Total Abdominal Histerektomi Yapılan Hastalarda İntraoperatif Ketamin İnfüzyonu Ve Deksketoprofen Uygulamalarının Akut Postoperatif Ağrı Ve Kronikleşen Ağrı Üzerine Etkilerinin Karşılaştırılması
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Tarih
2023
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışma ile total abdominal histerektomi cerrahisi geçiren hastalarda intraoperatif kullanılan
ketamin ve dekstketoprofen ile; oluşacak akut ağrıyı azaltmayı, intraoperatif opioid kullanımını azaltarak
hiperaljezi ve nöropatik ağrı geli şme insidansını azaltmayı, iki ajanın akut ve kronikleşen ağrı üzerine etkilerini
karşılaştırmayı amaçladık.
Yöntem: Etik Kurul onayı alındıktan sonra ASA 1-2 grubunda yer alan, VKİ<30 olan, 18-65 yaş
aralığında toplam 96 hasta; deksketoprofen (D), ketamin (K) ve ketamin-deksketoprofen (K-D) olmak üzere
randomizasyon yöntemi ile 3 gruba ayrıldı. Kontrol grubu yoktu. Rutin genel anestezi monitörizasyonu yapıldı
giriş değerleri kaydedildi ve tüm hastalara rutin genel anestezi yöntemi uygulandı. 0,5-1 MAC sevofluran
inhalasyonu ve 0,1-0,25 μg/kg/dk remifentanil infüzyonu ile idame sağlandı. Tüm hastalara postoperatif analjezi
için 1 mg/kg tramadol uygulandı ve antiemetik uygulandı.1.Grup (ketamin)’a rutin anestezi uygulamalarına ek
olarak indüksiyon aşamasında 0,25 mg/kg ketaminbolus yapıldı, cerrahi kesiden önce 5mcg/kg/dk ketamin
infüzyonu açıldı.
2.Grup (deksketoprofen)’a indüksiyon aşamasında 0,25mg/kg ketamin ve 50 mg=2ml deksketoprofen
bolus yapıldı, cerrahi kesiden önce 5mcg/kg/dk ketamin infüzyonu açıldı. 3.Grup (ketamin-deksketoprofen)’a
indüksiyon aşamasında 2 ml serum fizyolojik, 50 mg deksketoprofen bolus yapıldı, serum fizyolojik infüzyonu
açıldı. Cerrahi sonunda cilt kapatmaya geçilirken ketamin infüzyonu sonlandırıldı. Hastaların intraoperatif 1-5-30-
60.dakikadaki tansiyon, nabız, satürayon değerleri, toplam remifentanil - sevofluran tüketim miktarları kaydedildi.
Postoperatif tüm hastalara tramadol ile hazırlanmış hasta kontrollü analjezi cihazı takıldı. Postoperatif ilk 24 saat
VAS (Visual Analog Scale ) değerleri ve ilaçlara bağlı gelişen yan etkiler kaydedildi. Hastalarla telefon görüşmesi
yapılarak tüm hastaların postoperatif 1-2-3.ay ağrısı DN4 (Doluer Neuropathique 4 Questions) kriterlerine göre
sorgulandı.
Bulgular: Hastaların demografik verileri gruplar arası karşılaştırıldığında istatistiksel olarak anlamlı fark
yoktu. (p>0,05) Postoperatif VAS skorları gruplar arasında karşılaştırıldığında istatistiksel olarak anlamlı fark
vardı. (p<0,05) Postoperatif 1 gün boyunca yapılan takipte 1-4-8-12-24. saatlerde grup 3 (deksketoprofen)
hastalarında ketamin infüzyonu yapılan grup 1-2 ye göre genelde VAS skoru yüksek bulundu. Grup 2 (ketamindeksketoprofen)
‘de ise VAS skoru grup 1-3 e göre anlamlı daha düşük seyretti. ( p<0,05) Toplam cerrahi süresi
ve toplam anestezi süresi gruplar arasında karşılaştırıldığında anlamlı fark yoktu. (p>0,05)
Toplam remifentanil, sevofluran, ketamin miktarı grup 1-2-3 arasında karşılaştırıldığında elde edilen
sonuçlar istatiksel olarak anlamlı bulundu. (p>0,05) Postoperatif 1. ayda nöropatik ağrı açısından gruplar
karşılaştırıldığında DN4 skoru ketamin grubunda (grup 1) anlamlı en düşük bulundu. Grup 1 (ketamin) ve grup 3
(deksketoprofen) 1.aydaki DN4 skorları karşılaştırıldığında istatistiksel olarak anlamlı bulundu. (p<0,05) Tüm
gruplarda postoperatif 1.ay ve 3.aydaki DN4 skoru karşılaştırıldığında istatistiksel olarak anlamlı bulundu.
