Comparison of postoperative analgesia methods in lower abdominal surgery [Alt batin cerrahilerinde postoperatif analjezi yöntemlerinin karşilaştirilmasi]
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Objective: The present study aimed to determine the advantage and disadvantage of different postoperative analgesia methods in patients undergoing cesarean section or hysterectomy under general anesthesia. Material and methods: Following ethics committee approval and patient informed consents, 120 patients were recruited from the ASA I-III groups. Patients were divided randomly into 6 groups. IM-D group received intramuscular diclofenac sodium (75 mg) every 12 hours. IM-ME group received intramuscular meperidine (1 mg kg -1) every 6 hours. IM-DME group received intramuscular meperidine (1 mg kg-1)-diclofenac sodium (75 mg) combination every 12 hours. EP-MO group received epidural morphine (bolus of 3 mg and 0.06 mg mL-1 morphine; 6 ml h-1) infusion. EP-MOB group received epidural infusion of morphine-bupivacaine combination (bolus of 2 mg morphine + 35 mg bupivacaine combination, 2 mg ml-1 bupivacaine + 0.03 mg mL-1 morphine combination; 6 ml h-1). IV-MO group received intravenous morphine via patient-controlled analgesia (loading dose of 3 mg, bolus of 1 mg and 20 minutes lockout interval). Heart rate, mean arterial pressure, SpO 2, pain and sedation levels were recorded at 2, 6, 12, 24 and 48 hours. Furthermore, additional analgesic consumption and side effects were also recorded. Results: Effective analgesia was in groups IM-DME, EP-MO, EP-MOB, and IV-MO. However, the lowest pain scores were obtained in groups EP-MO and EP-MOB. Sedation scores were higher in groups EP-MO and IV-MO. While the highest additional analgesic consumption was in groups IM-D and IM-ME, there was no additional analgesic consumption in groups EP-MO, EP-MOB and IV-MO. Side effects were not observed in any groups that required treatment. The highest incidence of side effects were in group IV-MO whereas the lowest incidence of side effects were observed in groups IM-DME and EP-MOB. Conclusion: While there was effective analgesia in groups IM-DME, EP-MO, EP-MOB, and IV-MO, IM diclofenac + meperidine combination and epidural bupivacaine + morphine combination seemed more advantageous when the side effects were considered. Copyright © 2006 by Türkiye Klinikleri.