Postoperatif Hasta Kontrollü Analjezi Uygulaması: Tek Merkez Deneyimi

Yıl 2019, , 171 - 176, 30.06.2019

Yeşim Şenaylı , Alper Salman , Altan Şahin

https://doi.org/10.16899/jcm.566754

Öz

Öz

Amaç: Bu retrospektif çalışmada postoperatif hasta kontrollü analjezi (HKA) uygulanan hastaların demografik özelliklerinin, ağrı durumlarının, kullanılan analjezik ajanların ve yan etkilerin incelenmesi amaçlanmıştır.

Gereç ve Yöntem: Hastanemizde yaklaşık 20 aylık periyotta HKA ile postoperatif analjezi tedavisi uygulanan hastalar retrospektif olarak değerlendirildi. Hastaların demografik bilgileri, klinik özellikleri, intravenöz veya epidural uygulama protokolleri kullanılarak servis şartlarında yaklaşık sekiz saat aralıklarla yapılan takip değerlendirme bulguları (ağrı, sedasyon, uykusuzluk, bulantı, kusma, kaşıntı) kaydedildi.

Bulgular: Çalışmaya alınan 810 hastanın %57,9’u kadın olup çoğu (%55,8) ortopedik cerrahi uygulanmış olan hastalardı. HKA, 730 (%90,4) hastada intravenöz, 80 (%9,6) hastada epidural yol ile uygulanmıştı. İntravenöz HKA kadınlarda, epidural HKA ise erkeklerde daha fazla tercih edilen bir uygulama idi. En sık tercih edilen analjezik ajan intravenöz uygulamada petidin iken, epidural uygulamada fentanil + bupivakain olarak saptandı. Hastalarda en sık görülen yan etkiler sedasyon/uyku hali, bulantı, kusma ve idrar retansiyonu idi.

Sonuç: Hastanemizde HKA uygulamasında intravenöz uygulamanın daha çok tercih edildiği, en sık tercih edilen analjezik ajanın intravenöz uygulamada petidin, epidural uygulamada fentanil + bupivakain olduğu görülmüştür. HKA ile ağrı tedavisi düşük yan etki düzeyleri ile iyi tolere edilmektedir.

Anahtar Kelimeler

: Hasta kontrollü analjezi, postoperatif ağrı

Postoperative Patient-Controlled Analgesia: A Single Center Experience

Öz

Abstract

Aim:The aim of this retrospective study was to investigate demographic characteristics, pain conditions, analgesic agents used, and side effects in patients who received postoperative patient-controlled analgesia (PCA).

Materials and Methods: Patients who received postoperative analgesia with PCA for approximately 20-month period in our hospital were retrospectively evaluated. Demographic information, clinical features and follow-up evaluation findings (pain, sedation, sleeplessness, nausea, vomiting, itching), which were obtained in approximately eight-hour intervals under service conditions using intravenous or epidural administration protocols, were recorded.

Results:Data of 810 patients were evaluated, of whom 57.9% were female and 55.8% underwent orthopedic surgery. PCA was administered by intravenous route in 730 patients (90.4%) and by epidural route in 80 patients (9.6%). Intravenous PCA was preferred more in females and epidural PCA was preferred more in males. While the most preferred analgesic agent was petidine in the intravenous PCA, it was fentanil + bupivacaine in the epidural PCA. The most common side effects were sedation/somnolence, nausea, vomiting, and urinary retention.

Conclusion:In our hospital, it was seen that intravenous PCA was more preferred and that the most frequently preferred analgesic agent was petidine in intravenous PCA and fentanyl + bupivacaine in epidural PCA. Pain treatment with PCA is well tolerated with low levels of side effect.

 

Anahtar Kelimeler

Patient-controlled analgesia, postoperative pain

Kaynakça

• Kaynaklar1. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97(2):534-40, table of contents.2. Rose DK, Cohen MM, Yee DA. Changing the practice of pain management. Anesth Analg 1997;84(4):764-72.3. Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med 2010;83(1):11-25.4. Rosenberg J, Kehlet H. Does effective postoperative pain management influence surgical morbidity? Eur Surg Res 1999;31(2):133-7.5. Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth 2001;87(1):36-46.6. Fitzgibbon DR, Ready LB. Drug choices for intravenous and spinal analgesia. Eur Surg Res 1999;31(2):108-11.7. Morlion B, Schäfer M, Betteridge N, Kalso E. Non-invasive patient-controlled analgesia in the management of acute postoperative pain in the hospital setting. Curr Med Res Opin 2018;34(7):1179-86.8. Chumbley GM, Hall GM, Salmon P. Why do patients feel positive about patient-controlled analgesia? Anaesthesia 1999;54(4):386-9.9. Chumbley GM, Hall GM, Salmon P. Patient-controlled analgesia: An assessment by 200 patients. Anaesthesia 1998;53(3):216-21.10. Pöpping DM, Zahn PK, Van Aken HK, Dasch B, Boche R, Pogatzki-Zahn EM. Effectiveness and safety of postoperative pain management: A survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): A database analysis of prospectively raised data. Br J Anaesth 2008;101(6):832-40.11. Wigfull J, Welchew E. Survey of 1057 patients receiving postoperative patient-controlled epidural analgesia. Anaesthesia 2001;56(1):70-5.12. Woodhouse A, Hobbes AF, Mather LE, Gibson M. A comparison of morphine, pethidine and fentanyl in the postsurgical patient-controlled analgesia environment. Pain 1996;64(1):115-21.13. Mann C, Pouzeratte Y, Boccara G, et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology 2000;92(2):433-41.14. Polanco-García M, García-Lopez J, Fàbregas N, Meissner W, Puig MM, PAIN-OUT-Spain Consortium. Postoperative pain management in Spanish hospitals: A cohort study using the PAIN-OUT registry. J Pain 2017;18(10):1237-52.15. Woodhouse A, Ward ME, Mather LE. Intra-subject variability in post-operative patient-controlled analgesia (PCA): Is the patient equally satisfied with morphine, pethidine and fentanyl? Pain 1999;80(3):545-53.16. Wu CL, Cohen SR, Richman JM, et al. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: A meta-analysis. Anesthesiology 2005;103(5):1079-88; quiz 1109-10.17. McNicol ED, Ferguson MC, Hudcova J. Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain. Cochrane Database Syst Rev 2015;(6):CD003348.