Öz
Özet
Amaç. Omuz cerrahisi uygulanan hastalarda postoperatif ağrı önemli bir sorundur. Çalışmamızda omuz cerrahisi sonrasında postoperatif ağrı tedavisi için subakromial kateter uyguladığımız 26 hastayı prostektif randomize bir çalışma ile değerlendirdik. Yöntem. Operasyonun sonunda subakromial alana kateter yerleştirilerek lokal anestezik+opioid infüzyonu başlandı. Subakromial kateter 24 saat yerinde tutuldu. Hastaların ağrıları Vizüel Ağrı Skalası (VAS) ile değerlendirildi. VAS’ı >7 olanlara meperidin 0,5 mg/kg iv, VAS’ı 5-7 olanlara tenoksikam 20 mg iv, 2 saat sonra halen VAS >3 olanlara ek analjezik olarak parasetamol 1 gr iv uygulandı. Bulgular. 24 saat boyunca takip edilen hastaların hiçbirinde meperidin ihtiyacı olmadı. VAS’ı 5-7 arasında olan 7 hastaya Tenoksikam 20 mg iv yapıldı. Ağrısı devam eden 7 kadın hastaya Parasetamol 1 mg iv ek olarak uygulandı. Sonuç. Subakromial kateter, yan etki ve komplikasyona neden olmaması, işlemin kolay uygulanması ve etkin bir analjezi sağlaması nedeniyle omuz cerrahisi geçiren hastalarda güvenle kullanılabileceğini düşünmekteyiz. Bu hastalarda sistemik opioid ihtiyacını azaltması, opioide bağlı yan etkilerin (bulantı-kusma, kabızlık, kaşıntı vb.) görülmemesine neden olarak hasta konforunu arttırır. Ek analjezik ihtiyacının sadece kadın cinsiyette olması, cinsiyetin ağrı değerlendirmesi üzerine etkisini göstermesi açısından önemli olduğunu düşünmekteyiz.
Anahtar sözcükler: Subakromial infüzyon, cinsiyet, omuz artroskopisi
Abstract
Aim. Postoperative pain is a major problem in patients who have undergone surgery of the shoulder joint. We retrospectively evaluated 26 patients in whom a subacromial catheter had been placed for postoperative pain management following shoulder surgery. Method. Infusion of local anesthetics and/or opioids through a subacromial catheter, placed at the end of the procedure, was started after surgery. This catheter was kept in place for 24 hours. The patients’ pain was evaluated by using a visual analog scale (VAS). Patients with a VAS score greater than 7 were given meperidine, 0.5 mg/kg i.v., those with a score of 5-7 received tenoxicam, 20 mg i.v., and patients who continued to have a score of >5 at the end of 30 minutes were given paracetamol, 1 g i.v. as an additional analgesic injection. Results. None of the patients had a need for meperidine after 24 hours of surveillance. Seven patients with a VAS score of 5-7 were given tenoxicam, while seven patients, all female, who had continuing pain, received paracetamol. Conclusion. A subacromial catheter, which does not cause adverse effects or complications, is easy to apply and allows effective analgesia, can be used with confidence in the postoperative pain management of patients undergoing shoulder surgery. The need for supplementary analgesia in women only is significant, indicating the role of the patient’s sex in pain perception.
Keywords: Subacromial infusion, gender, shoulder arthroscopy
Anahtar Kelimeler
Kaynakça
- Muittari PA, Nelimarkka O, Seppälä T, Kanto JH, Kirvelä OA. Comparison of the analgesic effects of intrabursal oxycodone and bupivacaine after acromioplasty. J Clin Anesth 1999; 11: 11-6.
- Savoie FH, Field LD, Jenkins RN, Mallon WJ, Phelps RA 2nd. The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy 2000; 16: 339-42.
- Borgeat A, Schäppi B, Biasca N, Gerber C. Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patientcontrolled analgesia. Anesthesiology 1997; 87: 1343-7.
- Borgeat A, Tewes E, Biasca N, Gerber C. Patient-controlled Interscalene Analgesia with Ropivacaine After Major Shoulder Surgery: PCIA vs PCA. Br J Anaesth 1998; 81:603-5. de Nadal M, Agreda G, Massenet S. Efficacy of bupivacaine infiltration upon postoperative pain after ambulatory shoulder arthroscopy under general anaesthesia. Br J Anaesth 1998; 80: A595.
- Singelyn FJ, Seguy S, Gouverneur JM. Interscalene brachial plexus analgesia after open shoulder Surgery: Continuous versus patient-controlled infusion. Anesth Analg 1999; 89: 1216-20.
- Pere P, Pitkänen M, Rosenberg PH, Björkenheim JM, Linden H, Salorinne Y, Tuominen M. Effect of continuous interscalene brachial plexus block on diaphragm motion and on ventilatory function. Acta Anaesthesiol Scand 1992; 36: 53-7.
- Pere P. The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine plus fentanyl on diaphragmatic motility and ventilatory function. Reg Anesth 1993; 18: 93-7.
- Koltka K, Batmaz M, Atalar AC, Demirhan M, Küçükay S, Şentürk M, Pembeci K. Omuz Cerrahisi’nde postoperatif analjezi sağlama yöntemlerinin karşılaştırılması. Türk Anest Rean Der Dergisi 2008; 36: 38-44.
