بررسی مقایسه‌ای دو روش استفاده‌ی پیش‌گیرانه از ترکیب کتامین- متوکلوپرامید با کتامین- فنتانیل بر روی درد پس از عمل جراحی کوله‌سیستکتومی لاپاروسکوپیک تحت بیهوشی عمومی

حیدری طبایی زواره, سید مرتضی; غنوی, مهران; رئیسی, لیلا

بررسی مقایسه‌ای دو روش استفاده‌ی پیش‌گیرانه از ترکیب کتامین- متوکلوپرامید با کتامین- فنتانیل بر روی درد پس از عمل جراحی کوله‌سیستکتومی لاپاروسکوپیک تحت بیهوشی عمومی

نوع مقاله : مقاله های پژوهشی

نویسندگان

¹ استاد، گروه بیهوشی و مراقبت‌های ویژه، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

² دانشجوی پزشکی، دانشکده‌ی پزشکی و کمیته‌ی تحقیقات دانشجویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

³ پرستار هوشبری، اتاق عمل الکتیو، بیمارستان الزهرا (س)، اصفهان، ایران

چکیده

مقدمه: درد از جمله عوارض شایع پس از عمل جراحی است که جهت کاهش آن، از روش‌های مختلفی نظیر ترکیب دو یا چند دارو جهت افزایش اثر، استفاده می‌شود. هدف از اجرای این طرح، مقایسه‌ی دو روش استفاده‌ی پیش‌گیرانه از ترکیب کتامین و متوکلوپرامید یا کتامین و فنتانیل بر درد پس از عمل جراحی کوله‌سیستکتومی لاپاروسکوپیک بود.روش‌ها: در یک مطالعه‌ی کارآزمایی بالینی 2 سو کور، 90 بیمار زن و مرد با کلاس 1 و 2 بیهوشی بر اساس طبقه‌بندی American Society of Anesthesiologists (ASA)، کاندیدای عمل جراحی کوله‌سیستکتومی انتخاب و به دو گروه تقسیم شدند. نیم ساعت قبل از اتمام جراحی، بیماران گروه اول، ترکیب mg/kg 5/0 کتامین با mg/kg 1/0 متوکلوپرامید و بیماران گروه دوم، ترکیب mg/kg 5/0 کتامین با µg/kg 5/0 فنتانیل را به شکل داخل وریدی آهسته دریافت کردند. پس از پایان عمل، شدت درد بیماران بر اساس معیار VAS (Visual analog scale) ارزیابی و میان دو گروه مقایسه شد.یافته‌ها: میانگین شدت درد در انتهای ریکاوری، همچنین در 2، 6، 12 و 24 ساعت بعد از عمل، در گروه متوکلوپرامید و کتامین به شکل معنی‌داری کمتر از گروه کتامین و فنتانیل بود (001/0 > P).نتیجه‌گیری: استفاده پیش‌گیرانه از ترکیب متوکلوپرامید و کتامین نسبت به ترکیب فنتانیل و کتامین باعث تخفیف بیشتر درد بعد از عمل در بیماران می‌گردد و با عوارض جدی بعد از عمل نیز همراه نیست.

کلیدواژه‌ها

عنوان مقاله [English]

Comparing the Preventive Effect of Combination of Ketamine with Metoclopramide or Fentanyl on the Postoperative Pain after Laparoscopic Cholecystectomy under General Anesthesia

نویسندگان [English]

Seyed Mortaza Heidari-Tabaee-Zavare ¹
Mehran Qanavi ²
Leila Raeesi ³

¹ Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

² Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

³ Nurse Anesthetist, Operating Room, Alzahra Hospital, Isfahan, Iran

چکیده [English]

Background: Pain is one of the most common postoperative complications that can be reduced via different methods like combination of two or more drugs to make synergistic effect. This research aimed to comparing the preventive effect of using combination of ketamine and fentanyl or ketamine and metoclopramide on the postoperative pain after laparoscopic cholecystectomy.Methods: In a double-blinded clinical trial study, 90 patients in class I and II of ASA (American Society of Anesthesiologists) classification who were candidates for laparoscopic cholecystectomy were divided into two groups. Half an hour before completion of the operation, patients in the first group received intravenous metoclopramide (0.1 mg/kg) and ketamine (0.5 mg/kg) slowly; while the patients in the second group received intravenous ketamine (0.5 mg/kg) and fentanyl (0.5 µg/kg) slowly. After completion of operation, the pain severity was evaluated based on the visual analogue score (VAS) and the data were compared between the two groups.Findings: The main pain score in ketamine and metoclopramide group at the end of recovery, also at the 2nd, 6th, 12th, 24th postoperative hours, was significantly lower than ketamine and fentanyl group (P < 0.001).Conclusion: Preventive administration of ketamine and metoclopramide causes more reduction in postoperative pain than ketamine and fentanyl and is not associated with any severe postoperative complication.

کلیدواژه‌ها [English]

Postoperative pain
Metoclopramide
Ketamine
Fentanyl

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