Kanser Ağrısında Hasta Kontrollü Analjezi Cihazı ile Morfin ve Morfine Eklenen Deksmedetomidinin Analjezik Etkisinin Karşılaştırılması

Süleyman Selçuk Gök; Demet Laflı Tunay; Murat Türkeün Ilgınel; Ersel Güleç; Hayri Tevfik Özbek

Research Article

Kanser Ağrısında Hasta Kontrollü Analjezi Cihazı ile Morfin ve Morfine Eklenen Deksmedetomidinin Analjezik Etkisinin Karşılaştırılması

Year 2020, Volume: 3 Issue: 2, 53 - 61, 31.08.2020

Süleyman Selçuk Gök Demet Laflı Tunay Murat Türkeün Ilgınel Ersel Güleç Hayri Tevfik Özbek

Abstract

Amaç: Bu çalışmada, kanser ağrısının tedavisinde, morfine deksmedetomidin ekleyerek morfin tüketimini ve opioide bağlı yan etkileri azaltmayı ve daha iyi analjezik etki sağlamayı amaçladık.
Gereç ve yöntem: Bu çalışmaya 20 ila 80 yaş arası 20 yetişkin kanser hastası dahil edildi. Çift kör, kendinden kontrollü, prospektif bu çalışmada, hastalar ardışık olarak iki gruba ayrıldı. Böylece toplam 40 hasta takip edildi. Ağrı kontrolü, grup M (n = 20)’de tek başına morfin (40 mg morfin/100 mL salin), grup D (n=20)’de ise morfin + deksmedetomidin (200 mcg deksmedetomidin + 40 mg morfin / 100 mL salin) içeren hasta kontrollü analjezi (HKA) cihazı ile sağlandı. Ağrı (VAS) ve sedasyon skalaları, kan basıncı, kalp atım hızı, toplam morfin tüketimi, bulantı / kusma ve opioide bağlı diğer yan etkiler 48 saat boyunca 4 saat aralıklarla kaydedildi. İki grup arasında 24 saatlik arınma periyodu bırakıldı.
Bulgular: Grup D'de ortalama VAS skorları 4, 12 ve 16. saat zaman aralıklarında anlamlı olarak düşüktü (p <0.05). Diğer zaman aralıklarındaki ortalama VAS skorları da Grup D'de daha düşüktü, ancak istatistiksel olarak anlamlı bulunmadı. Grup M'de ortalama VAS değerlerindeki azalma 32. saatte sabit düzeye gelirken, grup D’de 16. saatte sabitlendi. Gruplar arasında ortalama sedasyon skalası skorları, toplam morfin tüketimi ve diğer yan etkiler açısından istatistiksel olarak anlamlı bir fark yoktu.
Sonuç: Her ne kadar morfin tüketimi ve sedasyon seviyeleri etkilenmese de, kanser ağrısında morfine 2 mcg/mL dozunda deksmedetomidin eklenerek VAS skorlarının azaldığı sonucuna vardık. Deksmedetomidinin dozunda yapılacak değişikliklerin daha ileri çalışmalarda kullanılabileceğine inanıyoruz.
Anahtar kelimeler: Deksmedetomidin, hasta kontrollü analjezi, kanser ağrısı, morfin.

