Omuz cerrahisi olgularında postoperatif analjezik tüketimine cinsiyetin etkisi
Omuz cerrahisi olgularında postoperatif analjezik tüketimine cinsiyetin etkisi
Yazar: Zengin, Çağatay; Pişkin, Ahmet; Kelsaka, Ebru; Sezgin, Hicabi; Erdoğan, Murat; Gülman, Birol
Dergi: Cumhuriyet Tıp Dergisi, Vol. 36 No. 1, 2013
Anahtar kelimeler: Subakromial infüzyon, cinsiyet, omuz artroskopisi ; Subacromial infusion, gender, shoulder arthroscopy

ÖzetAmaç. Omuz cerrahisi uygulanan hastalarda postoperatif ağrı önemli bir sorundur. Çalışmamızda omuz cerrahisi sonrasında postoperatif ağrı tedavisi için subakromial kateter uyguladığımız 26 hastayı prostektif randomize bir çalışma ile değerlendirdik. Yöntem. Operasyonun sonunda subakromial alana kateter yerleştirilerek lokal anestezik+opioid infüzyonu başlandı. Subakromial kateter 24 saat yerinde tutuldu. Hastaların ağrıları Vizüel Ağrı Skalası (VAS) ile değerlendirildi. VAS’ı >7 olanlara meperidin 0,5 mg/kg iv, VAS’ı 5-7 olanlara tenoksikam 20 mg iv, 2 saat sonra halen VAS >3 olanlara ek analjezik olarak parasetamol 1 gr iv uygulandı. Bulgular. 24 saat boyunca takip edilen hastaların hiçbirinde meperidin ihtiyacı olmadı. VAS’ı 5-7 arasında olan 7 hastaya Tenoksikam 20 mg iv yapıldı. Ağrısı devam eden 7 kadın hastaya Parasetamol 1 mg iv ek olarak uygulandı. Sonuç. Subakromial kateter, yan etki ve komplikasyona neden olmaması, işlemin kolay uygulanması ve etkin bir analjezi sağlaması nedeniyle omuz cerrahisi geçiren hastalarda güvenle kullanılabileceğini düşünmekteyiz. Bu hastalarda sistemik opioid ihtiyacını azaltması, opioide bağlı yan etkilerin (bulantı-kusma, kabızlık, kaşıntı vb.) görülmemesine neden olarak hasta konforunu arttırır. Ek analjezik ihtiyacının sadece kadın cinsiyette olması, cinsiyetin ağrı değerlendirmesi üzerine etkisini göstermesi açısından önemli olduğunu düşünmekteyiz.Anahtar sözcükler: Subakromial infüzyon, cinsiyet, omuz artroskopisi AbstractAim. Postoperative pain is a major problem in patients who have undergone surgery of the shoulder joint. We retrospectively evaluated 26 patients in whom a subacromial catheter had been placed for postoperative pain management following shoulder surgery. Method. Infusion of local anesthetics and/or opioids through a subacromial catheter, placed at the end of the procedure, was started after surgery. This catheter was kept in place for 24 hours. The patients’ pain was evaluated by using a visual analog scale (VAS). Patients with a VAS score greater than 7 were given meperidine, 0.5 mg/kg i.v., those with a score of 5-7 received tenoxicam, 20 mg i.v., and patients who continued to have a score of >5 at the end of 30 minutes were given paracetamol, 1 g i.v. as an additional analgesic injection. Results. None of the patients had a need for meperidine after 24 hours of surveillance. Seven patients with a VAS score of 5-7 were given tenoxicam, while seven patients, all female, who had continuing pain, received paracetamol. Conclusion. A subacromial catheter, which does not cause adverse effects or complications, is easy to apply and allows effective analgesia, can be used with confidence in the postoperative pain management of patients undergoing shoulder surgery. The need for supplementary analgesia in women only is significant, indicating the role of the patient’s sex in pain perception.Keywords: Subacromial infusion, gender, shoulder arthroscopy

Aim. Postoperative pain is a major problem in patients who have undergone surgery of the shoulder joint. We retrospectively evaluated 26 patients in whom a subacromial catheter had been placed for postoperative pain management following shoulder surgery. Method. Infusion of local anesthetics and/or opioids through a subacromial catheter, placed at the end of the procedure, was started after surgery. This catheter was kept in place for 24 hours. The patients’ pain was evaluated by using a visual analog scale (VAS). Patients with a VAS score greater than 7 were given meperidine, 0.5 mg/kg i.v., those with a score of 5-7 received tenoxicam, 20 mg i.v., and patients who continued to have a score of >5 at the end of 30 minutes were given paracetamol, 1 g i.v. as an additional analgesic injection. Results. None of the patients had a need for meperidine after 24 hours of surveillance. Seven patients with a VAS score of 5-7 were given tenoxicam, while seven patients, all female, who had continuing pain, received paracetamol. Conclusion. A subacromial catheter, which does not cause adverse effects or complications, is easy to apply and allows effective analgesia, can be used with confidence in the postoperative pain management of patients undergoing shoulder surgery. The need for supplementary analgesia in women only is significant, indicating the role of the patient’s sex in pain perception.