Pediyatrik Üroloji Operasyonlarında Epidural Tramadol Ve Morfinin Analjezik Etkinliğinın Karşılaştırılması
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Dosyalar
Tarih
2003
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi Tıp Fakültesi Dergisi
Erişim Hakkı
Attribution 3.0 United States
Özet
Çalışmamızda majör ürolojik (epispadiyas, hipospadiyas) ameliyat geçiren çocuklarda tek doz olarak epidural
aralıktan yapılan morfin ile tramadolün peroperatif hemodinamik etkisi, postoperatif analjezik etkinliği ve yan
etkileri karşılaştırıldı.
Majör ürolojik ameliyat geçiren yaşları 3 ile 14 yıl arasında değişen toplam 40 çocuk çalışma kapsamına alındı.
Entübasyonu takiben, lateral dekübitüs pozisyonu verildi. Bu pozisyonda epidural iğneyle epidural bölgeye
Morfin (M) grubuna 0.1 mg/kg morfin 0.2 mL/kg serum fizyolojik içinde, Tramadol (T) grubuna ise 2 mg/kg
tramadol 0.2 mL/kg serum fizyolojik içinde tek doz olarak verildi. Postoperatif dönemde 24 saat süresince kalp
atım hızı (KAH), sistolik arter basıncı (SAB), solunum sayısı, ağrı skorları ve sedasyon düzeyi izlendi. Yüz skoru
≥3 yetersiz analjezi olarak kabul edilerek, 20 mg/kg parasetamol suppozituar ile tedavi edildi. İlk analjezik
gereksinim zamanı kaydedildi. Sedasyon düzeyi; four-point sedasyon skorlaması ile 0-3 arasında puan verilerek
değerlendirildi.
Postoperatif dönemde, ağrı skorları, analjezik ihtiyaçları açısından gruplar arasında anlamlı bir fark gözlenmedi.
Morfin grubunda bulantı, kusma, allerjik döküntü, sedasyon skorları ve solunum depresyonu, tramadol grubuna
nazaran anlamlı fazla idi.
Pediyatrik girişimlerde daha sıklıkla genel anestezi uygulanmasına rağmen, rejyonel anestezi, hem intraoperatif
hem de postoperatif dönemde uygulanabilmekte, postoperatif dönemde solunum merkezlerinde depresyon
yapmaksızın etkin analjezi ve erken mobilizasyon sağlanmaktadır.Epidural verilen morfin, tramadol’e nazaran
daha fazla yan etkileri gözlendiğinden ağrı skorları arasında anlamlı fark olmadığı için tramadol‘ün güvenle
kullanılabileceğini düşünüyoruz.
In this study peroperative hemodynamic effects, postoperative analgesic effects and side effects of single dosage epidural application of tramadole and morphine were compared in children operated on for urological conditions. Fourty children aged between 3-14 operated on for urological conditions were included in the study. Following intubation, lateral decubitis position were instuted. In this position single dosages of 0.1 mg/kg morphine in 0.2 ml/kg isotonic saline solution to the Morphine group and 2 mg/kg tramadole in 0.2 ml/kg isotonic saline solution to Tramadole group was given to epidural space with an epidural syringe. During the post-operative 24 hours heart rate, systolic blood pressure, respiration rate, pain score and sedation level of the patients were followed up. Patients having 3 or less visual analogous score were accepted to have inadequate analgesia and treated with application of 20 mg/kg paracetamol supposituary. First analgesia requiring time was noted. Sedation level was evaluated by four-point sedation scorring between 0-3. In the post-operative period, pain scores, analgesic requirement rates were also similar in both groups. Nausia and vomitting, allergic rash, sedation score and respiratory depression were high in morphine group compared to tramadol group. Although general anesthesia is more oftenly applicated in pediatric interventions, regional anesthesia can also be applicated both intra and post-operatively offering adequate analgesia and early mobilization without causing respiratory depression in the post-operative period. We conclude that tramadole can safely be used epidurally as it has less side effects with the same efficacy as compared to the epidural usage of morphine.
In this study peroperative hemodynamic effects, postoperative analgesic effects and side effects of single dosage epidural application of tramadole and morphine were compared in children operated on for urological conditions. Fourty children aged between 3-14 operated on for urological conditions were included in the study. Following intubation, lateral decubitis position were instuted. In this position single dosages of 0.1 mg/kg morphine in 0.2 ml/kg isotonic saline solution to the Morphine group and 2 mg/kg tramadole in 0.2 ml/kg isotonic saline solution to Tramadole group was given to epidural space with an epidural syringe. During the post-operative 24 hours heart rate, systolic blood pressure, respiration rate, pain score and sedation level of the patients were followed up. Patients having 3 or less visual analogous score were accepted to have inadequate analgesia and treated with application of 20 mg/kg paracetamol supposituary. First analgesia requiring time was noted. Sedation level was evaluated by four-point sedation scorring between 0-3. In the post-operative period, pain scores, analgesic requirement rates were also similar in both groups. Nausia and vomitting, allergic rash, sedation score and respiratory depression were high in morphine group compared to tramadol group. Although general anesthesia is more oftenly applicated in pediatric interventions, regional anesthesia can also be applicated both intra and post-operatively offering adequate analgesia and early mobilization without causing respiratory depression in the post-operative period. We conclude that tramadole can safely be used epidurally as it has less side effects with the same efficacy as compared to the epidural usage of morphine.
Açıklama
İnönü Üniversitesi Tıp Fakültesi Dergisi
10(2) 71-75 (2003)
Anahtar Kelimeler
Epidural Anestezi, Morfin, Tramadol, Epidural Anesthesia, Morphine, Tramadole
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Demiaran, Yavuz ; Akman, R. Yavuz ;Kocaman, Buket ; Erol, Ali ;İnönü Üniversitesi Tıp Fakültesi Dergisi 10(2) 71-75 (2003)
