ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Postoperative pain therapy in beating-heart coronary revascularization patients who were applied the fast-track protocol: a randomized, placebo controlled study
Aslı Demir1, Burçin Öztürk1, Şerife Bektaş1, Adnan Yalçınkaya2, Elif Dilber1, Ersin Kadiroğulları2, Atilla Halil Elhan3, Özcan Erdemli1
1Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Ankara
2Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara
3Ankara Üniversitesi Tıp Fakültesi, Biyoistatistik Anabilim Dalı, Ankara
DOI : 10.5606/tgkdc.dergisi.2011.006
Background: The present study aimed to investigate the effects of the use of dexketoprofen trometamol and diclofenac sodium in combination with tramadol analgesia on postoperative pain control, sedation, and use of tramadol, as well as their possible side effects that may occur due to nonsteroidal anti-inflammatory drug (NSAID) use in patients having beating-heart coronary artery bypass surgery.

Methods: In this randomized, placebo-controlled study, which was approved by the hospital ethics committee, patients who were planned to undergo elective beating-heart coronary artery bypass surgery were divided into three groups (n=15). During the closure of sternum's skin 1 mg/kg-1 intramuscular and 20 mg intravenous tramadol were administered to the patients. During transfer, the dose of remifentanil infusion was decreased by 50% and remifentanil infusion was stopped after the transfer of the patient to the intensive care unit (ICU). During the closure of sternum's skin, in addition to tramadol, group 1 received 1 ampoule (50 mg) intramuscular (i.m.) dexketoprofen trometamol; group 2 received 1 ampoule (75 mg) i.m. diclofenac sodium; and, group 3 received i.m. physiological saline solution. The patient groups were planned and medications were administered by a doctor other than both anesthesiologist and the ICU specialist who attended the patient. Pain visual analogue scale (VAS) and Ramsey sedation scores were recorded at the postoperative 1, 3, 6, 12, and 24 hours. At the same measurement points, nausea, vomiting, gastrointestinal complaints, the need for anti-emetics, tramadol requirement, and bleeding amounts were also recorded. Patients with VAS >3 in ICU were administered 1 mg kg-1 i.m. tramadol.

Results: No difference was observed between groups in terms of age, sex, weight, and operation time. There was no significant difference between groups in terms of VAS values recorded at postoperative 1, 6, and 24 hours. The VAS values recorded at the postoperative 3rd hour were significantly higher in groups 2 and 3 compared to group 1. Visual analog scale values recorded at postoperative 12 hours were significantly lower in group 1 compared to group 3. No difference was observed between groups in terms of Ramsey sedation scale scores, nausea/vomiting, anti-emetic medication, and gastrointestinal complaints. Bleeding amount determined at postoperative 12 and 24 hours was significantly higher in group 3 compared to groups 1 and 2.

Conclusion: Good quality analgesia is essential for early extubation and short-ICU stay of patients undergoing coronary surgery. We found that dexketoprofen trometamol + tramadol combination that we used for this purpose was more effective than both diclofenac + tramadol and placebo + tramadol combinations.

Keywords : Dexketoprofen trometamol; diclofenac sodium; heart surgery; postoperative pain
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