24 research outputs found
PERIOPERATIVE ANALGESIA WITH DICLOFENAK IN RECONSTRUCTIVE ACL SURGERY IN ATHLETES
SAŽETAK
Cilj istraživanja: Nesteroidni protuupalni analgetici
osnova su multimodalne analgezije i mogu znaÄajno
uÅ”tedjeti potroÅ”nju opijata pri lijeÄenju jakih poslijeoperacijskih
bolova. Preemptivni analgetski uÄinak redovitom
perioperacijskom primjenom diklofenaka nije
ispitivan u velikim ortopedskim zahvatima. Ovaj je rad
dizajniran da bi se odredilo hoÄe li preemptivna primjena
diklofenaka prijeoperacijski i u 48 poslijeoperacijskih
sati unaprijediti postojeÄi multimodalni program: smanjiti
bolove i/ili smanjiti potroŔnju opijatnog analgetika
fentanila.
Ispitanici i metode: Ispitivanje je provedeno u razdoblju
od dvije godine na 80 pacijenata koji su se podvrgavali
elektivnim rekonstrukcijskim zahvatima na prednjemu
križnom ligamentu koljena. Pacijenti su bili podijeljeni
u dvije skupnine: jedni su preemptivno veÄer prije zahvata
i u 48 poslijeoperacijskih sati dobivali 150 mg
peroralnog
diklofenaka, a drugi placebo. Svi su pacijenti
poslijeoperacijski primali kombiniranu intraartikularnu
analgeziju, kontinuiranu 24-satnu infuziju tramadola
200 mg i metamizola 2500 g te intravenski fentanil,
prema potrebi. Äetiri puta u 48 sati mjerile su se vizualno-
analogne skale bolova u mirovanju i tijekom vježbi
te 24-satna potroŔnja opijata.
Rezultati: Ispitanici u preemptivnoj diklofenak skupini
pokazali su statistiÄki znaÄajno manju prosjeÄnu
potroÅ”nju opijatnog analgetika fentanila te znaÄajno
manji intenzitet bolova u mirovanju i tijekom vježbi u
odnosu na kontrolnu skupinu (p<0,001).
ZakljuÄak: Preemptivni diklofenak pokazao je
unaprjeÄenje multimodalne analgezije u 48 poslijeoperacijskih
sati nakon elektivnoga rekonstrukcijskog zahvata
na prednjemu križnom ligamentu. Može se
preporuÄiti kao preemptivna komponenta multimodalnog
zbrinjavanja akutne poslijeoperacijske boli u rekonstrukcijskoj
kirurgiji koljena.SUMMARY
Objectives: Nonsteroidal antiinflammmatory drugs are
recommended for the multimodal analgetic management
of postoperative pain and may have significant
opioid-sparing effect after major surgery. Preemptive
analgesic efficacy of nonsteroidal antiinflammatory drug
diclofenac have not been evaluated after major orthopedic
surgery. This study was designed to determine
whether the administration of a preemptive doses of
diclofenac to patients who have undergone anterior cruciate
ligament reconstruction would enhance analgesia,
and/or decrease consumption of opioid analgetic fentanyl.
Patients and methods: We evaluated 80 patients undergoing
anterior cruciate ligament reconstruction. The
patients were divided into two groups: ones preemptively,
the night before and for 48 hr after operation,
received oral diclofenac and others placebo. All patients
postoperatively received combined intraarticular analgesia,
continious 24-hr intravenous infusion of 200 mg tramadolum and 2,5 g metamisolum and intravenous
fentanyl as needed. The outcome measures included
visual-analog pain scores at rest and movements preoperatively
and four times during 48 hours and the total
dose of fentanyl during 24 horus.
Results: The total dose of fentanyl were significantly less
in the diclofenac group, and pain scores were significantly
less in the diclofenac group at rest and movements
than in the control group (p<0,001).
Conclusion: Preemptive diclofenac demonstrated an
improved analgesic effect during 48 hours postoperatively.
