Kolesistektomi operasyonlarında intraoperatif parasetamol infüzyonu uygulaması ile intraperitoneal levobupivakain infiltrasyonunun postoperatif analjezi üzerine etkinliğinin karşılaştırılması
Küçük Resim Yok
Tarih
2009
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Laparoskopik cerrahi sonrası, postoeratif erken dönemde hastaların çoğunda ciddi ağrı oluşmakta ve güçlü bir analjeziye ihtiyaç duyulmaktadır. Bu nedenle cerrahi sonrası hastanın şikayetlerini azaltmak veya ortadan kaldırmak amacıyla pek çok yöntem geliştirilmeye çalışılmaktadır. Çalışmamızda kolesistektomi operasyonlarında intraoperatif parasetamol infüzyonu uygulaması ile intraperitoneal ve insizyonel levobupivakain uygulamasını postoperatif analjezi üzerine etkinliğinin karşılaştırılmasını amaçladık.Çalışma Etik Kurul onayı alınan, taşlı kese tanısı ile elektif şartlarda laparoskopik kolesistektomi yapılmasına karar verilen ASA I-II grubu 80 hasta üzerinde gerçekleştirilmiştir. Grup I'e (n=40) safra kesesi çıktıktan 20 mL %0,25'lik levobupivakain intraperitoneal, 4 trokar giriş deliklerinin çevresine 2,5 mL olacak şekilde %0,25 levobupivakain infiltrasyonu ve operasyon bitimine 15 dakika kaldığında ağırlığı 50 kg altındakilere 1,5 mL/kg %0,9 NaCl, 50 kg üzerindekilere 100 mL %0,9 NaCl infüzyonu uygulanmıştır. Grup II'ye (n=40) safra kesesi çıktıktan 20 mL %0,9 NaCl intraperitoneal, 4 trokar giriş deliklerinin çevresine 2,5 mL olacak şekilde %0,9 NaCl infiltrasyonu ve operasyon bitimine 15 dakika kaldığında ağırlığı 50 kg altındakilere 15 mg/kg, 50 kg üzerindekilere 1g parasetamol infüzyonu uygulanmıştır. Operasyonun son 15. dakika, operasyon sonu, ekstübasyon sonrası ve postoperatif dönemde hemodinami, postoperatif yatarken, otururken, öksürme ve yürüme sırasında ağrı şiddetleri VAS ile değerlendirilmiştir. Cerrahi ekiple görüşülerek operasyonun güçlük derecesini belirlemek için cerrahi güçlük skorları ve hasta memnuniyeti skorları kaydedilmiştir.Postoperatif erken dönemde intraperitoneal levobupivakain infiltrasyon uygulanan hastalarda VAS değerlerinin istatistiksel olarak anlamlı düşük olduğu saptanmıştır. İntraoperatif parasetamol infüzyon uygulanan hastalarda postoperatif analjezi süresinin kısa ve ek analjezik uygulama sayısının istatistiksel olarak anlamlı fazla olduğu saptanmıştır. Cerrah ve hasta memnuniyeti intraperitoneal levobupivakain uygulanan grupda istatistiksel olarak anlamlı iyi olduğu görülmüştür.Postoperatif analjezide intraperitoneal levobupivakain infiltrasyonun daha iyi analjezi sağlaması ve hastaların daha az ağrılı bir postoperatif dönem geçirmesi nedeniyle memnuniyetlerinin fazla olduğu saptanmıştır.Anahtar kelimeler: Laparoskopik kolesistektomi, postoperatif ağrı, analjezik, parasetamol, levobupivacain
Most patients need strong analgesics because of the severe pain they experience immediately after laparoscopic surgeries. Therefore, many studies have been conducted in order to find a technique to reduce or eliminate these patients? postoperative complaints. In our study, we aimed to compare the efficiency of intraoperative paracetamol infusion, and intraperitoneal and incisional levobupivacaine administration in terms of providing postoperative analgesia in cholecystectomy procedures.Getting Research Ethics Committee approval, the study included 80 patients in ASA I-II group who were scheluded for elective laparoscopic cholecystectomy after the diagnosis of gallbladder stones. In group 1 (n=40), after removing the gallbladder, 20 mL of 0,25% intraperitoneal levobupivacaine was administered, 2,5 mL of 0,25% levobupivacaine infiltration was applied around 4 trocar puncture points separately; and 15 minutes before the end of the surgery ,1,5 mL/kg 0,9% and 100 mL of 0,9% NaCI infusions were applied to the patients under 50 kg and over 50 kg respectively. In group II (n=40), after removing the gallbladder, 20 mL of 0,9% intraperitoneal NaCI was administered, 2,5 mL of 0,9% NaCI infiltration was applied around 4 trocar puncture points separately, and 15 minutes before