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The efficacy of intraperitoneal ropivacaine or ropivacaine plus meperidine in postoperative analgesia after gynecologic laparoscopy
88
Posters
•
Postop. Pain Management
248. The efficacy of intraperitoneal ropivacaine or ropivacaine plus meperidine in postoperative analgesia after gynecologic laparoscopy
249. Intrathecal morphine: effects on perioperative hemodynamics, postoperative stress response and analgesia for abdominal total hysterectomy
Karaman S, Kocabas S, Ergu¨ n S, Firat V, Uyar M, Sendag F Email: [email protected] Ege University, Medical Faculty, Anaesthesiology and Reanimation Department, Ege University Medical Faculty, Bornova, IZMIR, TURKEY
Karaman S, Kocabas S, Uyar M, Zincircioglu C, Firat V Email: [email protected] Ege University, Medical Faculty, Anaesthesiology and Reanimation Department Bornova, IZMIR Affiliate TURKEY
Introduction: There are many studies on intraperitoneal bupivakain with or without different concentrations of epinephrine and/or opioid in the literature. In this study, we aimed to compare ropivacaine with ropivacaine plus meperidine and serum physiologique in postoperative analgesia. Material and Methods: Sixty patients aged 18-50 years, undergoing elective gynecologic laparoscopy were included in this study. All operations were performed by the same surgical and anaesthesia teams. Patients were randomized into three groups: Group I (n⫽18, R), Group II (n⫽17, RM), Group III (n⫽20, S). In all patients, anaesthesia was induced with remifentanil 1 mcg/kg, propofol 2 mg/kg and vecuronium 0.1 mg/kg. Anaesthesia was maintained with 0.5 mcg/kg/min remifentanil for the first five minutes and later 0.25 mcg/kg/min remifentanil infusion and 1-2% sevoflurane in 50 %O2⫹%N2O. Vecuronium 0.02 mg/kg was used as necessary. All procedures were performed with intraabdominal gas (CO2) pressure level at 14 mmHg and intraabdominal gas was evacuated at the end of the procedure. Patients in Group R were given 0.75% ropivakain 3 mg/kg in 200 mL serum physiologique; patients in Group RM were given 0.75% ropivacaine 3 mg/kg in 200 mL serum physiologique⫹50 mg pethidine; patients in Group S were given 200 mL serum physiologique through the trocars. Patients were evaluated for VAS, sedation, total analgesic requirement, shoulder pain, times to intestinal activity, standing up without help and first analgesic requirement. All patients were given diclofenac sodium when they had pain (VAS 3 3) and 1 mg/kg pethidine IM was also given when pain persisted. Results: Groups did not differ significantly in demographic data, duration of surgery, and analgesic requirement during 3-hour observation in the recovery room and after discharge. Pain scores were highest 30 minutes after the procedure in all groups. At that time the pain score in the ropivacaine and meperidine group was lower than that in the ropivacaine group and control group (3,7⫾2,4 vs 4,7⫾2,6, 6,7⫾2,3 respectively). Beyond that time, the groups did not differ in pain scores and analgesic requirements. Conclusion: Postoperative pain is the highest within 30 minutes after laparoscopy. Intraperitoneal infiltration of ropivacaine and meperidine was effective in reducing pain immediately after operative laparoscopy, but the effect was not seen beyond 30 minutes.
Introduction: Intrathecal opioids provide postoperative analgesia and hemodynamic stability by depressing the neuroendocrine response. In this study, we aimed to evaluate the effects of preemptive intrathecal morphine on perioperative hemodynamics, postoperative stress response and analgesia. Material and Methods: 24 patients aged 30-60 years, undergoing elective hysterectomy were included in this study. Group I (n⫽ 12): Intrathecal Morphine, Group II (n⫽ 12): Control Group. Patients in Group I were given 5 g/kg morphine, by 25-gauge Whitacre spinal needle. This procedure was not applied in Group II. In both groups, anaesthesia was induced with 2 mg/kg propofol, 1 g /kg remifentanil, 0.1 mg/kg vecuronium and end-tidal 1-1.5% sevoflurane and standardized. Patient bloods were taken at two hours before operation, postoperative 1., 2. and 4. hours and blood adrenalin, noradrenalin and glucose levels were evaluated. Patients taken to the postoperative care unit were given morphine to provide analgesia by PCA at a loading dose of 5 mg, bolus dose of 1 mg, lock-out time of 30 minutes when they had a VAS ⱖ3. When analgesia was inadequate and VASⱖ3, diclofenac i.m. was given as a rescue analgesic. Results: Demographic data were similar in both groups. There were no differences in perioperative hemodynamics (p⬎0.05). Postoperative VAS scores and total morphine consumption (10.77 mg, 20 mg) were significantly lower in the intrathecal morphine group (p⫽0.00). Postoperative epinephrin, norepinephrin and glucose levels were higher than the preoperative levels (p⬍0.05) and when the two groups were compared values were lower in the intrathecal morphine group (p⬍0.05). Conclusion: Intrathecal morphine increased postoperative analgesia quality, decreased morphine consumption and depressed the systemic stress response.