Diclofenac can be reccommend as a preemptive
component of multimodal pain management in patients
undergoing anterior cruciate ligament reconstruction
Chronic obstructive pulmonary disease ā multisistemic disease
KroniÄna opstruktivna pluÄna bolest (KOPB) složena je bolest, obilježena opstrukcijom u diÅ”nim putevima uzrokovanom promjenama u diÅ”nim putevima i pluÄnom parenhimu. Posljedica je dugotrajne inhalacije toksiÄnih Äestica i plinova koji pokreÄu lokalnu i sistemsku upalu. MorfoloÅ”ke i ireverzibilne funkcionalne promjene posljedica su upale na razini diÅ”nih puteva, pluÄnog parenhima i krvnih žila. Upalne se promjene mogu dokazati i u sistemskoj cirkulaciji. Sistemne upalne promjene znaÄajno pridonose patofiziologiji brojnih izvanpluÄnih, sistemskih posljedica KOPB-a. ShvaÄanje KOPB-a kao multisustavne bolesti pridonijelo je boljem razumijevanju i novom kliniÄkom pristupu ovoj kroniÄnoj bolesti.Chronic obstructive pulmonary disease (COPD) is a disease of the lungs characterized by chronic airflow obstruction, secondary to the presence of specific structural abnormalities of the airways and the pulmonary parenchima. The etiology of the airway obstruction and emphysematous destruction that cause airway limitation is the persistent lung tissue injury produced by the chronic inhalation of toxic particles and gases. These structural abnormalities are associated with an inflammatory reaction of airways, alveoli and pulmonary vessels. This abnormal inflammatory reaction can also be detected in the systemic circulation. The systemic inflammation contributes significantly to the pathobiology of numerous extrapulmonary effects of the disease, systemic effects of COPD. The interplay between the intrapulmonary and extrapulmonary effects of COPD has important clinical outcomes
Malignant Pleural Mesothelioma in Patients Hospitalised at the Clinical Hospital Centre Rijeka between 1989 and 2008
Maligni mezoteliom pleure (MMP) relativno je rijedak tumor. Glavni mu je uzrok izloženost azbestu, i to u veÄini sluÄajeva profesionalna.
Retrospektivno smo analizirali medicinsku dokumentaciju bolesnika s MMP-om lijeÄenih u Zavodu za pulmologiju Interne klinike KliniÄkoga bolniÄkog centra Rijeka u periodu 1989.-2008. godine s ciljem
prikaza incidencije MMP-a u navedenom periodu.
U razdoblju od 1989. do 2008. godine lijeÄili smo 121 pacijenta s MMP-om, i to 117 muÅ”karaca i 4 žene.
U ovom periodu primjeÄujemo kontinuiran porast broja novooboljelih godiÅ”nje od MMP-a. Sigurnu profesionalnu izloženost azbestu naÅ”li smo kod 72 bolesnika koji su bili zaposleni u brodograÄevnoj
industriji.
Incidencija malignog mezotelioma pleure u znaÄajnom je porastu u naÅ”oj regiji. Mislimo da to nije povezano s boljom i bržom dijagnostikom veÄ s dugom latencijom bolesti te sliÄan trend oÄekujemo i ubuduÄe.
Procjena je da Äe broj oboljelih od MMP-a rasti do 2020. g. u SAD-u i Europi, dok Äe u zemljama u razvoju u kojima rad s azbestom nije adekvatno nadziran i pravno ograniÄen taj trend obolijevanja biti i duži.Malignant pleural mesothelioma (MPM) is a relatively rare tumour, mainly associated with occupational exposure to asbestos. We retrospectively analysed the records of MPM patients treated at the Pulmonology Department of the Clinic for Internal Diseases, Clinical Hospital Centre Rijeka between 1989 and 2008. to establish the incidence of MPM in that period.
Between 1989 and 2008 the hospital received 121 MPM patients, 117 of whom were men and four women.
We observed a continued increase in newly diagnosed MPM patients from year to year. Occupational exposure to asbestos was established in 72 patients who worked in shipbuilding.
