Modifiye Radikal Mastektomi Operasyonlarýnda Postoperatif Analjezi Amaçlý Uygulanan Ýntravenöz Parasetamolün Morfin Tüketimi Üzerine Etkisi

Paracetamol is combined with opioids or used alone for management of post-operative pain. Ýn this study, we investigated the effect of intravenous (IV) paracetamol on morphine consumption used for post-operative pain after modified radical mastectomy. SixtyASA l-lll patients scheduled for modified radical mastectomy under general anesthesia were randomly allocated into two groups by using closed envelope system (Group P; n= 30, Group S; n= 30). Anesthesia was induced with fentanil 1-2/vg/kg, cisatracurium 0.15 mg/kg and propofol 2-2.5 mg/kg, maintained with sevoflurane 1-2%, N20 66%/Oz. Group P received paracetamol 1 g, infused in 15 minutes one hour before the end of surgery and at six hours intervals in post-operative 24 hours. Þaline infusion was given to Group S at the same time. Ali patients were connected to a patient controlled analgesia device adjusted to deliver morphine 5 mg as loading, 1 mg bolus and five minutes lock-out time. A bolus of morphine 5 mg was administered if visu-al analog scale (VAS) s 4. l/AS scores, sedation, respiratory rate, heart rate, blood pressure, Sp02, morphine consumption and side effects were recorded. Demographic parameters were similar. Morphine consumption was less in Group P (p< 0.001). The demand and delivery doses of morphine was higher in Group S (p< 0.001). VAS scores were lower in paracetamol group (p< 0.008). Aithough the side effects such as nausea-vomiting, urinary retention and itching were more in Group S, it was not sta-tistically significant. Ýn this study, aithough statistically not significant, we have demonstrated that paracetamol used for post-operative pain can reduce morphine consumption and side effects while providing an effective analgesia.

The Effect of Irýtravenous Paracetamol on Morphine Consumption Used for Post-Operative Pain After Modified Radical Mastectomy

Postoperatif aðrý tedavisinde parasetamoi, tek baþýna veya opioidlerle kombine edilerek kullanýlmaktadýr. Bu çalýþmada, modifiye radikal mastektomi uygulanan hastalarda postoperatif analjezi amacýyla kullanýlan intravenöz (IV) parasetamolün morfin tüketimi üzerine etkisi araþtýrýldý. Genel anestezi ile modifiye radikal mastektomi uygulanacak ASA l-lll 60 hasta çalýþmaya alýndý. Premedikasyon yapýlmayan hastalar kapalý zarf çekme yöntemiyle randomize olarak iki gruba ayrýldý (Grup P; n= 30, Grup S; n= 30). Anestezi indüksiyonu 1-2 pg/kg fentanil, 0.15 mg/kg cisatrakuryum ve 2-2.5 mg/kg propofol, idame %1-2 sevofluran, %66 N20/02 ile saðlandý. Grup P'ye cerrahi bitiminden bir saat önce ve postoperatif 24 saat süreyle, altý saat arayla 1 g IV paraseta-mol 15 dakika in füzyon þeklinde uygulandý. Grup S'ye ayný zaman aralýklarýnda þalin in füzyonu yapýldý. Postoperatif her iki gruba da morfin ile hazýrlanmýþ hasta kontrollü analjezi cihazý baðlandý. Morfin dozlarý 5 mg yükleme dozu, beþ dakika kilit süresi ve 1 mg bolus olarak ayarlandý. Vizüel analog skala (VAS) >4 ise 5 mg IV morfin botus dozu yapýldý. VAS aðrý skorlarý, sedasyon, solunum sayýsý, kalp hýzý, kan basýncý, Sp02, total morfin tüketimi ve yan etkiler takip edildi. Demografik özellikler her iki grupta benzerdi. Grup P'de morfin tüketimi %40 daha az bulundu (p< 0.001). istenilen ve verilen bolus sayýsý Grup S'de anlamlý olarak daha fazlaydý (p< 0.001). VAS skorlarý parasetamoi uygulanan grupta daha düþüktü (p< 0.008). Bulantý, kusma, idrar retansiyonu ve kaþýntý gibi yan etkiler Grup S'de daha fazla görülmekle birlikte istatistiksel olarak anlamlý deðildi. Bu çalýþmada, postoperatif aðrý tedavisinde kullanýlan IV parasetamolün etkin bir analjezi saðlarken morfin tüketimi ve istatistiksel olarak anlamlý olmamakla beraber yan etki insidansýný azalttýðý gösterildi.