Öz
Amaç
Laparoskopik cerrahi sonrasında önemli oranda postlaparoskopik omuz ağrısı (PLSP) görülmektedir. Bu çalışmanın amacı, laparoskopik jinekolojik cerrahi gerçekleştirilen hastalarda pulmoner rekruitment manevrasının (PRM) PLSP, postoperatif ağrı ve hasta sonuçlarına etkisini araştırmaktır.
Yöntem
Nisan 2023 ile Ekim 2023 tarihleri arasında benign sebeplerle laparoskopik jinekolojik operasyon gerçekleştirilen hastalar retrospektif olarak incelendi. Hastalar PRM uygulanan grup (grup PRM, n=45) ve uygulanmayan kontrol grubu (grup K, n=46) olarak iki gruba ayrıldı. Grup PRM’de operasyon bitiminde manuel yöntemle 40 cmH20 basınçlı 5 rekruitment manevrası gerçekleştirildi. Postoperatif 6, 12 ve 24. saatlerdeki PLSP vizüel analog skala (VAS) skorları, postoperatif yara yeri VAS skorları, ambülasyon süreleri, postoperatif bulantı-kusma (PONV) mevcudiyeti, bağırsak hareketleri zamanı ile hastanede kalış süreleri karşılaştırıldı.
Bulgular
Çalışmaya yaş ortalaması 49,4±9 yıl olan toplam 91 hasta dahil edildi. En çok gerçekleştirilen operasyon, total laparoscopic hysterectomy, bilateral salpingo-oophorectomy idi. Grup PRM’de PLSP oranı Grup K’ye göre anlamlı olarak düşük idi (%31,1 vs. %63, p=0,002). Grup PRM’de postoperatif 6 (3,6 vs. 5,8), 12 (3,3 vs. 4,9) ve 24. saatteki (2,8 vs. 3,9) ortalama PLSP VAS skorları anlamlı olarak düşük saptandı (hepsi için p<0,001). Grup PRM’de aynı zamanda postoperatif 6. saat yara ağrı skorları da anlamlı olarak düşüktü (4,8 vs. 5,7, p=0,009). Grup PRM’de ambülasyon süresi (6,6±0,9 vs. 7,5±1,5 saat, p=0,002) ile bağırsak hareketlerinin geri gelme süresi de anlamlı olarak düşük idi (14,2±4 vs. 16,4±5 h, p=0,038). Grup PRM’de PONV oranı (%28,9 vs. %37) ve hastanede kalış süresi (2,2±0,4 vs. 2,3±0,5 gün) düşük olmakla birlikte anlamlı farklılık saptanmadı.
Sonuç
Benign laparoskopik jinekolojik cerrahilerde operasyon bitiminde kolayca uygulanabilen PRM, PLSP ve erken dönem yara ağrısının azaltılmasında etkilidir. Bununla birlikte postoperatif ambülasyon süresinin ve bağırsak fonksiyonlarının geri dönmesinde de faydalıdır.
Anahtar Kelimeler: Anahtar kelimeler: Erken ambülasyon, laparoskopi, omuz ağrısı, pnömoperitoneum, postoperatif ağrı, pulmoner rekruitman manevras
Kaynakça
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