ÖZET

Amaç:

Sezaryen sonrası postoperatif ağrı tedavisinde, opioid ihtiyacını azaltmayı ve dolayısıyla opioidle ilişkili yan etkilerin insidansını azaltmayı amaçlayan çeşitli multimodal analjezi stratejileri mevcuttur. Bu çalışma, genel anestezi ile sezaryen olan hastalarda uygulanan dört farklı multimodal analjezi stratejisinde, tramadol ihtiyacındaki azalmayı ve analjezi kalitesini karşılaştırmayı amaçladı.

Yöntem:

Genel anestezi altında elektif sezaryen yapılan toplam 160 hasta geriye dönük olarak şu gruplardan birine dahil edildi: sadece tramadol bazlı hasta kontrollü analjezi, tramadol bazlı hasta kontrollü analjezi artı diklofenak fitil, tramadol bazlı hasta- kontrollü analjezi artı diklofenak fitil artı parasetamol ve tramadol bazlı hasta kontrollü analjezi artı diklofenak artı transversus abdominis plan bloğu. Görsel analog skala skorları ve tramadol kullanımı 2., 4., 8., 12. ve 24. saatlerde izlenerek kaydedildi.

Bulgular:

İkinci, 4. ve 8. saatlerde, sadece tramadol kullanılan hasta kontrollü analjezi grubu diğer tüm gruplardan anlamlı olarak daha yüksek görsel analog skala puanlarına sahipti (p<0,05). Yirmi dördüncü saatte, transversus abdominis plan bloğu grubu, hem tramadol bazlı hasta kontrollü analjezi grubu hem de tramadol bazlı hasta kontrollü analjezi artı diklofenak grubundan daha düşük skorlara sahipti (p<0,01 ve p=0,014). Kümülatif tramadol tüketimi, tramadol temelli hasta kontrollü analjezi alan grupta en yüksek, transversus abdominis plan bloğu grubunda ise tüm zaman noktalarında en düşük düzeyde olarak görülürken (p<0,05), kalan iki grubun tüketimleri benzerdi (p>0,05).

Sonuç:

Tramadol bazlı hasta kontrollü analjezi tek başına genel anestezi altında sezaryen sonrası etkili ağrı kontrolü sağlamamaktadır. Transversus abdominis plan bloğu tabanlı multimodal analjezi protokolü, en belirgin opioid koruyucu etkiye sahipken, parasetamol ek fayda sağlamıyor gibi görünmektedir.

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Transvers Abdominis Plan Bloğu Tabanlı Multimodal Analjezi Protokolü, Sezaryen Sonrası Tramadol İhtiyacını Azaltır

ÖZET

References