(p<0,05)
Sonuç: İntraoperatif subanestetik dozda ketamin postoperatif akut (VAS) ve kronik ağrı (DN4) skorlarını
düşürerek ağrı gelişme insidansını azalttı; deksketoprofen ile birlikte kullanıldığında bu etki daha güçlüydü. Aynı
zamanda intraoperatif uygulanan ketamin,
Objective: In this study, intraoperatively used ketamine and dexketoprofen in patients undergoing total abdominal hysterectomy; We aimed to reduce the acute pain that will occur, to reduce the incidence of hyperalgesia and neuropathic pain by reducing intraoperative opioid use, and to compare the effects of the two agents on acute and chronic pain. Material - Method: After the approval of the Ethics Committee, a total of 96 patients in the ASA 1-2 group, with a BMI <30, between the ages of 18-65; dexketoprofen (D), ketamine (K) and ketamine-dexketoprofen (K-D) were divided into 3 groups by randomization method. There was no control group. Routine general anesthesia monitoring was performed, entry values were recorded, and routine general anesthesia method was applied to all patients. Maintenance was provided with 0.5-1 MAC sevoflurane inhalation and 0.1-0.25 μg/kg/min remifentanil infusion. Tramadol 1 mg/kg was administered to all patients for postoperative analgesia and antiemetic was administered. In addition to the routine anesthesia applications, 0.25 mg/kg bolus was administered to the 1st group (ketamine) during the induction phase, and a 5mcg/kg/min ketamine infusion was initiated before the surgical incision. In Group 2 (dexketoprofen), 0.25mg/kg ketamine and 50mg=2ml dexketoprofen bolus were administered during the induction phase, 5mcg/kg/min ketamine infusion was opened before the surgical incision. In the 3rd group (ketamine-dexketoprofen), 2 ml saline and 50 mg dexketoprofen bolus were administered during the induction phase, and the saline infusion was opened. At the end of the surgery, the ketamine infusion was terminated while the skin was closed. The patients' intraoperative blood pressure, pulse, saturation values, and total remifentanil - sevoflurane consumption amounts were recorded at 1-5-30-60th minutes. A patient-controlled analgesia device prepared with tramadol was inserted in all patients postoperatively. VAS (Visual Analog Scale) values in the first 24 hours postoperatively and side effects due to drugs were recorded. All patients were questioned according to DN4 (Doluer Neuropathique 4 Questions) criteria for postoperative 1-2-3 month pain by making phone calls. Results: When the demographic data of the patients were compared between the groups, there was no statistically significant difference. (p>0.05) When the postoperative VAS scores were compared between the groups, there was a statistically significant difference. (p<0.05) 1-4-8-12-24 in 1 day postoperative follow-up. In general, the VAS score was found to be higher in group 3 (dexketoprofen) patients compared to group 1-2 who received ketamine infusion. In group 2 (ketamine dexketoprofen), the VAS score was significantly lower than in group 1-3. ( p<0.05) There was no significant difference when the total surgery time and total anesthesia time were compared between the groups. (p>0.05) When the total amount of remifentanil, sevoflurane and ketamine was compared between groups 1-2-3, the results were found to be statistically significant (p>0.05) When the groups were compared in terms of neuropathic pain in the postoperative 1st month, the DN4 score was found to be the lowest in the ketamine group (group 1). Group 1 (ketamine) and group 3 (dexketoprofen) DN4 scores at 1 month were found to be statistically significant. (p<0.05) Postoperative DN4 score at 1st month and 3rd month was found statistically significant in all groups. (p<0.05) Conclusion: Intraoperative subanesthetic dose of ketamine decreased the incidence of pain development by lowering postoperative acute (VAS) and chronic pain (DN4) scores; This effect was stronger when used with dexketoprofen. It also reduced the need for intraoperatively administered ketamine, remifentanil and sevoflurane. Follow-up of 3 months or more is required for chronic pain follow-up.
