The analgesic effect of local anesthetic concentrations by infusion of bolus in postoperative patient with wound infiltration

Tıpta Uzmanlık TeziÇalışmamızın amacı; abdominal histerektomi operasyonu geçirecek hastaların cilt altına yerleştirilen infiltrasyon kataterinden levobupivakain infiltrasyonunun, cilt altına tek doz levobupivakain kullanılması ve kontrol grubu ile karşılaştırarak postoperatif ağrı, opioid tüketimi, yan etkiler, hasta ve cerrah memnuniyeti üzerine etkinliğinin karşılaştırılmasıdır. Randomize, prospektif, çift kör olarak planlanan çalışmada, abdominal histerektomi operasyonu geçirecek 60 hasta çalışma kapsamına alındı. Standart genel anestezi uygulanan hastalara, operasyonun sonunda cerrah tarafından Grup I (n=20)'e cilt altı 20 ml serum fizyolojik, Grup II (n=20)'ye cilt altı 20 ml % 0,25 levobupivakain, Grup III (n=20)'e cilt altı infiltrasyon kateteri yerleştirilip, 9 ml/saat infüzyon halinde % 0,25 levobupivakain 6 saat süreyle verildi. Tüm hastalara operasyon odasından çıkmadan önce takılan intravenöz hasta kontrollü analjezi yöntemiyle, tramadol infüzyonu uygulandı. Postoperatif ağrı değerlendirilmesinde; yatarken ve otururken10 cm'lik yatay bir çizgi üzerinde, çizginin en solunun ağrısızlığı (0), en sağının ise dayanılamayacak kadar şiddetli ağrıyı (10) gösterdiği Visual Analog Skala kullanıldı. Postoperatif ½. , 1. , 2. , 4. , 6. ,12. ve 24. saatlerde otururken ve yatarken visual analog skala değerleri, tramadol tüketimi, yan etkiler kaydedildi. 24 saat sonunda hasta ve cerrah memnuniyet düzeyleri sorgulandı . Yatarken ve otururken visual analog skala değerleri postoperatif ½. saatte Grup I'de Grup II ve Grup III'e göre anlamlı derecede yüksek bulundu (p 0.05). Sonuç olarak, abdominal histerektomi operasyonu geçiren hastalara cilt altına yerleştirilen infiltrasyon kataterinden levobupivakain infiltrasyonunun, cilt altına tek doz levobupivakain verilmesine göre yan etki sıklığı daha az olup, daha etkin bir analjezi sağlamaktadır.AbstractThe aim of our study is to make a comparison between the two different techniques applied on the patients undergoing abdominal hysterectomy procedure; levobupivacaine infiltration by the infiltration catheter placed subcutanously and the subcutaneous injection of a single dose of levobupivacaine in terms of postoperative pain, opioid consumption, side effects, and patient and surgeon satisfaction. A control group was also included. 60 patients who were to undergo abdominal hysterectomy operation were included in this randomised, prospective, and double-blinded study. Standard general anaesthesia technique was used in all patients. At the end of the surgery, 20 ml of physiological saline solution to Group 1 (n=20), 20 ml of 0.25% subcutaneous levobupivacaine to Group II (n=20), and 0.25% levobupivacaine via subcutaneous infiltration catheter for 6 hours with an infusion of 9ml/h to Group III (n=20) were given by the surgeon. All the patients received tramadol infusion with the technique of intravenous patient controlled analgesia which was applied before the patients were moved out of the operating room. In the evaluation of postoperative pain, the Visual Analog Scale was used: while sitting and lying, on an horizontal line of 10-cm, the very left (0) signifies no pain, and the very right (10) signifies very severe and excruciating pain. In the postoperative 1/2, 1, 2, 4, 6, 12, and 24th hours, while sitting and lying; visual analog scale results, tramadol consumption, and side effects were recorded. Patient and surgeon satisfaction levels were evaluated at the end of 24 hours. As sitting and lying, visual analog scale results in postoperative 1/2 hours were significantly higher in group I compared to Groups II and III (p<0.01). Visual analog scale results in postoperative 1, 2, 4, 6, and 12th hours were significantly lower in Group III compared to Groups I and II (p<0.01). Tramadol consumption in postoperative 1/2 hour was significantly higher in group I compared to Groups II and III (p<0.01). In postoperative 1, 2, 4, 6, 12, and 24th hours tramadol consumption was significantly lower in Group III compared to other two groups (p<0.01). The incidence of postoperative nausea and vomiting was lower in Group III compared to Groups I and II (p<0.05). In terms of patient and surgeon satisfaction, Group III had better results than Groups I and II had. (p<0.05). As to other side effects (dizziness, sleepiness, diarrhea, constipation, itching), there was no significant difference among three groups (p