In our region the incidence of MPM has been rising signifi cantly. We believe that this is not related to improved diagnostics, but to the long latency of the disease. This is why we expect this trend to continue for a while. In the USA and Europe, MPM incidence is expected to peak by 2020, while in countries with poor control over asbestos use this may take longer
RonilaÄki odgovor tijela u ronjenju u apnei
Rekreativno ronjenje je sve popularniji sport, iako je sposobnost Äovjeka da boravi na i pod vodom znaÄajno fizioloÅ”ki limitiran. Razumijevanje tih ograniÄenja poveÄava sigurnost i užitak sportskog ronjenja
COMPARISON OF WIRE GUIDED TUBE THORACOSTOMY IN COMPARISON TO CLASSICAL SURGICAL CHEST TUBE PLACEMENT
Cilj istraživanja: Torakalna drenaža standardni je postupak koji se izvodi radi drenaže
zraka i tekuÄine iz pleuralnog prostora. Cilj ovog istraživanja bio je dokazati da se koriÅ”tenjem
ciljane žicom vodiljom potpomognute tehnike torakalne drenaže s patentnim izumom, odnosno
zakrivljenim dilatatorom, može postiÄi brže, preciznije, jednostavnije i bezbolnije postavljanje
torakalnog drena s manje komplikacija i kraÄim boravkom u bolnici u odnosu na klasiÄnu
kirurŔku tehniku.
Ispitanici i metode: Istraživanje je obuhvatilo 80 bolesnika s pleuralnim izljevom i
pneumotoraksom kojima je bilo indicirano postavljanje torakalne drenaže. Bolesnici su
podijeljeni u dvije skupine. Bolesnicima u jednoj skupini (39 bolesnika) torakalni dren je
postavljen ciljanom žicom vodiljom potpomognutom tehnikom torakalne drenaže (C skupina),
a u drugoj skupini (41 bolesnik) klasiÄnom kirurÅ”kom tehnikom (K skupina). Svakom bolesniku
zabilježeni su opÄi podaci (matiÄni broj, dob, spol, visina, težina), kliniÄki parametri
neposredno prije postavljanja drena (svijest, krvni tlak, broj udaha u minuti, puls), podaci o
broju dana od postavljanja do vaÄenja torakalnog drena, broj re-drenaža, potreba za
antibioticima, bolnost mjerena VAS-ljestvicom tijekom postupka i 24 h nakon, trajanju boravka
nakon torakalne drenaže.
Rezultati: Dokazali smo da je preciznost postavljanja u C skupini statistiÄki znaÄajno
veÄa nego u K skupini. Kod svih bolesnika bez obzira na dijagnozu preciznost postavljanja
torakalnog drena bila je 78.4% u C skupini u odnosu na 36.6% u K skupini, (p < 0,001), u
skupinii bolesnika sa pleuralnim izljevom, 78,2% u C u odnosu na 37,5% K skupini (p = 0,005),
u bolesnika sa pneumotoraksom, 78.6% u C skupini u odnosu na 35.3% u K skupini (p = 0.029).
U C skupini bilo je statistiÄki znaÄajno manje curenja tekuÄine uz dren (p<0,0014). Ukupno u
C skupini bilo je statistiÄki znaÄajno manje bolesnika s komplikacijama (p<0,005) i koriÅ”tenjem
antibiotika. Po vremenu izvoÄenja postupka drenaže, bolnosti tijekom izvoÄenja postupka i 24
h nakon, pojavi subkutanog emfizema, infekciji mjesta insercije, vremenu na torakalnoj
drenaži, broju redrenaža i boravku u bolnici skupine se nisu statistiÄki znaÄajno razlikovale.
ZakljuÄak: KoriÅ”tenjem ciljane žicom vodiljom potpomognute tehnike torakalne
drenaže s patentnim izumom, odnosno zakrivljenim dilatatorom, može se postiÄi preciznije
postavljanje torakalnog drena, sa znaÄajno manje komplikacija nego klasiÄnom kirurÅ”kom
tehnikom.Objective: Thoracic drainage is the standard procedure performed for drainage of air or
fluid from the pleural space. The objective of this study was to prove that using the targeted
wire guide technique (TWG) with curve dilator can achieve faster, more accurate, easier and
less painful for patients indicated for chest tube placement with fewer complications and less
time spent in hospital, in comparison to classical surgical technique (CS).
