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    A Comparison of Ketamine and Paracetamol for Preventing Remifentanil Induced Hyperalgesia in Patients Undergoing Total Abdominal Hysterectomy
    (Ivyspring Int Publ, 2012) Yalcin, Naime; Uzun, Sema Tuncer; Reisli, Ruhiye; Borazan, Hale; Otelcioglu, Seref
    Background: The aim of this prospective, randomized, placebo-controlled study was to compare the effects of ketamine and paracetamol on preventing remifentanil induced hyperalgesia. Methods: Ninety patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups to receive (I) either saline infusion; (II) 0.5 mg/kg ketamine iv bolus or (III) 1000 mg iv paracetamol infusion before induction of anesthesia. Until the skin closure, anesthesia was maintained with 0.4 mu g/kg/min remifentanil infusion in all groups, additionally Group II received 5 mu g/kg/min ketamine infusion. Pressure pain thresholds were measured the day before surgery during the preoperative visit for baseline measurements and repeated postoperatively at 24 and 48 hours (hrs). Pressure pain thresholds were established by digital algometer on three different peri-incisional regions for calculating mean pressure pain threshold values. The visual analogue scale (VAS), sedation scores, total morphine consumption and side effects were assessed postoperatively. Results: Demographic characteristics, duration of surgery and anesthesia were similar in the three groups. Pain thresholds at the incision region were significantly lower at 24 and 48 hrs postoperatively in Group I than the other Groups (p<0.05). In Group., pain thresholds were lower compared with preoperative baseline values. Thresholds in Group II and Group III were higher compared with preoperative baseline values (p<0.05) The VAS scores at all evaluation times were significantly higher in Group. when compared to Group.. and at 2, 4, 6,12 hrs were higher in Group I than Group III (p<0.05). The morphine consumption was higher in Group III at 24 and 48 hrs postoperatively (p<0.05). Conclusion: It was shown that ketamine and paracetamol were both effective in preventing remifentanil induced hyperalgesia.
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    The effects of the administration of subfacial levobupivacaine infusion with the ON-Q pain pump system on postoperative analgesia and tramadol consumption in cesarean operations
    (Kare Publ, 2010) Tuncer, Sema; Aysolmaz, Gokhan; Reisli, Ruhiye; Erol, Atilla; Yalcin, Naime; Yosunkaya, Alper
    Objectives: In this study, the effects of administration of subfacial levobupivacaine infusion with the ON-Q pain pump system were investigated in elective cesarean operations for postoperative pain control and tramadol-sparing effect. Methods: Fifty ASA I-II patients scheduled for cesarean operation were enrolled into this study. Patients were randomly divided into two groups: Group I served as a control group, without the ON-Q pain pump system, whereas Group II received the ON-Q pain pump system with subfacial 0.25% levobupivacaine infusion for 24 hours at 4 ml/hour. All patients received a standard anesthetic protocol. At the end of the surgery, all patients received tramadol i.v. via a PCA (Patient Controlled Analgesia) device. Pain scores were assessed at 2, 6, 12 and 24 hours postoperatively. Tramadol consumption and adverse effects were noted in the first 24 hours following surgery. Results: The pain scores were significantly lower in the levobupivacaine group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the levobupivacaine group than in the control group (p<0.05). Group II used less antiemetic and had less postoperative nausea and vomiting, and the difference was statistically significant (p<0.05). Conclusion: No complication occurred as a result of the ON-Q pain pump system. Subfacial levobupivacaine infusion with the ON-Q pain pump system diminished postoperative pain and the need for tramadol use following cesarean operations.