Keywords

deksmedetomidin, hasta kontrollü analjezi, kanser ağrısı, morfin

References

1. Cherny N: The management of cancer pain. Handbook of Pain Management, (ed) Melzack R,  Wall PD, Edinburg, Churchill Livingstone. 2003;641-66.  
2. World Health Organization: Cancer pain relief. Geneva, WHO 1986.  
3. Tang C, Xia Z. Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic. J Pain Res. 2017;10:1899–904. Doi:10.2147/JPR.S139387
4. Lin TF, Yeh YC, Lin FS, et al. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia. Br J Anaesth. 2009;102:117–22. Doi:10.1093/bja/aen320
5. Feng M, Chen X, Liu T, et al. Dexmedetomidine and sufentanil combination versus sufentanil alone for postoperative intravenous patient-controlled analgesia: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2019;19:81. doi: 10.1186/s12871-019-0756-0
6. Unlugenc H, Gunduz M, Guler T, et al. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol. 2005;22(5):386-91. Doi:10.1017/s0265021505000669.
7. Gunes Y, Ozbek TH, Gunduz HM, et al. Patient-controlled analgesia: comparison of morphine to dexmedetomidine plus morphine in patients undergoing laminectomy. Neurosurg Quart. 2008;18(3):178-81. Doi:10.1097/WNQ.0b013e318182099d
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9. Song JW, Shim JK, Song Y, et al. Effect of ketamine as an adjunct to intravenous patient-controlled analgesia, in patients at high risk of postoperative nausea and vomiting undergoing lumbar spinal surgery. BJA. 2013;111:630–5 Doi:10.1093/bja/aet192
10. Peng K, Liu HY, Wu SR, Cheng H, et al. Effects of combining Dexmedetomidine and opioids for postoperative intravenous patient-controlled analgesia: a systematic review and meta-analysis. Clin J Pain. 2015;31:1097–104. doi:10.1097/AJP.0000000000000219.
11. Taoda M, Adachi YU, Uchihashi Y, et al. Effect of dexmedetomidine on the release of [3H]-noradrenaline from rat kidney cortex slices: characterization of alpha2-adrenoceptor. Neurochem Int. 2001;38:317–22.
12. Ossipov MH, Suarez LJ, Spaulding TC. Antinociceptive interactions between alpha 2-adrenergic and opiate agonists at the spinal level in rodents. Anesth Analg. 1989;68:194–200.
13. Klepstad P, K.S., Cherny N, Hanks G, et al. Research Steering Committee of the EACP, Pain and treatments in European palliative care units. A cross sectional survey from the European Association for Palliative Care Research Network. Palliat Med 2005;19:477–84.  
14. Peng K, Zhang J, Meng XW, et al. Optimization of postoperative intravenous patient-controlled analgesia with opioid-Dexmedetomidine combinations: an updated meta-analysis with trial sequential analysis of randomized controlled trials. Pain Physician. 2017;20:569–96.
15. Paris A, Tonner PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol. 2005;18:412–8. Doi:10.1097/01.aco.0000174958.05383.d5.
16. Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of Dexmedetomidine in humans. Anesthesiology. 2000;93:382–94. Doi:10.1097/00000542-200008000-00016.
17. Maze M, Virtanen R, Daunt D, et al. Effects of dexmedetomidine, a novel imidazole sedative-anesthetic agent, on adrenal steroidogenesis: in vivo and in vitro studies. Anesth Analg. 1991;72:204–8. doi:10.1213/00000539-199108000-00015.
18. Nelson LE, Lu J, Guo T, et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep- promoting pathway to exert its sedative effects. Anesthesiolgy. 2003;98:428–36. Doi:10.1097/00000542-200302000-00024.

Year 2020, Volume: 3 Issue: 2, 53 - 61, 31.08.2020

Süleyman Selçuk Gök Demet Laflı Tunay Murat Türkeün Ilgınel Ersel Güleç Hayri Tevfik Özbek