Patients and methods: Our clinical study included total of 80 patients with indication
of thoracic drainage, due to pneumothorax or pleural effusion. The experimental group
consisted of consisted of 39 patients with chest tube placed with TWG technique. The control
group consisted of 41 patients whose chest tube was placed using the CS technique. We
registered for all the patients their personal records (i.e. PIN, age, gender, height and weight).
We also registered their clinical data (i.e. consciousness, blood pressure, respiratory rate,
pulse), number of days spent in the hospital after tube placement, number of redreinage, use of
antibiotics, soreness according to VAS scale during procedure and 24 hours after.
Results: The TWG technique with curve dilator was significantly more successful in
achieving precise chest tube placement, irrespective of patient diagnosis (TWG vs. CS in all
patients, 78.4% vs. 36.6%, p < 0.001). In the pleural effusion group, TWG and CS had success
rates of 78.2% and 37.5% (p = 0.005), respectively, while in pneumothorax group, TWG and
CS had success rates of 78.6% and 35.3% (p = 0.029), respectively. In the TWG technique
group was a significantly lesser leakage of fluid along the drain compared to the CS technique
group (p = 0.0014). In the TWG technique group was significantly lesser complication rate
(p = 0.005) and usage of antibiotics (p = 0.0434). There were no significant differences
between the two groups concerning time spent for the procedure, pain measurements, infections
of tube insertion sites, number of redreinage, number of days spent in the hospital after tube
placement.
Conclusion: We found that using the TWG technique with the curved dilator for
thoracic drainage statistically significant advantage to the TWG technique in comparison to
the CS technique regarding precise chest tube placement within the pleural cavity. In CS
technique we found statistically higher noumber of complications
COMPARISON OF WIRE GUIDED TUBE THORACOSTOMY IN COMPARISON TO CLASSICAL SURGICAL CHEST TUBE PLACEMENT
Cilj istraživanja: Torakalna drenaža standardni je postupak koji se izvodi radi drenaže
zraka i tekuÄine iz pleuralnog prostora. Cilj ovog istraživanja bio je dokazati da se koriÅ”tenjem
ciljane žicom vodiljom potpomognute tehnike torakalne drenaže s patentnim izumom, odnosno
zakrivljenim dilatatorom, može postiÄi brže, preciznije, jednostavnije i bezbolnije postavljanje
torakalnog drena s manje komplikacija i kraÄim boravkom u bolnici u odnosu na klasiÄnu
kirurŔku tehniku.
Ispitanici i metode: Istraživanje je obuhvatilo 80 bolesnika s pleuralnim izljevom i
pneumotoraksom kojima je bilo indicirano postavljanje torakalne drenaže. Bolesnici su
podijeljeni u dvije skupine. Bolesnicima u jednoj skupini (39 bolesnika) torakalni dren je
postavljen ciljanom žicom vodiljom potpomognutom tehnikom torakalne drenaže (C skupina),
a u drugoj skupini (41 bolesnik) klasiÄnom kirurÅ”kom tehnikom (K skupina). Svakom bolesniku
zabilježeni su opÄi podaci (matiÄni broj, dob, spol, visina, težina), kliniÄki parametri
neposredno prije postavljanja drena (svijest, krvni tlak, broj udaha u minuti, puls), podaci o
broju dana od postavljanja do vaÄenja torakalnog drena, broj re-drenaža, potreba za
antibioticima, bolnost mjerena VAS-ljestvicom tijekom postupka i 24 h nakon, trajanju boravka
nakon torakalne drenaže.
Rezultati: Dokazali smo da je preciznost postavljanja u C skupini statistiÄki znaÄajno
veÄa nego u K skupini. Kod svih bolesnika bez obzira na dijagnozu preciznost postavljanja
torakalnog drena bila je 78.4% u C skupini u odnosu na 36.6% u K skupini, (p < 0,001), u
skupinii bolesnika sa pleuralnim izljevom, 78,2% u C u odnosu na 37,5% K skupini (p = 0,005),
u bolesnika sa pneumotoraksom, 78.6% u C skupini u odnosu na 35.3% u K skupini (p = 0.029).
