Preempitif iv Parasetamol, iv NSAİ ve kombinasyonlarının batın cerrahisi sonrası hasta kontrollü analjezi ile oluşturulan analjezi kalitesine etkisi

AYŞENUR SÜMER COŞKUN

Preempitif iv Parasetamol, iv NSAİ ve kombinasyonlarının batın cerrahisi sonrası hasta kontrollü analjezi ile oluşturulan analjezi kalitesine etkisi

Thesis Type: Expertise In Medicine

Institution Of The Thesis: Ataturk University, Tıp Fakültesi, Cerrahi Tıp Bilimleri, Turkey

Approval Date: 2011

Thesis Language: Turkish

Student: AYŞENUR SÜMER COŞKUN

Supervisor: Canan Atalay

Open Archive Collection: AVESIS Open Access Collection

Abstract:

Objective: This study examined preemptive paracetamol, Nonsteroidal Anti-Inflammatory (NSAIDs) and their combinations in terms of their effects on the quality of the analgesia developed after post-abdomen surgery via Patient Controlled Analgesia (PCA), total fentanyl dose and related side effects.Material and method: 120 patients (SA I-II; age range: 18-70 years old) planned to undergo elective abdominal surgery under general aesthesia were randomly classified into four groups. Thirty (30) minutes before the preemptive surgery, the cases in Fentanyl Group (GF, n=30) were administered 100 ml iv 0.9% NaCl; the cases in Paracetamol Group (GP, n=30) 1 g iv paracetamol; the cases in NSAID Group (GN, n=30) 8 mg iv lornoksicam; and the cases in Paracetamol and NSAID Group (GPN, n=30) 1 g iv paracetamol and 8 mg iv lornoksicam. Anaesthesia induction was performed in all cases via 2 mg/kg propophol and 0.6 mg/kg rocuronium. Maintenance of anaesthesia was ensured via 60% Nitrous oxide ? 40% O2, 1?1.5% sevoflurane. In the postoperative period; iv fentanyl was administered to the control group cases (Group F) via the postoperative patient-controlled analgesia (PCA) device. In the remaining cases, in addition to the iv fentanyl, i.v paracetamol 1 g was infused to Group P cases at the postoperative 6th, 12th and 18th hours; i.v paracetamol 1g was infused to Group PN cases at the postoperative 6th, 12th and 18th hours; and no additional drug was infused to Group N cases at the postoperative hours. VAS score, blood pressure and heart rate, sedation score, nausea-vomiting score, patient satisfaction, side effects and total fentanyl dose were recorded at the postoperative 2nd, 4th, 8th, 12th and 24th hours. One Way ANOVA test and Chi-Square test were used for statistical analysis.Results: There was no difference between the groups in terms of demographic data (p>0.05). Total fentanyl consumption in the postoperative 24-hour period was recorded to be statistically significantly higher in Group F than in Group P, Group N and Group PN (p=0.001). Fentanyl consumption in Group N at the 2nd, 8th, 12th and 24th hours was found to be statistically significantly lower than Group F (p=0.012, p=0.009, p=0.004, p= 0.001). Fentanyl consumption of Group PN was found to be statistically significant lower than that of Group F at all postoperative measurement hours (p=0.004, p=0.001, p=0.001, p=0.001, p=0.001). No statistically significant difference was recorded between Group F and Group P at postoperative 2nd, 4th, 8th, and 12th hours (p>0.013). Respiratory depression, bradycardia and hypotension were not reported in any study cases.Conclusion: It was observed that preemptive 8mg lornoksicam reduced fentanyl consumption in patient-controlled analgesia, preemptive paracetamol had no such effect and lornoksicam-parecetamol combination did not prevail over use of lornoksicam alone.Keywords: i.v. PCA, Fentanyl, Lornoxicam, Paracetamol,