the end of the surgery, 15 mg/kg and 1 g of paracetamol infusions were recieved by the patients under 50 kg and over 50 kg respectively. Hemodynamy was evaluated 15 minutes before the end of the surgery, at the end of the surgery, after the extubation, and postoperatively. In the postoperative period, severity of pain while lying, sitting, coughing and walking was evaluated using VAS. Consulting the surgical team, surgical difficulty levels and patient satisfaction scores were noted in order to determine the difficulty of the surgery.In early postoperative period, it was found that VAS values were statistically significantly low in the patients who received intraperitoneal infiltration of levobupivacaine. In the patients who received intraoperative infusion of paracetamol, the duration of analgesia was shorter and the need for further analgesia was statistically significantly higher. Surgeon and patient satisfaction were significantly higher in the intraperitoneal levobupivacaine infiltration group.The study showed that, in the postoperative period, the intraperitoneal infiltration of levobupivacaine provides a more effective analgesia and higher patient satisfaction because of the less painful postoperative period it enables.Key words: Laparoscopik cholecystectomy, postoperative pain, analgesic, paracetamol, levobupivacaine
Most patients need strong analgesics because of the severe pain they experience immediately after laparoscopic surgeries. Therefore, many studies have been conducted in order to find a technique to reduce or eliminate these patients? postoperative complaints. In our study, we aimed to compare the efficiency of intraoperative paracetamol infusion, and intraperitoneal and incisional levobupivacaine administration in terms of providing postoperative analgesia in cholecystectomy procedures.Getting Research Ethics Committee approval, the study included 80 patients in ASA I-II group who were scheluded for elective laparoscopic cholecystectomy after the diagnosis of gallbladder stones. In group 1 (n=40), after removing the gallbladder, 20 mL of 0,25% intraperitoneal levobupivacaine was administered, 2,5 mL of 0,25% levobupivacaine infiltration was applied around 4 trocar puncture points separately; and 15 minutes before the end of the surgery ,1,5 mL/kg 0,9% and 100 mL of 0,9% NaCI infusions were applied to the patients under 50 kg and over 50 kg respectively. In group II (n=40), after removing the gallbladder, 20 mL of 0,9% intraperitoneal NaCI was administered, 2,5 mL of 0,9% NaCI infiltration was applied around 4 trocar puncture points separately, and 15 minutes before the end of the surgery, 15 mg/kg and 1 g of paracetamol infusions were recieved by the patients under 50 kg and over 50 kg respectively. Hemodynamy was evaluated 15 minutes before the end of the surgery, at the end of the surgery, after the extubation, and postoperatively. In the postoperative period, severity of pain while lying, sitting, coughing and walking was evaluated using VAS. Consulting the surgical team, surgical difficulty levels and patient satisfaction scores were noted in order to determine the difficulty of the surgery.In early postoperative period, it was found that VAS values were statistically significantly low in the patients who received intraperitoneal infiltration of levobupivacaine. In the patients who received intraoperative infusion of paracetamol, the duration of analgesia was shorter and the need for further analgesia was statistically significantly higher. Surgeon and patient satisfaction were significantly higher in the intraperitoneal levobupivacaine infiltration group.The study showed that, in the postoperative period, the intraperitoneal infiltration of levobupivacaine provides a more effective analgesia and higher patient satisfaction because of the less painful postoperative period it enables.Key words: Laparoscopik cholecystectomy, postoperative pain, analgesic, paracetamol, levobupivacaine
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