U C skupini bilo je statistiÄki znaÄajno manje curenja tekuÄine uz dren (p<0,0014). Ukupno u
C skupini bilo je statistiÄki znaÄajno manje bolesnika s komplikacijama (p<0,005) i koriÅ”tenjem
antibiotika. Po vremenu izvoÄenja postupka drenaže, bolnosti tijekom izvoÄenja postupka i 24
h nakon, pojavi subkutanog emfizema, infekciji mjesta insercije, vremenu na torakalnoj
drenaži, broju redrenaža i boravku u bolnici skupine se nisu statistiÄki znaÄajno razlikovale.
ZakljuÄak: KoriÅ”tenjem ciljane žicom vodiljom potpomognute tehnike torakalne
drenaže s patentnim izumom, odnosno zakrivljenim dilatatorom, može se postiÄi preciznije
postavljanje torakalnog drena, sa znaÄajno manje komplikacija nego klasiÄnom kirurÅ”kom
tehnikom.Objective: Thoracic drainage is the standard procedure performed for drainage of air or
fluid from the pleural space. The objective of this study was to prove that using the targeted
wire guide technique (TWG) with curve dilator can achieve faster, more accurate, easier and
less painful for patients indicated for chest tube placement with fewer complications and less
time spent in hospital, in comparison to classical surgical technique (CS).
Patients and methods: Our clinical study included total of 80 patients with indication
of thoracic drainage, due to pneumothorax or pleural effusion. The experimental group
consisted of consisted of 39 patients with chest tube placed with TWG technique. The control
group consisted of 41 patients whose chest tube was placed using the CS technique. We
registered for all the patients their personal records (i.e. PIN, age, gender, height and weight).
We also registered their clinical data (i.e. consciousness, blood pressure, respiratory rate,
pulse), number of days spent in the hospital after tube placement, number of redreinage, use of
antibiotics, soreness according to VAS scale during procedure and 24 hours after.
Results: The TWG technique with curve dilator was significantly more successful in
achieving precise chest tube placement, irrespective of patient diagnosis (TWG vs. CS in all
patients, 78.4% vs. 36.6%, p < 0.001). In the pleural effusion group, TWG and CS had success
rates of 78.2% and 37.5% (p = 0.005), respectively, while in pneumothorax group, TWG and
CS had success rates of 78.6% and 35.3% (p = 0.029), respectively. In the TWG technique
group was a significantly lesser leakage of fluid along the drain compared to the CS technique
group (p = 0.0014). In the TWG technique group was significantly lesser complication rate
(p = 0.005) and usage of antibiotics (p = 0.0434). There were no significant differences
between the two groups concerning time spent for the procedure, pain measurements, infections
of tube insertion sites, number of redreinage, number of days spent in the hospital after tube
placement.
Conclusion: We found that using the TWG technique with the curved dilator for
thoracic drainage statistically significant advantage to the TWG technique in comparison to
the CS technique regarding precise chest tube placement within the pleural cavity. In CS
technique we found statistically higher noumber of complications
RonilaÄki odgovor tijela u ronjenju u apnei
Rekreativno ronjenje je sve popularniji sport, iako je sposobnost Äovjeka da boravi na i pod vodom znaÄajno fizioloÅ”ki limitiran. Razumijevanje tih ograniÄenja poveÄava sigurnost i užitak sportskog ronjenja
COMPARISON OF WIRE GUIDED TUBE THORACOSTOMY IN COMPARISON TO CLASSICAL SURGICAL CHEST TUBE PLACEMENT
Cilj istraživanja: Torakalna drenaža standardni je postupak koji se izvodi radi drenaže
zraka i tekuÄine iz pleuralnog prostora. Cilj ovog istraživanja bio je dokazati da se koriÅ”tenjem
ciljane žicom vodiljom potpomognute tehnike torakalne drenaže s patentnim izumom, odnosno
zakrivljenim dilatatorom, može postiÄi brže, preciznije, jednostavnije i bezbolnije postavljanje
torakalnog drena s manje komplikacija i kraÄim boravkom u bolnici u odnosu na klasiÄnu
kirurŔku tehniku.
