Torakotomi Sonrasý Aðrý Tedavisinde Tramadol ve Deksmedetomidinin Kombinasyonu

AMAÇ: Bu çalýþmada torakotomi sonrasý aðrý tedavisinde tramadole adjuvan olarak deksmedetomidin eklenmesinin solunum fonksiyonlarýna, analjezi ve sedasyon üzerine etkisinin araþtýrýlmasý amaçlandý.
YÖNTEMLER: Torakotomi yapýlan 30 hasta randomize olarak iki gruba ayrýldý. Postoperatif hastalarýn ortalama kan basýncý (OAB), kalp hýzý (KAH), solunum sayýsý (SS) ve SpO2 deðerleri kaydedildi. Grup T’deki hastalara hasta kontrollü analjezi (HKA) ile 100 mL normal salin içinde 4 mg mL tramadol solüsyonu iv olarak HKA ayarlarý, 0,3 mg kg-1 sa-1 infüzyon, 10 mg ara bolus doz ve 20 dk kilitleme süresi olacak þekilde infüze edilmeye baþlandý. Grup D’deye ise ayný doz tramadol ile HKA iþlemine ek olarak deksmedetomidin 1,0 µg kg-1 dan 20 dk yükleme, 0,4 µg kg-1 sa-1 idame olacak þekilde 24 saat boyunca iv uygulandý. Analjezik etkinliði Visual analog skala (VAS) ile, sedasyon düzeyleri Ramsay sedasyon skalasý ile deðerlendirildi. Postoperatif dönemde arterial kan gazý (AKG), total tramadol tüketimi ve yan etkiler, zorlu vital kapasite (FVC), 1. saniye zorlu ekspiratuar volüm (FEV1), FEV1/FVC oraný ve vital kapasite (VC) deðerleri bakýldý ve gruplar karþýlaþtýrýldý.
BULGULAR: Gruplar dermografik olarak birbirine benzerdi Her iki gruptada etkin analjezi saðlandý. KAH, OAB, VAS, Ramsay sedasyon skalasý ve tramadol tüketimi Grup D de Grup T ye göre daha düþük bulundu FEV1, FVC, VC deðerlerinde her iki grup arasýnda istatistiksel olarak anlamlý fark bulunmadý.
SONUÇ: Torakotomi sonrasýnda postoperatif analjezi saðlamak amacýyla HKA yöntemi ile uygulanan tramadole deksmedetomidin ilavesinin hastalarda solunumu baskýlamadan, etkin sedasyon ve analjezi saðladýðý, tramadol tüketimini anlamlý düzeyde azalttýðý kanýsýna varýldý.

Combination of Dexmedetomidine and Tramadol In Treatment of Pain After Thoracotomy

OBJECTIVE: In this study, we aimed to investigate the effects of dexmedetomidine which was used as an adjuvant to tramadol, on respiratory functions, analgesia and sedation in the treatment of the pain after thoracotomy.
METHODS: 30 patients with thoracotomy were divided randomly into two groups. The postoperative vital values were recorded including mean blood pressure(MAP), heart rate(HR), respiratory rate(RR) and SpO2. Group T received patient-controlled analgesia (PCA) with 4 mg mL-1 tramadol iv in 100 ml normal saline solution. PCA settings were 0.3 mg kg-1 h-1 infusion, a bolus dose of 10 mg and 20 minute lockout interval. Group D received tramodol similar to group T, and dexmedetomidine 1.0 µg kg-1 20 minute as loading dose than 0.4 µg kg-1 h-1 iv. for maintanence over 24 hours. Analgesic efficacy was measured with Visual analog scale (VAS), sedation levels were assessed with Ramsay sedation scale. In the postoperative period, arterial blood gas, the total consumption of tramadol and its side effects, forced vital capacity (FVC),1 second forced expiratory volume (FEV1), FEV1/FVC, and forced vital capacity (VC) values were recorded, than groups were compared.
RESULTS: Patients were similar in both groups. In all groups, effective analgesia was achieved. HR, MAP, VAS, Ramsay sedation scale, and tramadol consumption was lower in Group D. In FEV1, FVC, VC values, there were not statistically significant differences between both groups.
CONCLUSION: It was concluded that using PCA in order to provide postoperative analgesia after thoracotomy, with the addition of dexmedetomidine to tramadol provides effective sedation and analgesia without respiration depression.