Comparison of The Effects of Intravenous Dexketoprofen, Lornoksicam and Diclofenac Sodium on Analgesic Effect and Tramadol Consumption In Patients Receiving Patient Controlled Tramadol.

TEZ9224Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2011.Kaynakça (s. 53-61) var.ix, 62 s. : res. (bzs. rnk.), tablo ; 29 cm.Amaç: Prospektif, randomize, çift kör, kontrollü çalışmamız postoperatif hasta kontrollü tramadol kullanan hastalarda anestezinin sonlanmasından 30 dakika önce başlayan ve 24 saat boyunca aralıklı bolus olarak devam eden deksketoprofen, lornoksikam ve diklofenak sodyum?un analjezi ve tramadol tüketimine etkilerinin karşılaştırılması amacıyla planlandı. Gereç ve Yöntem: İlaç Araştırmaları Etik Kurulu ve hastaların yazılı onayı alınarak elektif laparotomi uygulanan 80 hasta çalışmaya dahil edildi. Hastalar rastgele seçimle dört eşit gruba ayrıldı. Anestezi bitiminden otuz dakika önce birinci gruba (Grup I) 50 mg intravenöz deksketoprofen, ikinci gruba (GrupII) 8 mg intravenöz lornoksikam, üçüncü gruba (Grup III) 75 mg intravenöz diklofenak sodyum ve dördüncü gruba (Grup IV) ise 2 ml % 0,9 serum fizyolojik uygulandı. Periton kapatılması sırasında tüm hastalara postoperatif ağrının tedavisi için 1 mg/kg dozda tramadol yükleme dozu verildi. Tramadol?ü 0,2 mg/kg bolus olarak verebilen hasta kontrollü analjezi (HKA) cihazını hastaların kullanmasına izin verildi. HKA başlamasından sonra, hasta konforu, sedasyon, ağrı skorları, toplam tramadol tüketimleri, ek meperidin gereksinimi ve yan etkiler 1. dk?da ve 1., 2., 6., 12., 24. saatlerde kaydedildi. Bulgular: Grup III?de 1.dk?dan itibaren, Grup I ve II?de ise 30. dakikadan itibaren 24. saate kadar tüm çalışma periyodlarında sözel ağrı skorlarının Grup IV?e göre istatistiksel olarak önemli derecede düşük olduğu tespit edildi (p<0,001). Grup III?te 1. saatten, Grup I ve II de ise 6. saatten sonraki tüm çalışma periyodlarında ortalama tramadol tüketimi Grup IV?e göre önemli derecede düşük olduğu belirlendi(p<0,009). Ek meperidine gereksinim duyan hasta sayısının postoperatif 30. dakikadan sonraki tüm çalışma periyodlarında, Grup IV?te diğer gruplara göre önemli derecede yüksek olduğu belirlendi (p<0,01). Gruplar arasında bulantı ve kusma sıklığının Grup I, II ve III?de grup IV?e göre istatistiksel olarak önemli derecede daha az olduğu belirlendi (p<0,05). Sonuç: Tedavi grupları arasında diklofenak sodyum diğer gruplara göre en az tramadol tüketimi ve en düşük ağrı skorları sağladı.Aim: This prospective, randomized, double blinded, controlled study was designed to compare the effects of dexketoprofen, lornoksicam and diclofenac sodium, starting 30 minutes before the end of anaesthesia and continuing for 24 hour as an intermittent bolus, on postoperative analgesic effect and tramadol consumption in patients receiving postoperative patient controlled tramadol Material and Method: Following approval of drug research ethical committee and patient written consent, 80 patients undergoing elective laparotomy were recruited. Patients were randomly allocated into four groups. Thirty minutes before the end of anaesthesia; the first group (Group I) received 50 mg of dexketoprofen, the second group (Group II) received 8 mg of lornoksicam, the third group (Group III) received 75 mg of diclofenac sodium and the fourth group (Group IV) the control group and received 2 cc of 0.9 % saline intravenously. At the closure of peritoneum, all patients were given a loading dose of tramadol (1 mg/kg) for the management of postoperative analgesia. Patients were allowed to use a patient-controlled analgesia (PCA) device giving a bolus dose of tramadol 0.2 mg/kg. Discomfort, sedation, pain scores, cumulative tramadol consumption, supplement meperidine requirement and side effects were recorded at the first minute and at 1,2, 6, 12 and 24 hours after start of PCA. Results: Pain scores were significantly lower in group III at each study period than in group IV, whereas it was significantly lower in group I and II at only after postoperative 30 min than in group IV (p<0.01). Tramadol consumption was significantly lower in group III at each study period after the first postoperative hour than in group IV (p<0.009). It was also significantly lower in group I and II at each study period after the sixth postoperative hour than in group IV (p<0.001). The number of patients requiring supplement meperidine were found significantly higher in group IV at each study period after postoperative 30 min than in the other groups (p<0.01). The incidence of nausea and vomiting was found significantly lower in group I, II and III than in group IV (p<0.05). Conclusion: Among the treatment groups, diclophenac sodium provided lowest tramadol consumption and lower pain scores compared to the other treatment drugs.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi tarafından desteklenmiştir. Proje No: TF2010LTP36

