Buradasınız

İntravenöz Parasetamolün Torakoskopik Cerrahi Sonrası Postoperatif Analjezi Üzerine Etkinliği

Efficacy of Intravenous Paracetamol on Postoperative Analgesia after Thoracoscopic Surgery

Journal Name:

Publication Year:

Abstract (2. Language): 
In our study, we aimed to assess the efficacy of the intravenous paracetamol administration on postoperative analgesia after thoracoscopic surgery. Fourthy patients with an ASA physical status I-II were randomly assigned to receive intravenous administration of either 1 gr paracetamol or 100 ml saline, before induction of anesthesia and then every 6 h postoperatively for 24 h. Pain scores at rest and on movement, sedation scores, hemodynamic parameters, morphine usage, patient/nurse satisfaction, and side effects were evaluated. Time to first analgesic requirement, first mobilization and hospital discharge were recorded. In the paracetamol group; morphine consumption was lower at 2 nd , 4 th , 8 th , 12 th and 24 th hours (p=0.017, p=0.021, p<0.001, p<0.001, p<0.001), the incidence of nausea and vomiting was lower (p=0.001, p<0.001), time to first analgesic requirement was longer (p=0.0032) postoperatively, and first mobilization and hospital discharge were faster (p=0.0031, p=0.0015). Patient/nurse satisfaction with the analgesia were significantly greater (p<0.001, p<0.001). As a result, the use of paracetamol reduced the postoperative morphine requirement and increased patient and nurse satisfaction with fewer side effects. This approach may also contribute to earlier postoperative mobilization after thoracoscopic surgery.
Abstract (Original Language): 
Çalışmamızda, torakoskopik cerrahi sonrası intravenöz parasetamol uygulamasının postoperatif analjezi üzerine etkinliğini değerlendirmeyi amaçladık. ASA I-II grubu 40 hasta, anestezi indüksiyonundan önce ve postoperatif 24 saat içinde her 6 saatte bir intravenöz 1 gr parasetamol veya 100 ml serum fizyolojik verilmek üzere randomize olarak ayrıldı. Dinlenme ve hareket sırasındaki ağrı skorları, sedasyon skorları, hemodinamik parametreler, morfin kullanımı, hasta/hemşire memnuniyeti ve yan etkiler değerlendirildi. İlk analjezik gereksinim zamanı, ilk mobilizasyon ve hastaneden çıkış zamanları kaydedildi. Parasetamol grubunda; morfin tüketimi postoperatif 2., 4., 8., 12. ve 24. saatlerde daha düşük (p=0.017, p=0.021, p<0.001, p<0.001, p<0.001), bulantı ve kusma sıklığı daha az (p=0.001, p<0.001); ilk analjezi gereksinim zamanı daha uzun (p=0.0032), ilk mobilizasyon ve hastaneden çıkış süreleri daha kısa bulundu (p=0.0031, p=0.0015). Analjezi açısından hasta/hemşire memnuniyeti anlamlı olarak fazlaydı (p<0.001, p<0.001). Sonuç olarak, parasetamol kullanımı daha az yan etki ile postoperatif morfin gereksinimini azalttı ve hasta/hemşire memnuniyetini artırdı. Bu yaklaşım torakoskopik cerrahi sonrası erken postoperatif mobilizasyona da katkıda bulunabilir.
43-48

REFERENCES

References: 

1. Freixinet J, Canalis E, Rivas JJ et al. Surgical treatment of
primary spontaneous pneumothorax with video-assisted
thoracic surgery. Eur Respir J 1997;10:409-11.
2. Graeber GM, Jones DR. The role of thoracoscopy in thoracic
trauma. Ann Thorac Surg 1993;56:646-8.
3. Oderda GM, Evans RS, Lloyd J et al. Cost of opioid-related
adverse drug events in surgical patients. J Pain Symptom
Manage 2003;25:276-83.
4. Melzack R, Abbott F, Zackon W, Mulder D, Davis W. Pain on
a surgical ward: A surgery of the duration and intensity of pain
and the effectiveness of medication. Pain 1987;29:67-72.
5. Singh G. Gastrointestinal complications of prescription and
over-the counter nonsteroidal antiinflammatory drugs: A view
from the ARAMIS datadase. Am J Therapeut 2000;7:115-21.
6. Delbos A ,Boccard E. The morphine-sparing effect of
propacetamol in orthopedic postoperative pain. J Pain Sympt
Manage 1995;10:279-86.
7. Hernandez-Palazon J, Tortosa JA, Martinez-Lage JF, PerezFlores D. Intravenous administration of propacetamol reduces
morphine consumption after spinal fusion surgery. Anesth
Analg 2001;92:1473-6.
8. Peduto VA, Ballabio M, Stefanini S. Efficacy of propacetamol
in the treatment of postoperative pain. Morphine-sparing effect
in orthopedic surgery. Acta Anaesthesiol Scand 1998;42:293-8. V.A. Çınar, ark.
48
9. Van Aken H, Thys L, Veekman L, Buerkle H. Assessing
analgesia in single and repeated administrations of
propacetamol for postoperative pain: Comparison with
morphine after dental surgery. Anesth Analg 2004;98:159-65.
10. Haas DA. An update on analgesics for the management of acute
postoperative dental pain. J Can Dent Assoc 2002;68:476-82.
11. Wilson E, David A, Mackenzie N, Grand IS: Sedation during
spinal comparison of propofol and midazolam. Br J Anaesth
1990;64:48-52.
12. Kampe S, Warm M, Landwehr S et al. Clinical equivalence of
IV paracetamol compared to IV dipyrone for postoperative
analgesia after surgery for breast cancer. Curr Med Res and
Opin 2006;22:1949-54.
13. Sinatra RS, Torres J, Bustos AM. Pain management after major
orthopedic surgery: Current strategies and new concepts. J Am
Acad Orthop Surg 2002;10:117–29.
14. Atef A, Fawaz AA. Intravenous paracetamol is highly effective
in pain treatment after tonsillectomy in adults. Eur Arch
Otorhinolaryngol 2008;265:351-5.
15. Mac TB, Girard F, Chouinard P et al. Acetaminophen decreases
early post-thoracotomy ipsilateral shoulder pain in patients with
thoracic epidural analgesia: A double-blind placebo-controlled
study. J Cardiothorac Vasc Anesth 2005;19:475-8.
16. Cattabriga I, Pacini D, Lamazza G et al. Intravenous
paracetamol as adjunctive treatment for postoperative pain after
cardiac surgery: A double blind randomized controlled trial.
Eur J Cardiothorac Surg 2007;32:527-31.
17. Remy C, Marret E, Bonnet F. Effects of acetaminophen on
morphine side-effects and consumption after major surgery;
meta-analysis of randomized controlled trials. Br J Anaesth
2005;94:505–13.
18. Cakan T, Inan N, Culhaoglu S, Bakkal K, Başar H. Intravenous
paracetamol improves the quality of postoperative analgesia but
does not decrease narcotic requirements. J Neurosurg
Anesthesiol 2008;20:169-73.
19. Akarca A. Kalça Artroplastisinde Preemptif ve Peroperatif
Uygulanan Parasetamolün Postoperatif Morfin Tüketimi
Üzerine Etkisi (Uzmanlık Tezi). Adana: Çukurova Üniversitesi;
2008.

Thank you for copying data from http://www.arastirmax.com