The analgesic effect of preemptive lornoxicam at elective lumbar disk surgery

Gökhan KURT, Zerrin ÖZKÖSE, Melis GÖKÇE, Şahin YARDIM, Berrin IŞIK, Memduh KAYMAZ

Abstract

Aim: Our aim for this study was to investigate the analgesic effect of preemptive 8 or 16 mg lornoxicam versus placebo which was applied to the patients before elective lumbar disc surgery.Materials and Methods: 60 patients who were in ASA I-II group were investigated during elective lumbar surgery. The patients were randomly evaluated in three groups. The groups were arranged as follows: At the first group (Group P) 100 mL saline solution was used, at the second group (Group L8) 8 mg lornoxicam was used and at the third group (Group L16) 16 mg lornoxicam in 100 mL saline solution was used. Intravenous 5 mg kg-1 thiopental, 0.2 µg kg-1 sec-1 remifentanil infusion and 0.1 mg kg-1 iv pancuronium bromür were used for induction of anaesthesia, and 1 % concentration of isoflurane in 50 % O2 50 % air was used for maintenance of anaesthesia at all groups. According to the arterial blood pressure which would be held in range of preoperative value ±20%, remifentanil infusion rate was arranged. Preoperative, postoperative Aldrete≥9 period, and there after 2-4-6-24th hours; VAS data, peroperative total remifentanil consumption and side effects were recorded. Patients were observed at least for 1 hour at the recovery room and 24 hour at the service. One mg kg-1 im pethidine hydrochlorur was applied after the first analgesic request of the patient (VAS≥4) and then 0.5 mg kg-1 pethidine was applied intravenously. Postoperative first additional analgesic requirement time and total pethidine hydrochlorur consumption during 24 hour was recorded. Postoperative "first analgesic requirement time" was longer at Group L16 than Group L8 and Group P. At Group L8 postoperative "first analgesic requirement time" was significantly longer then Group P. Pethidine hydrochlorur consumption during the postoperative 24 hours was evaluated significantly less in Group L16 and Group L8 then Group P (p≤0,05).Results: There was no significant difference at peroperative consumption of remifentanil between three groups. Postoperative "first analgesic requirement time" was longer at Group L16 than Group L8 and Group L8 significantly longer then Group P. During the postoperative 24 hours pethidine hydrochlorur consumption significantly less in Group L16 and Group L8 then Group P (p?0,05).Conclusion: Preempitive lornoxicam has postoperative analgesic effect at lumbar disc surgery. On the other hand we have concluded that when 16 mg lornoxicam is used, analgesia time is longer than 8 mg lornoxicam application.

Özet

Amaç: Elektif lomber disk cerrahisi uygulanacak olgularda preemptif uygulanan 8 ve 16 mg lornoksikamın analjezik etkinliğini plasebo ile karşılaştırarak değerlendirmeyi amaçladık.Gereç ve Yöntem: Lomber disk cerrahisi planlanan, ASA I-II grubu, 60 olgu preoperatif dönemde rasgele 3 gruba ayrılarak; 1. gruba (Grup P) 100 mL serum fizyolojik (SF), 2. gruba (Grup L8) 8 mg lornoksikam ve 3. gruba (Grup L16) da 16 mg lornoksikam 100 mL SF içinde iv yolla verildi. Anestezi indüksiyonu iv 5 mg kg-1 tiyopental ve eşzamanlı 0.2 µg kg-1 dk-1 remifentanil infüzyonu ve 0.1 mg kg-1 pankuronyum bromid ile sağlandı. Anestezi idamesi 6 L dk-1 % 50 O2 % 50 hava içerisinde % 1 konsantrasyonda izofluran ve remifentanil infüzyonu ile sürdürüldü. Remifentanil infüzyon hızı, arteriyel kan basıncı anestezi öncesi alınan değere göre ±% 20 aralığında kalacak şekilde titre edildi. Olguların preoperatif, postoperatif Aldrete≥9 olduğu dönemdeki ve bundan sonraki 2., 4., 6. ve 24. saatlerdeki VAS değerleri, peroperatif tüketilen toplam remifentanil miktarı ile varsa yan etkiler kaydedildi. En az bir saat derlenme odasında ve 24 saat serviste izlenen hastalara ilk kez VAS≥4 olduğunda 1 mg kg-1 im, daha sonra ise 0.5 mg kg-1 petidin hidroklorür iv yolla verildi. Postoperatif ilk ilave analjezik gereksinim zamanı ve 24 saatte tüketilen toplam petidin hidroklorür miktarı kaydedildi.Bulgular: Gruplar arasında peroperatif tüketilen toplam remifentanil miktarında fark bulunmazken, postoperatif ilk analjezik gereksinim zamanı Grup L16'da Grup L8'e ve Grup L8'de de Grup P'ye göre anlamlı ölçüde uzun, postoperatif 24 saat boyunca tüketilen petidin hidroklorür miktarı da Grup L16 ve Grup L8'de Grup P'ye göre anlamlı ölçüde az bulundu (p≤0.05).Sonuç: Lomber disk cerrahisinde preemptif verilen lornoksikamın postoperatif analjezik etkinliği olduğuna ve 16 mg'lık dozunun 8 mg'a göre daha uzun süre analjezi sağladığı kanısına vardık.