok iken (p>0.05), 40. dakikadan itibaren Grup A’nın ortalama arter basıncının her iki gruptan daha düşük olduğu görülmüştür (p<0.01). PSI verilerinde gruplar arası fark saptanmamıştır (p>0.05). Postoperatif ilk 1 saat içinde Grup C’deki VAS değerleri diğer iki gruptan anlamlı düzeyde daha düşük olduğu tespit edilmiştir (p<0.05). Gruplar ilk ilaç alım zamanı açısından değerlendirildiğinde A, B, C gruplarının ilk ilaç alım zamanı sırasıyla 3, 3.5, 5 saat olarak tespit edilmiş olup, Grup C’deki hastaların ilk ilaç alım zamanlarının diğer iki gruptan anlamlı şekilde daha uzun olduğu saptanmıştır (p<0.01). Gruplar arası hasta-hekim memnuniyeti açısından herhangi bir fark tespit edilmemiştir. Bütün bu veriler göz önüne alındığında tramadol üçüncü molar diş cerrahi çekim ağrısında fentanile ve plaseboya göre daha etkin bir analjezi sağlamaktadır. Anksiyete, bilinçli sedasyon, fentanil, oral cerrahi, postoperatif ağrı, tramadol. 2.
COMPARING THE EFFECT OF TRAMADOL AND FENTANYL ON ANXIETY AND POSTOPERATIIVE PAIN IN IMPACTED THIRD MOLAR SURGERY The aim of this study was to evaluate and compare the effect of fentanil and tramadol, used in combination in the sedation procedures in dentistry to control anxiety of the patients, on postoperative third molar surgical extraction pain and patints’ anxiety. This prospective randomized double-blind placebo-controlled study include 60 patient having horizontal third molar extraction operation indication and whose APAIS scores above 10 point. All the paients firstly were given 0.03 mg/ kg bolus midazolam and then they were randomized three groups; Group A only midazolam, Group B midazolam and 1µg/ kg fentanyl, Grup C midazolam and 1 mg/ kg tramadol. All the vital signs were recorded and intraoperatif PSI samples were taken. Patients were assessed for postoperatif pain, adverse effects, patient-surgeon satisfaction. No differences were found in the heart rate records between the groups (p>0.05). Mean blood pressure readings were also similar till the 40th minute after when mean blood pressure of the patients in Group A were found lower then the other two groups (p<0.01). No difference was found in PSI scores between the groups (p<0.05). In the postoperative pain assessments, VAS scores of paients in Group C were lower than the other two groups in the postoperative 1st hour (p<0.05). The first rescue analgesic taking time in Groups A, B, C were reported 3, 3.5, 5 hours respectively and the first rescue analgesic taking time in Groups C was determined much longer than the other two groups (p<0.01). No difference was found in the patint- surgeon satisfaction between the groups. In conclusion tramadol has a better analgesic effect on third molar surgery than fentanil and placebo. Key Words: Anxiety, conscious sedation, fentanyl, oral surgery, potoperative pain, tramadol.
COMPARING THE EFFECT OF TRAMADOL AND FENTANYL ON ANXIETY AND POSTOPERATIIVE PAIN IN IMPACTED THIRD MOLAR SURGERY The aim of this study was to evaluate and compare the effect of fentanil and tramadol, used in combination in the sedation procedures in dentistry to control anxiety of the patients, on postoperative third molar surgical extraction pain and patints’ anxiety. This prospective randomized double-blind placebo-controlled study include 60 patient having horizontal third molar extraction operation indication and whose APAIS scores above 10 point. All the paients firstly were given 0.03 mg/ kg bolus midazolam and then they were randomized three groups; Group A only midazolam, Group B midazolam and 1µg/ kg fentanyl, Grup C midazolam and 1 mg/ kg tramadol. All the vital signs were recorded and intraoperatif PSI samples were taken. Patients were assessed for postoperatif pain, adverse effects, patient-surgeon satisfaction. No differences were found in the heart rate records between the groups (p>0.05). Mean blood pressure readings were also similar till the 40th minute after when mean blood pressure of the patients in Group A were found lower then the other two groups (p<0.01). No difference was found in PSI scores between the groups (p<0.05). In the postoperative pain assessments, VAS scores of paients in Group C were lower than the other two groups in the postoperative 1st hour (p<0.05). The first rescue analgesic taking time in Groups A, B, C were reported 3, 3.5, 5 hours respectively and the first rescue analgesic taking time in Groups C was determined much longer than the other two groups (p<0.01). No difference was found in the patint- surgeon satisfaction between the groups. In conclusion tramadol has a better analgesic effect on third molar surgery than fentanil and placebo. Key Words: Anxiety, conscious sedation, fentanyl, oral surgery, potoperative pain, tramadol.