Posters
•
Postop. Pain Management
248. The efficacy of intraperitoneal ropivacaine or ropivacaine plus meperidine in postoperative analgesia after gynecologic laparoscopy
249. Intrathecal morphine: effects on perioperative hemodynamics, postoperative stress response and analgesia for abdominal total hysterectomy
Karaman S, Kocabas S, Ergu¨ n S, Firat V, Uyar M, Sendag F Email: [email protected] Ege University, Medical Faculty, Anaesthesiology and Reanimation Department, Ege University Medical Faculty, Bornova, IZMIR, TURKEY
Karaman S, Kocabas S, Uyar M, Zincircioglu C, Firat V Email: [email protected] Ege University, Medical Faculty, Anaesthesiology and Reanimation Department Bornova, IZMIR Affiliate TURKEY
Introduction: There are many studies on intraperitoneal bupivakain with or without different concentrations of epinephrine and/or opioid in the literature. In this study, we aimed to compare ropivacaine with ropivacaine plus meperidine and serum physiologique in postoperative analgesia. Material and Methods: Sixty patients aged 18-50 years, undergoing elective gynecologic laparoscopy were included in this study. All operations were performed by the same surgical and anaesthesia teams. Patients were randomized into three groups: Group I (n⫽18, R), Group II (n⫽17, RM), Group III (n⫽20, S). In all patients, anaesthesia was induced with remifentanil 1 mcg/kg, propofol 2 mg/kg and vecuronium 0.1 mg/kg. Anaesthesia was maintained with 0.5 mcg/kg/min remifentanil for the first five minutes and later 0.25 mcg/kg/min remifentanil infusion and 1-2% sevoflurane in 50 %O2⫹%N2O. Vecuronium 0.02 mg/kg was used as necessary. All procedures were performed with intraabdominal gas (CO2) pressure level at 14 mmHg and intraabdominal gas was evacuated at the end of the procedure. Patients in Group R were given 0.75% ropivakain 3 mg/kg in 200 mL serum physiologique; patients in Group RM were given 0.75% ropivacaine 3 mg/kg in 200 mL serum physiologique⫹50 mg pethidine; patients in Group S were given 200 mL serum physiologique through the trocars. Patients were evaluated for VAS, sedation, total analgesic requirement, shoulder pain, times to intestinal activity, standing up without help and first analgesic requirement. All patients were given diclofenac sodium when they had pain (VAS 3 3) and 1 mg/kg pethidine IM was also given when pain persisted. Results: Groups did not differ significantly in demographic data, duration of surgery, and analgesic requirement during 3-hour observation in the recovery room and after discharge. Pain scores were highest 30 minutes after the procedure in all groups. At that time the pain score in the ropivacaine and meperidine group was lower than that in the ropivacaine group and control group (3,7⫾2,4 vs 4,7⫾2,6, 6,7⫾2,3 respectively). Beyond that time, the groups did not differ in pain scores and analgesic requirements. Conclusion: Postoperative pain is the highest within 30 minutes after laparoscopy. Intraperitoneal infiltration of ropivacaine and meperidine was effective in reducing pain immediately after operative laparoscopy, but the effect was not seen beyond 30 minutes.
Introduction: Intrathecal opioids provide postoperative analgesia and hemodynamic stability by depressing the neuroendocrine response. In this study, we aimed to evaluate the effects of preemptive intrathecal morphine on perioperative hemodynamics, postoperative stress response and analgesia. Material and Methods: 24 patients aged 30-60 years, undergoing elective hysterectomy were included in this study. Group I (n⫽ 12): Intrathecal Morphine, Group II (n⫽ 12): Control Group. Patients in Group I were given 5 g/kg morphine, by 25-gauge Whitacre spinal needle. This procedure was not applied in Group II. In both groups, anaesthesia was induced with 2 mg/kg propofol, 1 g /kg remifentanil, 0.1 mg/kg vecuronium and end-tidal 1-1.5% sevoflurane and standardized. Patient bloods were taken at two hours before operation, postoperative 1., 2. and 4. hours and blood adrenalin, noradrenalin and glucose levels were evaluated. Patients taken to the postoperative care unit were given morphine to provide analgesia by PCA at a loading dose of 5 mg, bolus dose of 1 mg, lock-out time of 30 minutes when they had a VAS ⱖ3. When analgesia was inadequate and VASⱖ3, diclofenac i.m. was given as a rescue analgesic. Results: Demographic data were similar in both groups. There were no differences in perioperative hemodynamics (p⬎0.05). Postoperative VAS scores and total morphine consumption (10.77 mg, 20 mg) were significantly lower in the intrathecal morphine group (p⫽0.00). Postoperative epinephrin, norepinephrin and glucose levels were higher than the preoperative levels (p⬍0.05) and when the two groups were compared values were lower in the intrathecal morphine group (p⬍0.05). Conclusion: Intrathecal morphine increased postoperative analgesia quality, decreased morphine consumption and depressed the systemic stress response.