COX 1-2 İnhibitörlerinin Roküronyum Enjeksiyon Ağrısının Önlenmesine Etkileri: Randomize, Kontrollü, Çift Kör Çalışma
Öz
Amaç: Rokuronyum yaygın kullanımı olan nöromusküler bloker ajandır. Anestezi uygulamalarında rokuronyum enjeksiyonuna bağlı ağrı, sıklıkla görülen bir yan etkidir. Bu çalışmada roküronyumun enjeksiyon ağrısını önlemek için Cox1-2 inhibitörü(deksketoprofen) kullanılmış ve etkileri kontrol grubuyla karşılaştırılmıştır.
Gereç ve Yöntemler: Genel anestezi uygulanan 60 hasta çalışmaya dahil edildi ve 2 gruba ayrıldı. Genel anestezi uygulamasından 10 dakika önce bütün hastaların el dorsumu veya brakiyel venine intraket takıldı. Grup 1’deki hastalara IV deksketoprofen(50mg) ve Midazolam (0.3mg/kg), grup 2’deki hastalara 2 ml IV SF ve Midazolam (0.3mg/kg) uygulandı. İlaç uygulandıktan sonra hastalar operasyon odasına alındı, monitörize edildi ve indüksiyonda 1mg/kg lidokain, 0,6 mg/kg rokuronyum ve 2mg/kg propofol uygulandı. Rokuronyum uygulanması sırasında hastalar 0-3 puanlık bir skorlama sistemi ile değerlendirildi. (0: tepki ve hareket yok, 3: ilaç verirken kolunu çekiyor) indüksiyon sırasında ve intraoperatif belli aralıklarla kalp hızı, ortalama kan basıncı ve SpO2 değerleri kaydedildi. Operasyon sonunda uyanma ünitesinde Aldrete Skoru 9 olduğunda hastalara 1-Uyumadan önce son ne hissettin, 2-Eline ilaç yapılırken ağrı hissettin mi? Soruları sorularak cevapları kaydedildi.
Bulgular: Gruplar arasında demografik ve vital değişkenler açısından fark yoktu. Grup 1’deki hastaların %53,3 ü el ya da kol çekme gözlenmezken bu oran grup 2’de %73.3 idi. Hastalar 1. Soruya benzer cevaplar vermiş ve anlamlı fark gözlenmemişti. 2. Soruya ise grup 2’de %16’sı ağrı hissettiğini belirtirken grup 1 de bu oran %3 olarak gözlendi.
Sonuç: Rokuronyum enjeksiyonunun neden olduğu ağrının sebepleri halen net bir şekilde ortaya konulamamakla birlikte birçok görüş öne sürülmüştür. Bunlardan biri de prostoglandin üretimine neden olarak ağrı eşiğinin düşürülmesidir. Bizde buradan yola çıkarak sadece cox-2 inhibisyonu ile ağrı algılanmasının azaltılabileceğini araştırdık. Cox inhibitörleri ağrının azaltılmasında etkili olmakla birlikte plasebo grubuna göre beklenen ağrı azalması gözlenmedi. Sonuç olarak rokuronyumun ağrı oluşturmasında PGE artışı esas sorumlu değildir. Ağrı oluşmasında diğer mekanizmalarında rolü bulunmaktadır.
Anahtar Kelimeler
Rocurronium Bromid injection pain Dexkethoprofen. Rocuronium; injection pain; cyclo-oxygenase inhibitors.
Kaynakça
- Referans1: Oda Y.Rocuronium bromide: clinical application of single-dose pharmacokinetic models to continuous infusion.J Anesth. 2018;32(1):1–2. 10.1007/s00540-017-2401-8
- Referans2: Mencke T, Beerhalter U, Fuchs-Buder T.Spontaneous movements, local reactions and pain on injection of rocuronium. A comparison between female and male patients.Acta Anaesthesiol Scand. 2001;45(8):1002–5. 10.1034/j.1399-6576.2001.450813.
- Referans3. Memis D, Turan A, Karamanlioglu B, Sut N, Pamukcu Z. The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl. Anesth Analg 2002;94:1517 - 20
- Referans4. Reddy MS, Chen FG, Ng HP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: a randomised, doubleblind controlled comparison with lidocaine. Anaesthesia 2001;56: 902 – 5
- Referans5. Cheong KF, Wong WH. Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment. Br J Anaesth 2000;84:106 – 7
- Referans6. Yonghong Zhang MD, Yong Xiang MD , Jin Liu MD. Prevention of pain on injection of rocuronium: a comparison of lidocaine with different doses of parecoxib. Journal of Clinical Anesthesia (2012) 24, 456–459
- Referans7. Borgeat A, Kwiatkowski D. Spontaneous movements associated with rocuronium: Is pain on injection the cause?Br J Anaesth.1997;79:382–3
- Referans8. Oh AY, Seo KS, Goo EK, Park YO, Kim SJ, Kim JH. Pretreatment of withdrawal movement associated with injection of rocuronium in children: Comparison of remifentanil, alfentanil and fentanyl.Acta Anaesthesiol Scand.2007;51:1190–3.
