LAPAROSKOPİK KOLESİSTEKTOMİ OPERASYONLARINDA İNTRAPERİTONEAL LEVOBUPİVAKAİNİN POSTOPERATİF AĞRI VE ANALJEZİK TÜKETİMİNE ETKİSİNİN KARŞILAŞTIRILMASI

COMPARISON OF EFFECTIVENESS ON POSTOPERATIVE PAIN AND ANALGESIC CONSUMPTION OF INTRAPERITONEAL LEVOBUPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY OPERATIONS

Özet

Amaç: Lokal anestezik infiltrasyonu üzerine yapt›¤›m›z çal›flmam›zda, laparoskopik kolesistektomilerde intraperitoneal levobupivakainin farkl› iki doz ve volümünün postoperatif a¤r› de¤erlendirilmesi ve analjezik tüketimine etkisinin karfl›laflt›r›lmas›n› amaçlad›k. Yöntem: Çal›flmam›za; 20-70 yafllar› aras›nda, ASA fiziksel durumu I-III olan elektif laparoskopik kolesistektomi operasyonu uygulanacak 60 hasta rastgele 3 grup oluflturulacak flekilde dahil edildi. Tüm hastalara bir gün önce Görsel Analog Skala (VAS) hakk›nda bilgi verildi. Hastalar üç çal›flma grubuna ayr›ld›. Grup I salin 60 mL, Grup II 2.5 mg mL -1 levobupivakain 60 mL, Grup III 2.5 mg mL -1 levobupivacain 30 mL olarak tan›mland›. Operasyon sonunda cerrahi ekip taraf›ndan trokar arac›l›¤›yla hepatodiyafragmatik alana, safra kesesi güdü¤üne, hepatoduodenal ligamente lokal anestezik uyguland›. Derlenme odas›na gelifl saati 0 olarak kabul edildi. 1 saat sonra ilk VAS de¤erlendirmesi yap›ld›. 2 saat sonra 2. VAS de¤erlendirildi. Hastalar servise gönderildikten sonra da 4., 12. ve 24. saat VAS de¤erleri kaydedildi. Hastalar›n sistolik, diyastolik ve ortalama kan bas›nçlar›, kalp at›m h›zlar› ve SpO 2 bazal de¤erleri ölçüldü. Tüm parametreler 1., 2., 4., 12., 24. saatlerde ölçüldü. Hastalar›n analjezik ihtiyaçlar›, memnuniyet skorlar›, komplikasyon varl›¤› kaydedildi. Bulgular: Çal›flmam›zda grup II ve grup III’ün postoperatif VAS de¤erleri grup I’e göre düflüktü. Grup I’de analjezik tüketimi fazla bulundu. Hasta memnuniyeti salin kulland›¤›m›z grupta düflük bulundu. Sonuç: Laparoskopik kolesistektomi operasyonlar›nda intraperitoneal levobupivakainin postoperatif analjezide etkin oldu¤u ve standart bir yöntem olarak kullan›labilece¤i kanaatindeyiz.

Abstract

Objective: In our study on local anesthetic infiltration, we aimed to compare postoperative analgesic effect and analgesic consumption of two different doses and volumes of intraperitoneal levobupivacaine in laparoscopic cholecystectomy. Method: Sixty patients between 20 and 70 years of age undergoing elective laparoscopic cholecystectomy with ASA physical status I-III were included to create three random groups in our study. All patients were informed about Visual analog scale(VAS) the day before the surgery. Patients were divided into three study groups. The groups was defined as; Group I saline60 mL, Group II 2.5 mg mL -1 levobupivacain 60 mL, Group III 2.5 mg mL -1 levobupivacain 30 mL. At the end of the operation, local anesthetic was applied to the hepatodiaphragmatic area, thoracic incision and hepatoduodenal ligament by general surgeon. The arrival time to the recovery room was accepted as 0. The first VAS assessment was made after 1 hour. After 2 hours the 2nd VAS was assessed. VAS values of 4th, 12th and 24th hours were recorded after the patients were transferred to the surgical unit. Patients' systolic, diastolic and mean blood pressure, heart rate and SpO 2 baseline values were measured. All parameters are measured at 1.- 2.- 4.- 12.- 24. hours. Patients' analgesic requirement, satisfaction scores, complications were recorded. Results: Postoperative VAS values of Group II and Group III were lower than Group I in our study. Analgesic consumption was higher in Group I. Patient satisfaction was low in group I. Conclusion: We conclude that intraperitoneal levobupivacaine is effective in postoperative analgesia in laparoscopic cholecystectomy operations and consider that may be used as a standard method.