Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Donör Nefrektomilerde Tek Doz Epidural Analjezinin Opioid Tüketimine Etkisi
The Effect of Single Shot Epidural Analgesia on Opioid Consumption
Hakan YILMAZa, Baturay Kansu KAZBEKa, Ülkü Ceren KÖKSOYa, Perihan EKMEKÇİa, Züleyha KAZAK BENGİSUNa, Filiz TÜZÜNERa
aUfuk Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon ABD, Ankara, TÜRKİYE
Turkiye Klinikleri J Anest Reanim. 2020;18(3):73-8
doi: 10.5336/anesthe.2020-78142
Article Language: TR
Full Text
ÖZET
 Amaç: Açık cerrahi teknikle yapılan, donör nefrektomilerde postoperatif dönemde ciddi ağrı yaşanabilmektedir. Preemptif analjezinin, kronik postoperatif ağrı gelişme riskini azaltabileceği de yaygın olarak kabul edilmektedir. Bu çalışmada, donör nefrektomilerde preemptif tek doz epidural analjezi (TDEA) uygulanması ile gerçekleştirilen analjezi yaklaşımlarının, postoperatif ağrı yönetimindeki etkinliği ve opioid tüketimine etkisi retrospektif olarak değerlendirilmiştir. Gereç ve Yöntemler: Hastalar, TDEA ve intravenöz hasta kontrollü analjezi (IVHKA) olmak üzere 2 grupta değerlendirilmiştir. Grup TDEA+IVHKA'da, preemptif tek doz epidural bupivakain ve morfin ile postoperatif dönemde IV tramadol hasta kontrollü analjezi (HKA) kullanılan hastalar yer alırken, grup IVHKA'da sadece IV tramadol HKA kullanılan hastalar yer almıştır. Hastaların ağrı skorları, postoperatif 0 (derlenme odası), 2, 4, 6, 12 ve 24. saatlerde vizüel analog skala (VAS) kullanılarak değerlendirilmiş ve kaydedilmiştir. Bulgular: HKA cihazından bolus talep ve sunumunun, grup TDEA+IVHKA'da istatistiksel olarak anlamlı şekilde düşük olduğu görülmüştür (p<0,001). Grup TDEA+IVHKA'da VAS ağrı skorlarının, tüm ölçüm noktalarında IVHKA grubundan istatistiksel olarak belirgin şekilde daha düşük olduğu bulunmuştur (p<0,001). Derlenme odasında TDEA+IVHKA grubundaki 32 hastanın 13 (%40,6)'ünde VAS ağrı skoru 0 iken, IVHKA grubundaki 34 hastanın 1 (%2,9)'inde 0 saptanmıştır (p<0,001). Grup TDEA+IVHKA'daki hastaların postoperatif ilk mobilizasyondaki ortalama VAS ağrı skorları (3,75±0,76), grup IVHKA'ya (5,35±0,81) göre istatistiksel olarak belirgin şekilde düşük bulunmuştur (p<0,001). Sonuç: Analjezide, tek doz epidural ve sistemik IV opioid kullanımı karşılaştırılmış ve TDEA tekniğinin, postoperatif ağrı skorlarını ve opioid tüketimini anlamlı şekilde düşürdüğü görülmüştür.

Anahtar Kelimeler: Açık donör nefrektomi; tek doz epidural; opioid; multimodal ağrı yönetimi
ABSTRACT
 Objective: Open donor nephrectomies are associated with serious postoperative pain. Preemptive analgesia is an accepted method of lowering the risk of chronic postoperative pain. This study evaluates the effect of multimodal analgesia via preemptive single shot epidural analgesia (SSEA) on the effectiveness of pain control and opioid consumption in a retrospective manner. Material and Methods: The patients were evaluated as SSEA and SSEA plus ntravenous patient controlled analgesia (IVPCA) groups. Group SSEA+IVPCA consisted of patients given preemptive single shot epidural bupivacaine and morphine and IV tramadol PCA while Group IVPCA consisted of patients given only IV tramadol PCA. Pain was evaluated using visual analog scale (VAS) in the postoperative 0 (recovery room), 2, 4, 6, 12 and 24th hours and recorded. Results: Group SSEA+IVPCA had significantly lower demand and delivery values (p<0.001). This group also had significantly lower VAS scores compared to the Group IVPCA at all measurement points (p<0.001). 13 (40.6%) of 32 patients in the Group SSEA+IVPCA had 0 as VAS scores while only 1 (2.9%) patient in the Group IVPCA had 0 as VAS score (p<0.001). Postoperative VAS scores at first mobilization in Group SSEA+IVPCA (3.75±0.76) were significantly lower compared to Group IVPCA (5.35±0.81) (p<0.001). Conclusion: We have compared single shot epidural and systemic opioid analgesia in open donor nephrectomies and concluded that single shot epidural analgesia lowers postoperative pain scores and opioid consumption in a significant manner.

Keywords: Open donor nephrectomy; single shot epidural; opioid; multimodal pain management
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