Objective: In this study, intraoperatively used ketamine and dexketoprofen in patients undergoing total abdominal hysterectomy; We aimed to reduce the acute pain that will occur, to reduce the incidence of hyperalgesia and neuropathic pain by reducing intraoperative opioid use, and to compare the effects of the two agents on acute and chronic pain. Material - Method: After the approval of the Ethics Committee, a total of 96 patients in the ASA 1-2 group, with a BMI <30, between the ages of 18-65; dexketoprofen (D), ketamine (K) and ketamine-dexketoprofen (K-D) were divided into 3 groups by randomization method. There was no control group. Routine general anesthesia monitoring was performed, entry values were recorded, and routine general anesthesia method was applied to all patients. Maintenance was provided with 0.5-1 MAC sevoflurane inhalation and 0.1-0.25 μg/kg/min remifentanil infusion. Tramadol 1 mg/kg was administered to all patients for postoperative analgesia and antiemetic was administered. In addition to the routine anesthesia applications, 0.25 mg/kg bolus was administered to the 1st group (ketamine) during the induction phase, and a 5mcg/kg/min ketamine infusion was initiated before the surgical incision. In Group 2 (dexketoprofen), 0.25mg/kg ketamine and 50mg=2ml dexketoprofen bolus were administered during the induction phase, 5mcg/kg/min ketamine infusion was opened before the surgical incision. In the 3rd group (ketamine-dexketoprofen), 2 ml saline and 50 mg dexketoprofen bolus were administered during the induction phase, and the saline infusion was opened. At the end of the surgery, the ketamine infusion was terminated while the skin was closed. The patients' intraoperative blood pressure, pulse, saturation values, and total remifentanil - sevoflurane consumption amounts were recorded at 1-5-30-60th minutes. A patient-controlled analgesia device prepared with tramadol was inserted in all patients postoperatively. VAS (Visual Analog Scale) values in the first 24 hours postoperatively and side effects due to drugs were recorded. All patients were questioned according to DN4 (Doluer Neuropathique 4 Questions) criteria for postoperative 1-2-3 month pain by making phone calls. Results: When the demographic data of the patients were compared between the groups, there was no statistically significant difference. (p>0.05) When the postoperative VAS scores were compared between the groups, there was a statistically significant difference. (p<0.05) 1-4-8-12-24 in 1 day postoperative follow-up. In general, the VAS score was found to be higher in group 3 (dexketoprofen) patients compared to group 1-2 who received ketamine infusion. In group 2 (ketamine dexketoprofen), the VAS score was significantly lower than in group 1-3. ( p<0.05) There was no significant difference when the total surgery time and total anesthesia time were compared between the groups. (p>0.05) When the total amount of remifentanil, sevoflurane and ketamine was compared between groups 1-2-3, the results were found to be statistically significant (p>0.05) When the groups were compared in terms of neuropathic pain in the postoperative 1st month, the DN4 score was found to be the lowest in the ketamine group (group 1). Group 1 (ketamine) and group 3 (dexketoprofen) DN4 scores at 1 month were found to be statistically significant. (p<0.05) Postoperative DN4 score at 1st month and 3rd month was found statistically significant in all groups. (p<0.05) Conclusion: Intraoperative subanesthetic dose of ketamine decreased the incidence of pain development by lowering postoperative acute (VAS) and chronic pain (DN4) scores; This effect was stronger when used with dexketoprofen. It also reduced the need for intraoperatively administered ketamine, remifentanil and sevoflurane. Follow-up of 3 months or more is required for chronic pain follow-up.
Açıklama
Anahtar Kelimeler
Akut Ağrı, Kronik Ağrı, İntraoperatif Ketamin İnfüzyonu, İntraoperatif Deksketoprofen Uygulamaları, Acute pain, Chronic pain, Intraoperative ketamine infusion, Intraoperative dexketoprofen
Kaynak
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Scopus Q Değeri
Cilt
Sayı
Künye
Karakaya, H. B. (2023). Total Abdominal Histerektomi Yapılan Hastalarda İntraoperatif Ketamin İnfüzyonu Ve Deksketoprofen Uygulamalarının Akut Postoperatif Ağrı Ve Kronikleşen Ağrı Üzerine Etkilerinin Karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyon Anabilim Dalı, Konya.