- Referans9. Klement W, Arndt JO. Pain on iv injection of some anaesthetic agents is evoked by the unphysiological osmolality or pH of their formulations.Br J Anaesth.1991;66:189–95.
- Referans10. Kindgen-Milles D, Klement W, Arndt JO. The nociceptive systems of skin, paravascular tissue and hand veins of humans and their sensitivity to bradykinin. Neurosci Lett. 1994;181:39–42
- Referans11. Yilmaz S, Hatiboglu Y.The evaluation of the effect of venous diameter measurement by ultrasonography on pain and withdrawal response.J Anesth. 2018;32(3):375–80
Effects of COX 1-2 Inhibitors on Prevention of Rocuronium Injection Pain: Controlled, Randomised, Double Blind Study
Öz
Aim: Rocuronium bromide is a painful agent during induction of general anaesthesia. The aim of the study is to investigate the effects of Cyclooxygenase (COX) inhibitors as a resque agent against the rocuronium pain.
Material and Methods: Sixty patients of either sex scheduled for under general anesthesia were enrolled in this study. Patients were allocated into two groups (Group 1: Dexkethoprofen group, Group 2: Control group). Pain was evaluated by during rocuronium injection, patients were scored by a scale showed below. 0; No movement response to injection, 1; Mild movement response to injection, 2; Hand withdrawal response to injection, 3; Arm withdrawal response to injection. We also evaluated the pain with 2 questions when the patient was in the recovery room. Question 1. What was the last feeling before you fall into sleep? and question 2. Did you feel any pain on your hand during medication injection for anesthesia?
Results: There were differences between the groups in terms of total pain score for example in group 1 there were 16 (53%) patients who did not make any movement during rocuronium injection while there were 22 (73%) patients in group 2.There was significant difference in injection rocuronium bromide pain between group 1: dexkethoprofen group, Group 2: control group in terms of the answer to the second question. Patients felt less pain than the control group. In the second question, 16% in group 2 stated that they felt pain, while this rate was observed as 3% in group 1.
Conclusion: The effect of cox inhibitors on rocuronium pain was seen in our study but control group is also effective in reducing pain in vascular width.
Anahtar Kelimeler
Rocuronium; injection pain; cyclo-oxygenase inhibitors. Rocuronium; injection, pain; cyclo-oxygenase inhibitors.
Kaynakça
- Referans1: Oda Y.Rocuronium bromide: clinical application of single-dose pharmacokinetic models to continuous infusion.J Anesth. 2018;32(1):1–2. 10.1007/s00540-017-2401-8
- Referans2: Mencke T, Beerhalter U, Fuchs-Buder T.Spontaneous movements, local reactions and pain on injection of rocuronium. A comparison between female and male patients.Acta Anaesthesiol Scand. 2001;45(8):1002–5. 10.1034/j.1399-6576.2001.450813.
- Referans3. Memis D, Turan A, Karamanlioglu B, Sut N, Pamukcu Z. The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl. Anesth Analg 2002;94:1517 - 20
- Referans4. Reddy MS, Chen FG, Ng HP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: a randomised, doubleblind controlled comparison with lidocaine. Anaesthesia 2001;56: 902 – 5
- Referans5. Cheong KF, Wong WH. Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment. Br J Anaesth 2000;84:106 – 7
- Referans6. Yonghong Zhang MD, Yong Xiang MD , Jin Liu MD. Prevention of pain on injection of rocuronium: a comparison of lidocaine with different doses of parecoxib. Journal of Clinical Anesthesia (2012) 24, 456–459
- Referans7. Borgeat A, Kwiatkowski D. Spontaneous movements associated with rocuronium: Is pain on injection the cause?Br J Anaesth.1997;79:382–3
- Referans8. Oh AY, Seo KS, Goo EK, Park YO, Kim SJ, Kim JH. Pretreatment of withdrawal movement associated with injection of rocuronium in children: Comparison of remifentanil, alfentanil and fentanyl.Acta Anaesthesiol Scand.2007;51:1190–3.
- Referans9. Klement W, Arndt JO. Pain on iv injection of some anaesthetic agents is evoked by the unphysiological osmolality or pH of their formulations.Br J Anaesth.1991;66:189–95.
- Referans10. Kindgen-Milles D, Klement W, Arndt JO. The nociceptive systems of skin, paravascular tissue and hand veins of humans and their sensitivity to bradykinin. Neurosci Lett. 1994;181:39–42
- Referans11. Yilmaz S, Hatiboglu Y.The evaluation of the effect of venous diameter measurement by ultrasonography on pain and withdrawal response.J Anesth. 2018;32(3):375–80
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 14 Sayı: 1 |
Kaynak Göster
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