İnguinal herni tamiri sonrası postoperatif ağrı üzerinde intratekal fentanil ve intratekal morfinin etkilerinin karşılaştırılması

Purpose: The aim of this study was to compare the effects of intrathecal fentanyl and intrathecal morphine combined with spinal anesthesia on postoperative pain control for inguinal hernia repair. Materials and Methods: Fifty patients aged 18-60 years with American Society of Anesthesiologists physical status I-II scheduled for elective inguinal hernia repair surgery were enrolled in this prospective randomized double-blinded study. Patients received spinal anesthesia with either 25 mcg fentanyl plus 12.5 mg heavy bupivacaine intrathecally (group F, n=25) or 0.1 mg morphine plus 12.5 mg heavy bupivacaine intrathecally (group M, n=25).Hemodynamic parameters, time to first analgesic requirement, postoperative pain scores, the number of analgesic requirements and side effects over postoperative 24 h were recorded. Results: Pain scores were significantly lower in group M compared with group F in the postoperative 24 h. The time to first analgesic requirement was higher in group M than group F. Analgesic requirement was higher in group F than group M for postoperative 24 h. Conclusion: We concluded that the addition of 0.1 mg morphine intrathecally to 12.5 mg heavy bupivacaine provides improved postoperative analgesia, especially after postoperative 12 h than 25 mcg fentanyl for inguinal hernia repair under spinal anesthesia.Amaç: Çalışmamızın amacı inguinal herni onarımı geçiren hastalarda intratekal fentanil ve intratekal morfin ile uygulanan spinal anestezinin postoperatif ağrı etkilerini karşılaştırmaktır. Gereç ve Yöntem: Elektif inguinal herni onarımı geçirecek olan 18-60 yaşları arasında, Amerikan Anesteziyologları Derneği fizik durum I-II’ye sahip olan 50 hasta, prospektif, randomize çift kör çalışmamıza dahil edildi. Hastalara 12.5 mg heavy bupivakaine ilave olarak bir grupta 25 mcg fentanil (grup F, n=25) ve diğer grupta 0,1 mg morfin (grup M, n= 25) intratekal yolla uygulandı. Hemodinamik ölçümler, postoperatif ilk analjezik gereksinimi için geçen süre, postoperatif ağrı skorları, analjezik gereksinim sayısı ve yan etkiler 24 saat içinde kaydedildi. Bulgular: Postoperatif 24 saatte ağrı skorları, grup F ile karşılaştırıldığında grup M’de belirgin olarak düşüktü. Postoperatif ilk analjezik gereksinim için geçen süre, grup M’de grup F’ye göre belirgin yüksekti. Postoperatif 24 saat için kümülatif analjezik gereksinim sayısı grup F’de grup M’e göre belirgin yüksekti. Sonuç: İnguinal herni tamiri geçirecek hastalarda spinal anestezi amacıyla intratekal 12,5 mg heavy bupivakaine 0,1 mg morfin eklenmesi, 25 mcg fentanil eklenmesine göre özellikle postoperatif 12 saat sonra daha etkili analjezi oluşturmuştur

