Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Comparison Of Dexmedetomidine and Morphine For Postoperative Pain and Sedation Management in Pediatric Patients Undergoing Congenital Cardiac Surgery: A Retrospective Study
Konjenital Kalp Cerrahisi Geçiren Pediatrik Hastalarda Postoperatif Ağrı ve Sedasyon Yönetimi İçin Deksmedetomidin Ve Morfinin Karşılaştırılması: Retrospektif Çalışma
Dilek ALTUNa, Ahmet ARNAZb, Abdullah DOĞANc, Ayda TÜRKÖZd
aDepartment of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Türkiye
bDepartment of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University, Medical Faculty, İstanbul, Türkiye
cClinical of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Türkiye
dDepartment of Anesthesiology and Reanimation,Bezmialem University Medical Faculty Hospital, İstanbul, Türkiye
Turkiye Klinikleri J Anest Reanim. 2020;18(2):35-43
doi: 10.5336/anesthe.2020-75419
Article Language: EN
Full Text
ABSTRACT
 Objective: In this retrospective study, it was aimed to compare the effects of dexmedetomidine and morphine on postoperative pain, sedation, extubation time and hemodynamics in patients who underwent congenital cardiac surgery. Material and Methods: From December 2012 to December 2013, 46 patients between 1 to 5 years of age, who underwent congenital cardiac surgery were included and divided into two groups based on the sedative regimen used in the postoperative period. Twenty-three patients (Group Morp) received morphine at an infusion dose of 0.01 to 0.04 mg/kg/h; 23 patients (Group Dex) received dexmedetomidine at an infusion dose of 0.05 to 0.5 mcg/kg/h. Pain scores were measured using Children's Hospital Eastern Ontario Pain Scale (CHEOPS); sedation scores with the Ramsay Sedation Scale (RSS); and hemodynamic parameters were recorded with these measured values. Sedation debth was monitored by using the Bispectral Index (BIS). In this retrospective study, postoperative pain, sedation and hemodynamic effects of intravenous dexmedetomidine in pediatric patients undergoing congenital cardiac surgery, and the effects of mechanical ventilation duration and length of intensive care unit (ICU) stay were compared with morphine. Results: Mean doses of morphine and dexmedetomidine infused were 7.04±3.94 mg/24 h and 94.33±48.38 mcg/24 h, respectively. BIS values were higher in Group Dex than Group Morp (p<0.01). Mechanical ventilation duration was shorter in Group Dex compared to Group Morp 5.74±1.98 hours vs 7.83±3.08 hours) (p<0.05). The length of ICU stay and other outcome measurements between the two groups were similar. Heart rate was lower in the group Dex only in the first two hours (p<0.01). CHEOPS pain scores were similar in two groups (p> 0.05). RSS scores at 1st, 2nd, 3rd, 4th hours were higher in Group Dex than Group Morp (p <0.01); however, there was no difference between the groups in terms of RSS scores at the 12th, 16th, 20th and 24th hours (p> 0.05). There was no difference between the groups in terms of the frequency of side effects (p> 0.05). Conclusion: With regard to our study findings, dexmedetomidine can provide effective analgesia and sedation with shorter mechanical ventilation duration without adverse reaction compared to morphine in pediatric patients undergoing congenital cardiac surgery.

Keywords: Dexmedetomidine; morphine; postoperative pain; cardiac surgical procedures; pediatrics
ÖZET
 Amaç: Bu retrospektif çalışmada konjenital kalp cerrahisi uygulanan hastalarda deksmedetomidin ve morfinin postoperatif ağrı, sedasyon, ekstübasyon süresi ve hemodinami üzerine etkilerinin karşılaştırılması hedeflenmiştir. Gereç ve Yöntemler: Aralık 2012 - Aralık 2013 tarihleri arasında konjenital kalp ameliyatı geçirmiş 1-5 yaş arası 46 hasta dahil edildi ve ameliyat sonrası dönemde kullanılan sedasyon rejimine göre iki gruba ayrıldı. Yirmi üç hasta (Morp grubu) 0.01-0.04 mg/kg/saat infüzyon dozunda morfin alırken ; 23 hasta (Dex grubu) 0.05-0.5 mcg/kg/saat intravenöz infüzyon dozunda deksmedetomidin almıştır. Ağrı skorları, Children's Hospital Eastern Ontario Ağrı Ölçeği kullanılarak; sedasyon skorları Ramsay Sedasyon Ölçeği ile ölçülmüştür; ve bu ölçülen değerler ile hemodinamik parametreler kaydedilmiştir. Sedasyon derinliği Bispectral Index kullanılarak izlenmiştir. Bu retrospektif çalışmada konjenital kalp cerrahisi geçiren pediyatrik hastalarda intravenöz deksmedetomidinin postoperatif ağrı, sedasyon ve hemodinamik etkileri ile mekanik ventilasyon süresi ile yoğun bakımda kalış süresine olan etkileri morfin ile karşılaştırılmıştır. Bulgular: İnfüze edilen ortalama morfin ve deksmedetomidin dozları sırasıyla 7.04±3.94 mg/24 saat ve 94.33±48.38 mcgµg/24 saat idi. BIS değerleri Dex grubunda Morp grubundan daha yüksekti (p<0.01). Dex grubunda mekanik ventilasyon süresi Morp grubuna göre daha kısaydı (morfin: 7,83±3,08 saat; deksmedetomidin: 5,74±1,98 saat) (p<0.05). İki grup arasında YBÜ'de kalış süresi ve diğer sonuç ölçümleri benzerdi. Kalp hızı deksmedetomidin grubunda sadece ilk iki saatte düşüktü (p<0.01). CHEOPS ağrı skorları iki grupta benzerdi (p>0.05). RSS skorları 1., 2., 3., 4. saatlerde Dex grubunda Morp grubundan daha yüksekti (p<0.01); bununla birlikte 12., 16., 20. ve 24. saatlerde RSS skorları bakımından gruplar arasında fark yoktu (p>0.05). Yan etki görülme sıklığı bakımından da gruplar arasında fark yoktu (p>0.05). Sonuç: Çalışma bulgularımıza göre, deksmedetomidin, konjenital kalp ameliyatı geçiren pediyatrik hastalarda morfine kıyasla yan etki olmadan daha kısa mekanik ventilasyon süresi ile etkili analjezi ve sedasyon sağlayabilmiştir.

Anahtar Kelimeler: Deksmedetomidin; morfin; postoperatif ağrı; kardiyak cerrahi işlemler; pediatri
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