Abstract

References

1. Cherny N: The management of cancer pain. Handbook of Pain Management, (ed) Melzack R,  Wall PD, Edinburg, Churchill Livingstone. 2003;641-66.  
2. World Health Organization: Cancer pain relief. Geneva, WHO 1986.  
3. Tang C, Xia Z. Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic. J Pain Res. 2017;10:1899–904. Doi:10.2147/JPR.S139387
4. Lin TF, Yeh YC, Lin FS, et al. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia. Br J Anaesth. 2009;102:117–22. Doi:10.1093/bja/aen320
5. Feng M, Chen X, Liu T, et al. Dexmedetomidine and sufentanil combination versus sufentanil alone for postoperative intravenous patient-controlled analgesia: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2019;19:81. doi: 10.1186/s12871-019-0756-0
6. Unlugenc H, Gunduz M, Guler T, et al. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol. 2005;22(5):386-91. Doi:10.1017/s0265021505000669.
7. Gunes Y, Ozbek TH, Gunduz HM, et al. Patient-controlled analgesia: comparison of morphine to dexmedetomidine plus morphine in patients undergoing laminectomy. Neurosurg Quart. 2008;18(3):178-81. Doi:10.1097/WNQ.0b013e318182099d
8. National Comprehensive Cancer Network. Adult cancer pain (Version 2.2019) March 15, 2019. Erişim tarihi: 16 Temmuz 2020. https://www.nccn.org/professionals/physician_gls/pdf/pain.pdf. (Google Scholar)
9. Song JW, Shim JK, Song Y, et al. Effect of ketamine as an adjunct to intravenous patient-controlled analgesia, in patients at high risk of postoperative nausea and vomiting undergoing lumbar spinal surgery. BJA. 2013;111:630–5 Doi:10.1093/bja/aet192
10. Peng K, Liu HY, Wu SR, Cheng H, et al. Effects of combining Dexmedetomidine and opioids for postoperative intravenous patient-controlled analgesia: a systematic review and meta-analysis. Clin J Pain. 2015;31:1097–104. doi:10.1097/AJP.0000000000000219.
11. Taoda M, Adachi YU, Uchihashi Y, et al. Effect of dexmedetomidine on the release of [3H]-noradrenaline from rat kidney cortex slices: characterization of alpha2-adrenoceptor. Neurochem Int. 2001;38:317–22.
12. Ossipov MH, Suarez LJ, Spaulding TC. Antinociceptive interactions between alpha 2-adrenergic and opiate agonists at the spinal level in rodents. Anesth Analg. 1989;68:194–200.
13. Klepstad P, K.S., Cherny N, Hanks G, et al. Research Steering Committee of the EACP, Pain and treatments in European palliative care units. A cross sectional survey from the European Association for Palliative Care Research Network. Palliat Med 2005;19:477–84.  
14. Peng K, Zhang J, Meng XW, et al. Optimization of postoperative intravenous patient-controlled analgesia with opioid-Dexmedetomidine combinations: an updated meta-analysis with trial sequential analysis of randomized controlled trials. Pain Physician. 2017;20:569–96.
15. Paris A, Tonner PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol. 2005;18:412–8. Doi:10.1097/01.aco.0000174958.05383.d5.
16. Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of Dexmedetomidine in humans. Anesthesiology. 2000;93:382–94. Doi:10.1097/00000542-200008000-00016.
17. Maze M, Virtanen R, Daunt D, et al. Effects of dexmedetomidine, a novel imidazole sedative-anesthetic agent, on adrenal steroidogenesis: in vivo and in vitro studies. Anesth Analg. 1991;72:204–8. doi:10.1213/00000539-199108000-00015.
18. Nelson LE, Lu J, Guo T, et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep- promoting pathway to exert its sedative effects. Anesthesiolgy. 2003;98:428–36. Doi:10.1097/00000542-200302000-00024.

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Details

Primary Language	Turkish
Subjects	Anaesthesiology
Journal Section	Articles
Authors	Süleyman Selçuk Gök This is me Demet Laflı Tunay 0000-0002-7984-1800 Murat Türkeün Ilgınel Ersel Güleç Hayri Tevfik Özbek This is me
Publication Date	August 31, 2020
Acceptance Date	August 13, 2020
Published in Issue	Year 2020 Volume: 3 Issue: 2

Cite

APA	Gök, S. S., Laflı Tunay, D., Ilgınel, M. T., Güleç, E., et al. (2020). Kanser Ağrısında Hasta Kontrollü Analjezi Cihazı ile Morfin ve Morfine Eklenen Deksmedetomidinin Analjezik Etkisinin Karşılaştırılması. Journal of Cukurova Anesthesia and Surgical Sciences, 3(2), 53-61.

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