A Comparative Study of the Efficacy of IV Dexketoprofen, Lornoxicam, and Diclophenac Sodium on Postoperative Analgesia and Tramadol Consumption in Patients Receiving Patient-Controlled Tramadol

OBJECTIVE: This study was designed to compare the effects of dexketoprofen, lornoxicam, and diclophenac sodium on postoperative analgesia and tramadol consumption in patients receiving postoperative patient-controlled tramadol after a major abdominal surgery. METHODS: Eighty patients were randomized to receive one of the four study drugs. Patients in group dexketoprofen (DT) received IV 50 mg dexketoprofen, group lornoxicam (LR) received IV 8 mg lornoxicam, group diclophenac sodium (DS) received 75 mg IV diclophenac sodium and group saline (S) received 0.9% saline in 2 mL syringes, 20 min before the end of anaesthesia. A standardized (1 mg kg(−1)) dose of tramadol was routinely administered to all patients as the loading dose at the end of surgery. Postoperatively, whenever patients requested, they were allowed to use a tramadol patient-controlled analgesia device giving a bolus dose (0.2 mg kg(−1)) of tramadol. Pain, discomfort, and sedation scores, cumulative tramadol consumption, supplemental meperidine requirement, and side effects were recorded. RESULTS: Visual rating scale and patient discomfort scores were significantly lower in DT, LR and DS groups compared to those in in group S (p<0.001). Cumulative tramadol consumption was significantly lower in non-steroidal anti-inflammatory drug (NSAID)-treated groups at each study period after the second postoperative hour than in group S (p<0.001). Supplemental meperidine requirement was significantly higher in group S at each study period after postoperative 30 min than in NSAID-treated groups (p<0.01). CONCLUSION: After major abdominal surgery, adding IV diclophenac, lornoxicam or dexketoprofen to patient-controlled tramadol resulted in lower pain scores, smaller tramadol consumption, less rescue supplemental analgesic requirement, and fewer side effects compared with the tramadol alone group

Hasta kontrollü tramadol alan hastalarda deksketoprofen, lornoksikam ve diklofenak sodyumun postoperatif analjezi ve tramadol tüketimi üzerine etkilerinin karşılaştırılması