Ispitanici i metode: Istraživanje je obuhvatilo 80 bolesnika s pleuralnim izljevom i
pneumotoraksom kojima je bilo indicirano postavljanje torakalne drenaže. Bolesnici su
podijeljeni u dvije skupine. Bolesnicima u jednoj skupini (39 bolesnika) torakalni dren je
postavljen ciljanom žicom vodiljom potpomognutom tehnikom torakalne drenaže (C skupina),
a u drugoj skupini (41 bolesnik) klasiÄnom kirurÅ”kom tehnikom (K skupina). Svakom bolesniku
zabilježeni su opÄi podaci (matiÄni broj, dob, spol, visina, težina), kliniÄki parametri
neposredno prije postavljanja drena (svijest, krvni tlak, broj udaha u minuti, puls), podaci o
broju dana od postavljanja do vaÄenja torakalnog drena, broj re-drenaža, potreba za
antibioticima, bolnost mjerena VAS-ljestvicom tijekom postupka i 24 h nakon, trajanju boravka
nakon torakalne drenaže.
Rezultati: Dokazali smo da je preciznost postavljanja u C skupini statistiÄki znaÄajno
veÄa nego u K skupini. Kod svih bolesnika bez obzira na dijagnozu preciznost postavljanja
torakalnog drena bila je 78.4% u C skupini u odnosu na 36.6% u K skupini, (p < 0,001), u
skupinii bolesnika sa pleuralnim izljevom, 78,2% u C u odnosu na 37,5% K skupini (p = 0,005),
u bolesnika sa pneumotoraksom, 78.6% u C skupini u odnosu na 35.3% u K skupini (p = 0.029).
U C skupini bilo je statistiÄki znaÄajno manje curenja tekuÄine uz dren (p<0,0014). Ukupno u
C skupini bilo je statistiÄki znaÄajno manje bolesnika s komplikacijama (p<0,005) i koriÅ”tenjem
antibiotika. Po vremenu izvoÄenja postupka drenaže, bolnosti tijekom izvoÄenja postupka i 24
h nakon, pojavi subkutanog emfizema, infekciji mjesta insercije, vremenu na torakalnoj
drenaži, broju redrenaža i boravku u bolnici skupine se nisu statistiÄki znaÄajno razlikovale.
ZakljuÄak: KoriÅ”tenjem ciljane žicom vodiljom potpomognute tehnike torakalne
drenaže s patentnim izumom, odnosno zakrivljenim dilatatorom, može se postiÄi preciznije
postavljanje torakalnog drena, sa znaÄajno manje komplikacija nego klasiÄnom kirurÅ”kom
tehnikom.Objective: Thoracic drainage is the standard procedure performed for drainage of air or
fluid from the pleural space. The objective of this study was to prove that using the targeted
wire guide technique (TWG) with curve dilator can achieve faster, more accurate, easier and
less painful for patients indicated for chest tube placement with fewer complications and less
time spent in hospital, in comparison to classical surgical technique (CS).
Patients and methods: Our clinical study included total of 80 patients with indication
of thoracic drainage, due to pneumothorax or pleural effusion. The experimental group
consisted of consisted of 39 patients with chest tube placed with TWG technique. The control
group consisted of 41 patients whose chest tube was placed using the CS technique. We
registered for all the patients their personal records (i.e. PIN, age, gender, height and weight).
We also registered their clinical data (i.e. consciousness, blood pressure, respiratory rate,
pulse), number of days spent in the hospital after tube placement, number of redreinage, use of
antibiotics, soreness according to VAS scale during procedure and 24 hours after.
Results: The TWG technique with curve dilator was significantly more successful in
achieving precise chest tube placement, irrespective of patient diagnosis (TWG vs. CS in all
patients, 78.4% vs. 36.6%, p < 0.001). In the pleural effusion group, TWG and CS had success
rates of 78.2% and 37.5% (p = 0.005), respectively, while in pneumothorax group, TWG and
CS had success rates of 78.6% and 35.3% (p = 0.029), respectively. In the TWG technique
group was a significantly lesser leakage of fluid along the drain compared to the CS technique
group (p = 0.0014). In the TWG technique group was significantly lesser complication rate
(p = 0.005) and usage of antibiotics (p = 0.0434). There were no significant differences
between the two groups concerning time spent for the procedure, pain measurements, infections
of tube insertion sites, number of redreinage, number of days spent in the hospital after tube
placement.
