Publication: Total abdominal histerektomi sonrası epidural hasta kontrollü analjezi ile multimodal analjezinin etkinlik ve yan etkilerinin karşılaştırılması
Abstract
Çalışmamızın amacı; total abdominal histerektomi geçirecek hastalarda epidural HKA yöntemi ile multimodal analjezinin etkinliklerinin karşılaştırılmasıdır. Total abdominal histerektomi operasyonu geçirecek 20-60 yaş arası, ASA I-II grubu 60 hasta randomize olarak epidural analjezi grubu (Grup E) ve multimodal analjezi grubu (Grup M) olarak iki gruba (n=30) ayrıldı. Grup E’de hastalara yan yatar pozisyonda, L3-4 intervertebral aralığından epidural alana girilerek 15 ml’de %0.25 bupivakain HCl ve 100 µg fentanil uygulandı. Tüm hastalarda anestezi indüksiyonu 2 mg/ kg propofol ve 0.5 mg/ kg atrakuryum iv ile sağlandı. Endotrakeal entübasyon sonrasında anestezi idamesi 2 MAC sevofluran ve O2 içinde %70 N2O ile kontrollü ventilasyonla sürdürüldü. Peroperatif kalp atım hızı, ortalama arteriyel kan basıncı, periferik oksijen satürasyonu ve tidal sonu karbondiyoksit değerleri 5’er dakikalık aralar ile kaydedildi. Grup E'de peroperatif dönemde % 0.25 bupivakain ve 3µg/ ml fentanil içeren solüsyondan 10 ml/ s infüzyon uygulandı. Derlenmede ise %0.125 bupivakain + 3 µg/ ml fentanil içeren solüsyon ile bazal infüzyon 5 ml/ saat, bolus 4 ml, kilitli kalma süresi 15 dk olacak şekilde epidural hasta kontrollü analjezi başlandı. Grup M’ye indüksiyonda lornoksikam 16 mg+ deksametazon 8 mg + parasetamol 1gr iv uygulandı. Operasyon bitiminde cerrahi insizyon hattına cerrah tarafından %0.25 bupivakain 20 ml ile infiltrasyon yapıldı. Derlenmede 10 mg/ ml meperidin içeren solüsyon ile bolus 1.5 ml, kilitli kalma süresi 8 dk olacak şekilde intravenöz hasta kontrollü analjezi başlandı. Aynı zamanda parasetamol 3x1 gr ve lornoksikam 2x16 mg iv uygulanmak üzere postoperatif analjezi planlandı. Hastalarda postoperatif 48 saat boyunca; kan basıncı, kalp atım sayısı, VAS skorları, uygulanan ek analjezik miktarları ve yan etkiler, GİS fonksiyonları (ilk bağırsak sesi zamanı, ilk defekasyon zamanı), ilk mobilizasyon zamanı, taburculuk zamanı kaydedildi. İki grup arasında ortalama arter basıncı, kalp atım sayısı, VAS skorları, uygulan
The aim of our study was to compare the efficacy of epidural PCA and multimodal analgesia in patients undergoing total abdominal hysterectomy. 60 Patients, aged between 20-60 years, ASA I-II group, undergoing total abdominal histerectomy were randomly assigned into two groups (n=30) as epidural analgesia group (Group E) and multimodal analgesia group (Group M). 0.25% bupivacaine and 100 µg fentanyl in 15 ml were injected epidurally from L34 intervertebral space to Group E patients preoperatively. In all patients, anesthesia was induced with 2 mg/ kg propofol and 0.5 mg/ kg atracurium iv. After endotracheal intubation, anesthesia was maintained with 2 MAC sevoflurane and 70% N2O in O2. Peroperative heart rate, mean arterial blood pressure, peripheral oxygen saturation and ETCO2 were recorded with 5 min. intervals. Peroperatively, 0.25% bupivacaine + 3µg/ ml fentanyl solution was infused epidurally with a rate of 10 ml/ h and at the recovery room, epidural patient controlled analgesia (basal infusion 5 ml/ h, bolus 4 ml, lockout time 15 min) was started with 0.125% bupivacaine + 3 µg/ ml fentanyl solution in Group E. Lornoxicam 16 mg+dexamethasone 8 mg+ paracetamol 1gr iv were administered to Group M during anesthesia induction. At the end of the operation, the surgeon infiltrated insicion with 0.25% bupivacaine 20 ml. At the recorvery room, intravenous meperidine (10 mg/ ml) patient controlled analgesia (1.5 ml bolus dose, 8 min lockout time) was started and postoperative paracetamol 3x1 gr and lornoxicam 2x16 mg iv were administered in Group M. Mean arterial blood pressure, heart rate, visual analogue scale (VAS) scores, additional analgesic requirement, side effects, GIS functions (first bowel movement time, first defecation time), first mobilization time and discharge time were recorded. There were no significant differences in blood pressure, heart rate, VAS score antly earlier than those of multimodal analgesia group (p<0.05). In patients undergoing total abdominal hysterectomy, multimodal analgesia (iv meperidine PCA, lornoxicam, paracetamol, dexametasone and wound infiltration) providing equivalent analgesia, can be a good alternative to epidural analgesia, although first defecation time was earlier with epidural PCA.
The aim of our study was to compare the efficacy of epidural PCA and multimodal analgesia in patients undergoing total abdominal hysterectomy. 60 Patients, aged between 20-60 years, ASA I-II group, undergoing total abdominal histerectomy were randomly assigned into two groups (n=30) as epidural analgesia group (Group E) and multimodal analgesia group (Group M). 0.25% bupivacaine and 100 µg fentanyl in 15 ml were injected epidurally from L34 intervertebral space to Group E patients preoperatively. In all patients, anesthesia was induced with 2 mg/ kg propofol and 0.5 mg/ kg atracurium iv. After endotracheal intubation, anesthesia was maintained with 2 MAC sevoflurane and 70% N2O in O2. Peroperative heart rate, mean arterial blood pressure, peripheral oxygen saturation and ETCO2 were recorded with 5 min. intervals. Peroperatively, 0.25% bupivacaine + 3µg/ ml fentanyl solution was infused epidurally with a rate of 10 ml/ h and at the recovery room, epidural patient controlled analgesia (basal infusion 5 ml/ h, bolus 4 ml, lockout time 15 min) was started with 0.125% bupivacaine + 3 µg/ ml fentanyl solution in Group E. Lornoxicam 16 mg+dexamethasone 8 mg+ paracetamol 1gr iv were administered to Group M during anesthesia induction. At the end of the operation, the surgeon infiltrated insicion with 0.25% bupivacaine 20 ml. At the recorvery room, intravenous meperidine (10 mg/ ml) patient controlled analgesia (1.5 ml bolus dose, 8 min lockout time) was started and postoperative paracetamol 3x1 gr and lornoxicam 2x16 mg iv were administered in Group M. Mean arterial blood pressure, heart rate, visual analogue scale (VAS) scores, additional analgesic requirement, side effects, GIS functions (first bowel movement time, first defecation time), first mobilization time and discharge time were recorded. There were no significant differences in blood pressure, heart rate, VAS score antly earlier than those of multimodal analgesia group (p<0.05). In patients undergoing total abdominal hysterectomy, multimodal analgesia (iv meperidine PCA, lornoxicam, paracetamol, dexametasone and wound infiltration) providing equivalent analgesia, can be a good alternative to epidural analgesia, although first defecation time was earlier with epidural PCA.