The comparison of three different analgesies groups for ESWL

YÖK Tez No: 225808Giriş - Amaç: ESWL (Extracorporeal Shock Wave Lithotripsy), üst üriner trakta bulunan taşın tedavisi için noninvaziv bir prosedürdür. Ancak bu tedavi yönteminin ağrılı bir işlem olduğu, işlem sırasında genel veya rejyonal analjezi gerekliliği yapılan çalışmalarla ortaya konulmuştur. Bu çalışmada ESWL tedavisi görecek hastalar için 3 farklı ajanın analjezik etkinliğinin ve yan etkilerinin karşılaştırılması amaçlanmıştır.Gereç ve Yöntem: Çalışma Ağustos 2006 ? Şubat 2007 arasında Düzce Üniversitesi ESWL polikliniğinde 30' arlı 3 gruptan oluşan toplam 90 hasta üzerinde yapılmıştır. 1. gruba parasetamol 1 g IV, 2. gruba lornoksikam 8 mg IV, 3. gruba tramadol 1.0 mg/kg IV uygulama öncesinde verildi.ESWL uygulaması sırasında hastaların ağrı değerlendirmesini yapmak için VAS (vizüel analog skala) kullanıldı. Prosedürden önce, prosedürün 1. dakikasında ve ESWL boyunca her 5 dakikada bir hemodinamik parametreler (noninvaziv sistolik-diastolik ve ortalama arter basıncı, kalp tepe atımı, solunum sayısı, periferik oksijen satürasyonu) kaydedildi. Prosedür boyunca yan etkiler bradikardi, bradipne, pruritis, bulantı kusma, baş ağrısı, baş dönmesi) kaydedildi. Hasta memnuniyeti ve ürolog memnuniyeti değerlendirildi.Bulgular: KAH ölçümleri, SAB ölçümleri, DAB ölçümleri, OAB ölçümleri, SPO2 ölçümleri gruplara göre istatistiksel olarak anlamlı farklılık göstermemektedir. VAS ölçümleri değerlendirildiğinde parasetamol, lornoksikam ve tramadolün etki başlangıç süreleri yakın olsa da, parasetamol ve lornoksikamın anajezik etki başlangıcının tramadole göre daha hızlı olduğu, ancak ilerleyen dönemde üç analjeziğin etki güçleri arasında fark olmadığı kanısına varıldı. Yan etki değerlendirmesinde gruplar arasında anlamlı fark görülmedi. Eklenen alfentanil miktarında, hasta memnuniyeti, ürolog memnuniyeti ve voltaj ölçümlerin de anlamlı farklılık görülmedi.Sonuç: Elde edilen veriler değerlendirildiğinde ESWL ağrı tedavisinde 1 g IV parasetamol, 8 mg IV lornoksikam ve 1 mg/kg IV tramadolün benzer etkiye sahip olduğu gözlenmiştir.Purpose: Extracorporeal Shock Wave Lithotripsy (ESWL) is a noninvasive procedure for the treatment of calculi located in the upper urinary tract. However previous studies indicated that this treatment method is painful, and requires general or regional analgesia during the procedure. The objective of this study was to compare the efficacy and side effect profile of three different analgesic agents.Methods: A total of 90 patients who underwent ESWL treatment at our institution Department of ESWL between August 2006 and February 2007 were randomized into 3 groups (30 in each group). Group I received paracetamol 1 g intravenous, group II received lornoxicam 8 mg intravenous, and group III received tramadol 1 mg/kg intravenous.Visual analog scale (VAS) was utilized to asses the degree of pain related to the ESWL treatment. Hemodynamic parameters (non-invasive sistolic-diastolic mean blood pressure, heart rate, respiratory rate, periferic oxygen saturation) were recorded before the procedure, at the first minute of the procedure and 5 Minutes intervals during ESWL. Also side effects (bradycardia, bradypnea, pruritus, vomiting, headache, and nausea) were recorded. Additionaly both patient and surgeon satisfaction were evaluated.Results: The measurament of hemodynamic parameters revealed no significant difference between these 3 groups. Regarding the VAS values, although the initiation of analgesic effects of these three compounds were relatively similar. Lornoxicam and paracetamol had a forter anelgesic effect than tramadol. On the other hand, it was observed that the anelgesic effects of these 3 agents were similar. Moreover, no significant difference was seen between 3 groups regarding the amount of additional alfentanil, and the degree of patient and surgeon satisfaction. On the other hand, the effect profiles of these 3 agents were also comparable.Conclusions: The results of this study suggest that paracetamol 1 g intravenous, lornoxicam 8 mg intravenous, and tramadol 1 mg/kg intravenous have similar analgesic effects with comparable side effects profile in patients who underwent ESWL treatment