GİRİŞ ve AMAÇ: Çalışmamızda büyük abdominal cerrahi sonrası deksketoprofen, lornoksikam ve diklofenak sodyumun postoperatif analjezi ve tramadol tüketimi üzerine etkilerinin karşılaştırılmasını amaçladık. YÖNTEM ve GEREÇLER: Çalışmaya dahil ettiğimiz 80 hastayı randomize olarak dört gruba ayırdık. Anestezinin sonlandırılmasından 20 dakika önce hastalara grup deksketoprofende (DT) deksketoprofen 50 mg IV, grup lornoksikamda (LR) lornoksikam 8 mg IV, grup diklofenak sodyumda (DS) diklofenak sodyum 75 mg IV ve grup salinde (S) %0,9 salin 2 mL IV uyguladık. Cerrahinin bitiminde yükleme dozu olarak tüm hastalara tramadol 1 mg kg-1 IV uyguladık. Postoperatif dönemde tüm hastalara 0,2 mg kg-1 bolus dozunda tramadol verecek olan hasta kontrollü analjezi cihazı kurduk. Ağrı, hasta konforu ve sedasyon skorları, toplam tramadol tüketimi, ek analjezik meperidin gereksinimi ve yan etkileri kaydettik. BULGULAR: Görsel derecelendirme skalası (visual rating scale; VRS) ve hasta konforu skorları grup S ile karşılaştırıldığında grup DT, LR ve DS’de belirgin olarak düşüktü (p<0,001). Toplam tramadol tüketimi postoperatif 2. saatten itibaren tüm çalışma zamanlarında nonsteroid antiinflamatuvar ilaç (NSAİİ) gruplarında grup S’e göre belirgin olarak düşüktü (p<0,001). Ek analjezik meperidin gereksinimi postoperatif 30. dakikadan sonra tüm çalışma zamanlarında grup S’de NSAİİ gruplarına göre belirgin yüksekti (p<0,01). TARTIŞMA ve SONUÇ: : Büyük abdominal cerrahi sonrası hasta kontrollü tramadol uygulamasına iv diklofenak, lornoksikam ve deksketoprofen eklenmesi, yalnız tramadol kullanımına göre daha düşük ağrı skorları, daha az tramadol tüketimi, ek analjezik gereksinimi ve yan etki sağlamaktadır.INTRODUCTION: This study was designed to compare the effects of dexketoprofen, lornoxicam, and diclophenac sodium on postoperative analgesia and tramadol consumption in patients receiving postoperative patient-controlled tramadol after a major abdominal surgery. METHODS: Eighty patients were randomized to receive one of the four study drugs. Patients in group dexketoprofen (DT) received IV 50 mg dexketoprofen, group lornoxicam (LR) received IV 8 mg lornoxicam, group diclophenac sodium (DS) received 75 mg IV diclophenac sodium and group saline (S) received 0.9% saline in 2 mL syringes, 20 min before the end of anaesthesia. A standardized (1 mg kg&amp;#8722;1) dose of tramadol was routinely administered to all patients as the loading dose at the end of surgery. Postoperatively, whenever patients requested, they were allowed to use a tramadol patient-controlled analgesia device giving a bolus dose (0.2 mg kg&amp;#8722;1) of tramadol. Pain, discomfort, and sedation scores, cumulative tramadol consumption, supplemental meperidine requirement, and side effects were recorded. RESULTS: Visual rating scale and patient discomfort scores were significantly lower in DT, LR and DS groups compared to those in in group S (<0.001). Cumulative tramadol consumption was significantly lower in non-steroidal anti-inflammatory drug (NSAID)-treated groups at each study period after the second postoperative hour than in group S (<0.001). Supplemental meperidine requirement was significantly higher in group S at each study period after postoperative 30 min than in NSAID-treated groups (<0.01). DISCUSSION AND CONCLUSION: After major abdominal surgery, adding IV diclophenac, lornoxicam or dexketoprofen to patient-controlled tramadol resulted in lower pain scores, smaller tramadol consumption, less rescue supplemental analgesic requirement, and fewer side effects compared with the tramadol alone group

Comparison of the Effects of Intrathecal Fentanyl and Intrathecal Morphine on Pain in Elective Total Knee Replacement Surgery

Objective. Total knee replacement is one of the most painful orthopedic surgical procedures. In this study, our goal was to compare the intraoperative and postoperative hemodynamic effects, the side effects, the effect on the duration of pain start, the 24-hour VAS, and the amount of additional analgesia used, of the fentanyl and morphine we added to the local anesthetic in the spinal anesthesia we administered in cases of elective knee replacement. Materials and Methods. After obtaining the approval of the Erciyes University Medical Faculty Clinical Drug Trials Ethics Committee, as well as the verbal and written consent of the patients, we included 50 patients in our prospective, randomized study. Results. In our study, the morphine group (Group M) had lower pain scores in the 2nd, 6th, 12th, and 24th hours compared to the fentanyl group (Group F). When additional analgesic requirements were compared, it was found that in the 2nd, 6th, and 24th hours fewer Group M patients needed more analgesics than did Group F patients. Conclusion. The fentanyl group also had lower first analgesic requirement times than did the morphine group. In terms of nausea and vomiting, there was no statistically significant difference between the two groups