بررسی تأثیر تجویز پیش‌گیرانه‌ی کتامین یا کتورولاک وریدی بر تسکین درد پس از عمل سزارین تحت بیهوشی نخاعی

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه بیهوشی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

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

چکیده

مقدمه: هدف ار انجام مطالعه‌ی حاضر، بررسی تأثیر تجویز وریدی کتورلاک و کتامین بر بی‌دردی پس از جراحی و مقایسه‌ی آن با دارونما در مادران باردار بود.روش‌ها: طی یک مطالعه‌ی کارآزمایی بالینی 150 مادر باردار کاندیدای سزارین در سه گروه توزیع شدند. در گروه اول، دوز اولیه‌ی 15 میلی‌گرم کتورولاک و 10 میلی‌گرم/ساعت تا پایان جراحی، در گروه دوم دوز اولیه‌ی 25/0 میلی‌گرم/کیلوگرم کتامین و 10 میلی‌گرم/ساعت تا پایان جراحی و در گروه سوم دارونما تجویز گشت. شدت درد پس از جراحی، نیاز به مسکن، متغیرهای همودینامیک حین عمل و ریکاوری و عوارض پس از جراحی در بیماران سه گروه بررسی و مقایسه گشت.یافته‌ها: شدت درد گروه کتورولاک در ساعت صفر، 4، 12 و 24 کمتر از کتامین (050/0 > P) و در ساعت 4، 12 و 24 کمتر از دارونما بود (010/0 > P). میانگین فشار سیستولیک گروه کتورولاک در دقایق صفر بیهوشی، 3، 5، 10، 40 و 70 حین عمل و 15، 45 و 75 ورود به ریکاوری، کمتر از کتامین بود (050/0 > P). میانگین فشار دیاستول در دقایق صفر بیهوشی، 3 و 5 حین عمل در کتورولاک کمتر از کتامین بود (050/0 > P)، اما در دقایق 30 و 45 ریکاوری، بیشتر از کتامین بود (050/0 > P). بروز افت فشار خون، دپرسیون تنفسی، آریتمی قلبی و توهم (Hallucination) بین سه گروه یکسان بود، اما بروز گر گرفتگی، تهوع، استفراغ و لرز در کتورولاک کمتر از دو گروه دیگر بود (050/0 > P).نتیجه‌گیری: تزریق کتورولاک به عنوان پیش‌دارو در جراحی سزارین، می‌تواند شدت درد پس از جراحی در مادران را کاهش دهد. از این رو، توصیه می‌شود که از کتورولاک به عنوان داروی ضد درد به جای کتامین در مادران باردار استفاده گردد.

کلیدواژه‌ها


عنوان مقاله [English]

Evaluation of the Preemptive Administration of Venous Ketamine or Ketorolac on Pain Relief after Cesarean Section under Spinal Anesthesia

نویسندگان [English]

  • Azadeh Bahadori 1
  • Anahita Hirmanpour 1
  • Milad Nilchi 2
1 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: This study aimed to compare the preemptive effect of intravenous ketorolac and ketamine on decreasing the pain of patient in cesarean surgeries.Methods: In a clinical trial study, 150 patients undergoing cesarean surgery were selected and randomly divided into three equal groups of the ketorolac, ketamine, and placebo. A stat dose of 15 mg ketorolac, continuing as 10 mg/hour till end of the surgery, a stat dose of 0.25 mg/kg ketamine continuing as 10 mg/hour till end of the surgery, and the same amount of normal saline was injected in the three groups, respectively. Postoperative pain intensity, analgesic requirement, hemodynamic changes during and after surgery, and adverse effects were compared between the three groups.Findings: The mean score of postoperative pain in ketorolac group was significantly lower in the return time of motor block, and 4, 12, and 24 hours later than ketamine and at 4, 12, 24 hours than placebo group (P < 0.05 for all). Mean systolic blood pressure was lower in ketorolac group in different periods of surgery and in recovery period (P < 0.05). Mean diastolic blood pressure was lower in ketorolac group in different periods during the surgery (P < 0.05), but ketamine group had lower diastolic blood pressure in recovery period (P < 0.05). Incidence of hypotension, respiratory depression, cardiac arrhythmia, and hallucination were equal in three groups; but flushing, shiver, and nausea and vomiting were lower in ketorolac group (P < 0.05).Conclusion: Injection of ketorolac as preemptive treatment could decrease postoperative pain intensity in patients who undergo cesarean surgery. It also has some cardiovascular protective effect and decrease incidence of flushing, shiver, and nausea and vomiting after surgery. So, we recommend preemptive use of ketorolac in cesarean surgeries.

کلیدواژه‌ها [English]

  • Pain
  • Cesarean section
  • Ketorolac
  • Ketamine
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