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Laparoskopik kolesistektomi sonrası ağrı tedavisinde tramadolün devamlı infüzyon ve hasta kontrollü analjezi ile uygulanmasının karşılaştırılması

Comparison of tramadol use in continuous infusion versus patient controlled analgesia in pain management after laparoscopic cholecystectomy

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Abstract (2. Language): 
Laparoscopic cholecystectomy is the gold standart operation in cholelithiasis. The efficacy, consumption and side effects of tramadol analgesia used either continuous infusion or patient controlled analgesia after laparoscopic cholecystectomy were compared in the present study. Thirty-five patients were recruited in each group constituted prospectively in a randomized manner. Tramadol with an intravenous loading dose of 100 mg and a subsequently continuous infusion of 12.5 mg/h for 24 hours was given in Group I. Patient controlled analgesia was used in Group II, and an intravenous loading dose of 50 mg tramadol with a basal infusion rate of 5 mg/h, a bolus dose of 20 mg, a lock-out time of 30 minute and a maximum dose of 200 mg with 4 hours limited were performed. Visual analog scale scores (0-100), peripheral oxygen saturation, respiratory rate, heart rate and noninvasive arterial blood pressure values were recorded in all patients at 0, 2, 4, 8, 12 and 24 hours. There were no significant differences between the two groups regarding age, gender, weight, ASA status and duration of the operation. There were no significant differences between the two groups on the basis of visual analog scale scores obtained at any of the time measurements. All the patients in Group I were treated with a total tramadol consumption of 400 mg whereas the patients in Group II were treated with a mean tramadol consumption of 164±52.19 (60-200) mg. Tramadol proved its efficacy and safety in the present study. There were no significant differences between the use of the drug in either route regarding efficacy.
Abstract (Original Language): 
Kolelitiyazisin tedavisinde altın standart laparoskopik kolesistektomidir. Bu çalış- mada laparoskopik kolesistektomi sonrası devamlı infüzyon veya hasta kontrollü analjezi olarak uygulanan tramadol analjezilerinin etkinliği, tüketimi ve yan etkileri karşılaştırılmıştır. Prospektif ve randomize olarak oluşturulan her iki grupta 35’er hasta çalışmaya dahil edildi. Grup I’deki hastalarda tramadol 100 mg intravenöz olarak verildikten sonra 12.5 mg/saat hızda 24 saat devamlı infüze edildi. Grup II’deki hastalara hasta kontrollü analjezi kullanıldı ve 50 mg yükleme dozu, 5 mg/ saat bazal infüzyon, bolus doz 20 mg, kilitli kalma 30 dk, 4 saat limitli 200 mg tramadol uygulandı. Hastaların 0, 2, 4, 8, 12, 24. saatlerde vizuel analog skala skorları (0-100), periferik oksijen satürasyonu, solunum sayısı, kalp atım hızı, non-invaziv arteryal kan basıncı değerleri kaydedildi. İki grup arasında yaş, cinsiyet, kilo, ASA ve ameliyat süresi açısından anlamlı farklılıklar saptanmadı. Vizuel analog skala skoruna göre hiçbir çalışma saatinde farklılık saptanmadı. Grup I’deki hastaların hepsi 400 mg tramadol ile tedavi olurken, Grup II’deki hastalar ise 164±52.19 (60- 200) mg tramadol ile tedavi edildi. Laparoskopik kolesistektomi sonrasında ağrı tedavisinde tramadol etkin ve güvenilir bulundu. İlacın her iki yöntemle verilmesinde etkinlik açısından farklılık saptanmadı.
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REFERENCES

References: 