Conclusion: We found that using the TWG technique with the curved dilator for
thoracic drainage statistically significant advantage to the TWG technique in comparison to
the CS technique regarding precise chest tube placement within the pleural cavity. In CS
technique we found statistically higher noumber of complications
Perioperacijska Analgezija Diklofenakom U Rekonstrukcijskim Zahvatima Na Koljenu SportaŔa
Objectives: Nonsteroidal antiinflammmatory drugs are recommended for
the multimodal analgetic management of postoperative pain and may have
significant opioid-sparing effect after major surgery. Preemptive
analgesic efficacy of nonsteroidal antiinflammatory drug diclofenac
have not been evaluated after major orthopedic surgery. This study was
designed to determine whether the administration of a preemptive doses
of diclofenac to patients who have undergone anterior cruciate ligament
reconstruction would enhance analgesia, and/or decrease consumption of
opioid analgetic fentanyl. Patients and methods: We evaluated 80
patients undergoing anterior cruciate ligament reconstruction. The
patients were divided into two groups: ones preemptively, the night
before and for 48 hr after operation, received oral diclofenac and
others placebo. All patients postoperatively received combined
intraarticular analgesia, continious 24-hr intravenous infusion of 200
mg tramadolum and 2,5 g metamisolum and intravenous fentanyl as needed.
The outcome measures included visual-analog pain scores at rest and
movements preoperatively and four times during 48 hours and the total
dose of fentanyl during 24 horus. Results: The total dose of fentanyl
were significantly less in the diclofenac group, and pain scores were
significantly less in the diclofenac group at rest and movements than
in the control group (p<0,001). Conclusion: Preemptive diclofenac
demonstrated an improved analgesic effect during 48 hours
postoperatively. Diclofenac can be reccommend as a preemptive component
of multimodal pain management in patients undergoing anterior cruciate
ligament reconstruction.Cilj istraživanja: Nesteroidni protuupalni analgetici osnova su
multimodalne analgezije i mogu znaÄajno uÅ”tedjeti
potroÅ”nju opijata pri lijeÄenju jakih poslijeoperacijskih
bolova. Preemptivni analgetski uÄinak redovitom perioperacijskom
primjenom diklofenaka nije ispitivan u velikim ortopedskim zahvatima.
Ovaj je rad dizajniran da bi se odredilo hoÄe li preemptivna
primjena diklofenaka prijeoperacijski i u 48 poslijeoperacijskih sati
unaprijediti postojeÄi multimodalni program: smanjiti bolove i/ili
smanjiti potroŔnju opijatnog analgetika fentanila. Ispitanici i
metode: Ispitivanje je provedeno u razdoblju od dvije godine na 80
pacijenata koji su se podvrgavali elektivnim rekonstrukcijskim
zahvatima na prednjemu križnom ligamentu koljena. Pacijenti su
bili podijeljeni u dvije skupnine: jedni su preemptivno veÄer
prije zahvata i u 48 poslijeoperacijskih sati dobivali 150 mg
peroralnog diklofenaka, a drugi placebo. Svi su pacijenti
poslijeoperacijski primali kombiniranu intraartikularnu analgeziju,
kontinuiranu 24-satnu infuziju tramadola 200 mg i metamizola 2500 g te
intravenski fentanil, prema potrebi. Äetiri puta u 48 sati mjerile
su se vizualno- analogne skale bolova u mirovanju i tijekom vježbi
te 24-satna potroŔnja opijata. Rezultati: Ispitanici u
preemptivnoj diklofenak skupini pokazali su statistiÄki
znaÄajno manju prosjeÄnu potroÅ”nju opijatnog analgetika
fentanila te znaÄajno manji intenzitet bolova u mirovanju i
tijekom vježbi u odnosu na kontrolnu skupinu (p<0,001).
ZakljuÄak: Preemptivni diklofenak pokazao je unaprjeÄenje
multimodalne analgezije u 48 poslijeoperacijskih sati nakon elektivnoga
rekonstrukcijskog zahvata na prednjemu križnom ligamentu.
Može se preporuÄiti kao preemptivna komponenta multimodalnog
zbrinjavanja akutne poslijeoperacijske boli u rekonstrukcijskoj
kirurgiji koljena