- Stein C, Comisel K, Haimerl E, Yassouridis A, Lehrberger K, Herz A, Peter K. Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 1991; 325: 1123-6.
- Khoury GF, Chen AC, Garland DE, Stein C. Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 1992; 77: 263-6.
- Barber FA, Herbert MA. The effectiveness of an anesthetic continuous-infusion device on postoperative pain control. Arthroscopy 2002; 18: 76-81.
- Harvey GP, Chelly JE, AlSamsam T, Coupe K. Patient-controlled ropivacaine analgesia after arthroscopic subacromial decompression. Arthroscopy 2004; 20: 451
- Sjölinger J, Srichaiyo S, Subbhagen L, Seriachius S, Torkelsen Ø. Do men have higher sensory pain thresolds than women? Proceedings of Freshmens Research Project 2001; 9: 79-83.
- Käll LB, Kowalski J, Stener-Victorin E. Assessing pain perception using the Painmatcher in patients with whiplash-associated disorders. J Rehabil Med 2008; 40: 171-7.
Öz
Aim. Postoperative pain is a major problem in patients who have undergone surgery of the shoulder joint. We retrospectively evaluated 26 patients in whom a subacromial catheter had been placed for postoperative pain management following shoulder surgery. Method. Infusion of local anesthetics and/or opioids through a subacromial catheter, placed at the end of the procedure, was started after surgery. This catheter was kept in place for 24 hours. The patients’ pain was evaluated by using a visual analog scale (VAS). Patients with a VAS score greater than 7 were given meperidine, 0.5 mg/kg i.v., those with a score of 5-7 received tenoxicam, 20 mg i.v., and patients who continued to have a score of >5 at the end of 30 minutes were given paracetamol, 1 g i.v. as an additional analgesic injection. Results. None of the patients had a need for meperidine after 24 hours of surveillance. Seven patients with a VAS score of 5-7 were given tenoxicam, while seven patients, all female, who had continuing pain, received paracetamol. Conclusion. A subacromial catheter, which does not cause adverse effects or complications, is easy to apply and allows effective analgesia, can be used with confidence in the postoperative pain management of patients undergoing shoulder surgery. The need for supplementary analgesia in women only is significant, indicating the role of the patient’s sex in pain perception.
Anahtar Kelimeler
Kaynakça
- Muittari PA, Nelimarkka O, Seppälä T, Kanto JH, Kirvelä OA. Comparison of the analgesic effects of intrabursal oxycodone and bupivacaine after acromioplasty. J Clin Anesth 1999; 11: 11-6.
- Savoie FH, Field LD, Jenkins RN, Mallon WJ, Phelps RA 2nd. The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy 2000; 16: 339-42.
- Borgeat A, Schäppi B, Biasca N, Gerber C. Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patientcontrolled analgesia. Anesthesiology 1997; 87: 1343-7.
- Borgeat A, Tewes E, Biasca N, Gerber C. Patient-controlled Interscalene Analgesia with Ropivacaine After Major Shoulder Surgery: PCIA vs PCA. Br J Anaesth 1998; 81:603-5. de Nadal M, Agreda G, Massenet S. Efficacy of bupivacaine infiltration upon postoperative pain after ambulatory shoulder arthroscopy under general anaesthesia. Br J Anaesth 1998; 80: A595.
- Singelyn FJ, Seguy S, Gouverneur JM. Interscalene brachial plexus analgesia after open shoulder Surgery: Continuous versus patient-controlled infusion. Anesth Analg 1999; 89: 1216-20.
- Pere P, Pitkänen M, Rosenberg PH, Björkenheim JM, Linden H, Salorinne Y, Tuominen M. Effect of continuous interscalene brachial plexus block on diaphragm motion and on ventilatory function. Acta Anaesthesiol Scand 1992; 36: 53-7.
- Pere P. The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine plus fentanyl on diaphragmatic motility and ventilatory function. Reg Anesth 1993; 18: 93-7.
- Koltka K, Batmaz M, Atalar AC, Demirhan M, Küçükay S, Şentürk M, Pembeci K. Omuz Cerrahisi’nde postoperatif analjezi sağlama yöntemlerinin karşılaştırılması. Türk Anest Rean Der Dergisi 2008; 36: 38-44.
- Stein C, Comisel K, Haimerl E, Yassouridis A, Lehrberger K, Herz A, Peter K. Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 1991; 325: 1123-6.
- Khoury GF, Chen AC, Garland DE, Stein C. Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 1992; 77: 263-6.
- Barber FA, Herbert MA. The effectiveness of an anesthetic continuous-infusion device on postoperative pain control. Arthroscopy 2002; 18: 76-81.
- Harvey GP, Chelly JE, AlSamsam T, Coupe K. Patient-controlled ropivacaine analgesia after arthroscopic subacromial decompression. Arthroscopy 2004; 20: 451
- Sjölinger J, Srichaiyo S, Subbhagen L, Seriachius S, Torkelsen Ø. Do men have higher sensory pain thresolds than women? Proceedings of Freshmens Research Project 2001; 9: 79-83.
- Käll LB, Kowalski J, Stener-Victorin E. Assessing pain perception using the Painmatcher in patients with whiplash-associated disorders. J Rehabil Med 2008; 40: 171-7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Mart 2014 |
| Yayımlandığı Sayı | Yıl 2014Cilt: 36 Sayı: 1 |