Kaynaklar
1. NIH Consensus Development Panel on Gall Stones
and Laparoscopic Cholecystectomy. JAMA 1993; 269:
1018-1024.
2. Widdison AL. A systematic review of the effectiveness
and safety of laparoscopic cholecystectomy. Ann R Coll
Surg Engl 1996; 78: 476.
3. Joris J, Cigarni I, Legrand M, et al. Metabolic and respiratory changes after cholecystectomy performed
via laparatomy or laparoscopy. Br J Anaesth 1992; 69:
341-345.
4. Ure BM, Troidl H, Spangenberger W, et al. Preincisional
local anaesthesia with bupivacaine and pain after laparoscopic cholecystectomy. A double-blind randomized
clinical trial. Surg Endosc 1993; 7: 482-488.
5. Karanikolas M, Swarm RA. Current trends in perioperative pain management. Anesthesiol Clin North America
2000; 18: 575-599.
6. Michaloliakou C, Chung F, Sharma S. Preoperative multimodal analgesia facilitates recovery after ambulatory
laparoscopic cholecystectomy. Anesth Analg 1996; 82:
44-51.
7. Szem JW, Hydo L, Barie PS. A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy. Surg Endosc 1996; 10: 44-48.
8. Pasqualucci A, Contardo R, Da Broi U, et al. The effects
of intraperitoneal local anesthetic on analgesic requirements and endocrine response after laparoscopic cholecystectomy: a randomized double-blind controlled
study. J Laparoendosc Surg 1994; 4: 405-412.
9. Dobbs FF, Kumar V, Alexander JI, Hull MG. Pain after
laparoscopy related to posture and ring versus clip steri-10 • Mart 2009 • Gülhane Tıp Derg Menteş ve ark.
lization. Br J Obstet Gyneacol 1987; 94: 262-266.
10. Soper NJ, Barteau JA, Clayman RV, Ashley SW,
Dunnegan DL. Comparison of early postoperative results for laparoscopic versus standart open cholecystectomy. Surg Gynecol Obstet 1992; 174: 114-118.
11. Lee IO, Kim SH, Kong MH, et al. Pain after laparoscopic
cholecystectomy: the effect and timing of incisional
and intraperitoneal bupivacaine. Can J Anaesth 2001;
48: 545-550.
12. Zubaroğlu E, Çalışkan K, Keskin K, Serim Ç, Seratlı O,
Özgüven R. Laparoskopik ve açık kolesistektominin post
operatif ağrı yönünden karşılaştırılması. Ağrı Dergisi
1997; 9: 24-29.
13. Rafa RB, Friderichs E. Reimann W, et al. Complementary
and synergistic antinociceptive interaction between the
enantiomers of tramadol. J Pharmacol Exp Ther 1992;
260: 275-285.
14. Spacek A. Kombinations-infusionanalgesie: eine alternative zur PCA? Anasthesiol Intensivemed Notfallmed
Schmertzher 1999; 34: 363-366.
15. Dauber A, Ure BM, Neugebauer E, Schmitz S, Troidl H.
Zur inzidenz postopertiver schmerzen auf chirurgischen
normalstation. Anaesthesist 1992; 81: 737-741.
16. Stamer UM, Maier C, Grond S, Veh-Schmidt B, Klaschik
E, Lehmann KA. Tramadol in the management of postoperative pain: a double-blind, placebo and active drug
controlled study. Eur J Anaesthesiol 1997; 14: 646-654.
17. Özyalçın S, Yücel A, Erdine S. Postoperatif analjezide
tramadol, petidin, morfin ve fentanil ile intravenöz
PCA. Türk Anest Rean Mec 1997; 25: 207-213.
18. Bamigbade TA, Langford RM. The clinical use of tramadol hydrochloride. Pain Reviews 1998; 5: 155-159.
19. Kırdemir P, Özkoçak I, Marşan A, Muratlı N, Güğüş
N. Hasta kontrollü analjezi (PCA) tramadol ve morfin
uygulamasının tramadol infüzyonu ile karşılaştırılması.
Gülhane Tıp Dergisi 2000; 42: 178-181.
20. Jellinek H, Haumer H, Grubhofer G, et al. Tramadol in
postoperative pain therapy. Patient controlled analgesia versus continuous infusion. Anaesthesist 1990; 39:
513-520.
21. Tunç M, Ulus F, Göktaş U, Sazak H, Şavkılıoğlu S.
Torakotomi sonrası ağrı tedavisinde; tramadol ile intravenöz hasta kontrollü analjezi ve devamlı infüzyonun
karşılaştırılması. S.D.Ü. Tıp Fak Derg 2006; 13: 5-10.
22. Rüd U, Fischer MV, Mewes R, Paravicini D. Postoperative
analgesia with tramadol. Continuous infusion versus
repetitive bolus administration. Anaesthesist 1994; 43:
316-321.

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