Laparoskopik kolesistektomi uygulanan hastalarda, ropivakain'in postoperatif ağrı ve stres yanıtı üzerine etkisi
Küçük Resim Yok
Tarih
2004
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
ÖZET Giriş: Laparoskopik kolesistektomide postoperatif ağrı önemli bir problem olmaya devam etmektedir. Bu amaçla, peroperatif lokal anestezik ilaçlar yaygın olarak kullanılmaktadır. Bu çalışmada amacımız, laparoskopik kolesistektomide insizyonel ve intraperitoneal uygulanan ropivakainin postoperatif ağrı ve stres cevabı üzerindeki etkisini değerlendirmekti. Gereç-Yöntem: Prospektif, tek-kör, randomize bu çalışmada, elektif laparoskopik kolesistektomi uygulanacak ASA skorları l-ll olan 45 hasta, üç gruba ayrıldı. Grup 1'e (n=14) preinsizyonel ve intraperitoneal, Grup 2'ye (n=17) preinsizyonel ve kolesistektomi sonrası intraperitoneal, Grup 3'e (n=14) kolesistektomi sonrası intraperitoneal ve insizyon yerlerine % 3.75 40 mL ropivakain uygulandı. Peroperatif (operasyondan önce, ensüflasyondan 15 dk sonra ve operasyon sonunda) epinefrin ve norepinefrin düzeylerine bakıldı. Postoperatif 24 saat süreyle analjezik ihtiyaçları ve ağrı düzeyleri vizüel analog skala (VAS) ile takip edildi. Bulgular: Üç grup arasında VAS, toplam analjezik ihtiyacı, yandaş ağrı ve bulantı-kusma yönünden istatiksel farklılık saptanmadı. En erken analjezik ihtiyacı Grup 2'de oldu (p<0.005). Omuz ağrısı Grup 3'te daha düşük oranda görüldü (p<0.005). Norepinefrin ve epinefrin düzeyleri açısından gruplar arasında farklılık saptanmadı. Sonuç: Ropivakain'in laparoskopik kolesistektomide girişim öncesi ve sonrası uygulanması postoperatif ağrı ve stres yanıt yönünden benzer sonuçlar vermektedir. Anahtar Sözcükler: Laparoskopik kolesistektomi, postoperatif ağrı, lokal anestezi, ropivakain
ABSTRACT BACKGROUND: Postoperative pain is still a current problem after laparascopic cholecystectomy. To overcome this major problem, many anesthetic and analgesic drugs were used clinically. Recently, local anethetic agents are the group of drugs wich are widely administered and accepted effective as well. In this study we aimed to evaluate the effect of incisionally and intraperitoneal^ administered ropivacaine on postoperative pain and stress response of the patients undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS: In this prospective, single-blinded, and randomized study; 45 patients undergoing laparoscopic cholecystectomy with the ASA scores l-ll were divided into three groups. 40 ml of 3,75 % ropivacaine was administered preincisionally and intraperitoneally to the patients of group I (n=14), preincisoinally and intraperitoneally after cholecystectomy of group II (n=17), and intraperitoneally and locally to the incisions after cholecystectomy to the patients of group III (n=14). The blood levels of epinephrine and norepinephrine were examined peroperatively ( preoperative, 15 minutes after insufflation and at the end of the operation). The levels of pain by Visual Analogue Scale (VAS) and the analgesic requirement of the patients were followed 24 hours postoperatively. RESULTS: Statistically no significant difference were found among the three groups for VAS, total analgesic requirements, accompanying pain, nausea and vomiting. The earliest analgesic requirements was seen in group II (p< 0,005). Shoulder pain was less seen in group III (p< 0,005). The levels of norepinephrine and epinephrine showed no statistically significant difference among the three groups. CONCLUSION: The preoperative and postoperative administrations of ropivacaine in laparoscopic cholecystectomy have similar effects on postoperative pain and stress response of the patients. KEY WORDS: Laparoscopic cholecystectomy, postoperative pain, local anesthesia, ropivacaine
ABSTRACT BACKGROUND: Postoperative pain is still a current problem after laparascopic cholecystectomy. To overcome this major problem, many anesthetic and analgesic drugs were used clinically. Recently, local anethetic agents are the group of drugs wich are widely administered and accepted effective as well. In this study we aimed to evaluate the effect of incisionally and intraperitoneal^ administered ropivacaine on postoperative pain and stress response of the patients undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS: In this prospective, single-blinded, and randomized study; 45 patients undergoing laparoscopic cholecystectomy with the ASA scores l-ll were divided into three groups. 40 ml of 3,75 % ropivacaine was administered preincisionally and intraperitoneally to the patients of group I (n=14), preincisoinally and intraperitoneally after cholecystectomy of group II (n=17), and intraperitoneally and locally to the incisions after cholecystectomy to the patients of group III (n=14). The blood levels of epinephrine and norepinephrine were examined peroperatively ( preoperative, 15 minutes after insufflation and at the end of the operation). The levels of pain by Visual Analogue Scale (VAS) and the analgesic requirement of the patients were followed 24 hours postoperatively. RESULTS: Statistically no significant difference were found among the three groups for VAS, total analgesic requirements, accompanying pain, nausea and vomiting. The earliest analgesic requirements was seen in group II (p< 0,005). Shoulder pain was less seen in group III (p< 0,005). The levels of norepinephrine and epinephrine showed no statistically significant difference among the three groups. CONCLUSION: The preoperative and postoperative administrations of ropivacaine in laparoscopic cholecystectomy have similar effects on postoperative pain and stress response of the patients. KEY WORDS: Laparoscopic cholecystectomy, postoperative pain, local anesthesia, ropivacaine
Açıklama
Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.
Anahtar Kelimeler
Genel Cerrahi, General Surgery