Use of the bispectral index to predict a positive awareness reaction to laryngeal mask airway-Fastrach insertion and intubation

WOS: 000250249500014PubMed: 17944640Aim: To determine whether the bispectral index (BIS) can be monitored to predict and indicate an awareness reaction to laryngeal mask airway-Fastrach (LMA-Fastrach) insertion and intubation at BIS values between 40 and 60. Methods: Fifty-one American Society of Anesthesiologists' (ASA) class I or II status patients aged over 20 years were included in this study. Midazolam 0.1 mg/kg was given for pre-medication, 30 min before induction. For induction, a 0.1-mu g/kg bolus injection of remifentanil was followed by infusion, and propofol was administered until the eyelash reflex disappeared; the infusion rate was adjusted to maintain BIS values between 40 and 60. Loss of the eyelash reflex, loss of response to verbal commands, yawning and total propofol consumption were recorded. Patients were tested for awareness twice at 1-min intervals using the isolated forearm technique. The test was considered to be positive if the patient squeezed a hand when asked; after muscle relaxation, the patient was intubated and the test was repeated. In the recovery room and ward, patients were asked whether they could recall this event. Results: Seven patients tested positive: two following LMA-Fastrach insertion and the remaining five following intubation. None of the patients had recall. Conclusion: Awareness during anaesthesia may occur at BIS levels that indicate adequate anaesthesia, but this is not associated with recall of the events later

Randomized Comparison of Efficacy of Paracetamol, Lornoxicam, and Tramadol Representing Three Different Groups of Analgesics for Pain Control in Extracorporeal Shockwave Lithotripsy

WOS: 000277213300027PubMed: 20184444Purpose: Extracorporeal shockwave lithotripsy (SWL) is the mainstay treatment modality for upper urinary tract stones. However, it is a relatively painful procedure and so an efficient analgesia is required for better clinical success. The ideal method of anesthesia has not been standardized. The objective of this randomized study, for the first time in the literature, was to compare the efficacy of three common analgesics, each belonging to a different group, in pain control during SWL. Patients and Methods: In this randomized controlled study, 90 patients with upper urinary tract stones undergoing SWL were randomly divided into three groups. Group I (n = 30) received 1 g of paracetamol, group II (n = 30) received 8 mg of lornoxicam, and group III (n = 30) had 1 mg/kg of tramadol. No premedication was applied in all groups. Pain scores by visual analog scale (VAS), blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were noted before procedure and at 1 minute and every 5 minutes during the SWL. Supplementary analgesic consumption was recorded. Moreover, all adverse effects and both patient and urologist satisfaction were documented. Results: Demographic parameters of the three groups were similar. All monitored parameters were also not different among the groups. The mean VAS scores at all measured times during SWL were below 4 except for two occasions, indicating a relatively efficient overall pain control provided by these three medications. Moreover, the mean VAS scores were similar among these three groups at all measured times during SWL except for those at 5 and 20 minutes at which groups III and II showed lesser pain control, respectively. No difference was observed in the amount of supplementary analgesia, which was required at higher voltages in a majority of patients. There was no significant difference in side effects. Conclusion: This study suggests that paracetamol, lornoxicam, and tramadol can be safely and efficiently preferred in pain control during SWL