20.500.12556/DKUM-69188 Uspešnost multimodalne analgezije po carskem rezu: učinkovitost infuzije levobupivakaina in ketorolaka v operativno rano Effectivness of multimodal post-caesarean section analgesia: efficacy of continuous in- wound infusion of levobupivacaine and ketorolac IZHODIŠČA: Neprekinjena infuzija lokalnega anestetika in nesteroidnega protivnetnega zdravila v rano je lahko učinkovit del multimodalne analgezije po carskem rezu, vendar so raziskave pokazale nasprotujoče zaključke. Z dvojno slepo, prospektivno randomizirano raziskavo smo želeli ugotoviti, ali je v skupni porabi piritramida za lajšanje pooperativne bolečine pomembna razlika med štirimi skupinami porodnic po carskem rezu, ki imajo neprekinjeno infuzijo analgetika preko katetra v rani. BOLNICE IN METODE: Po soglasju Republiške etične komisije in podpisanem soglasju porodnice smo randomizirali 61 porodnic za nenujni carski rez v eno od štirih skupin za neprekinjeno 48-urno infuzijo preko katetra v rano. Skupina 1 (n=15) je prejela 0,25% levobupivakain, skupina 2 (n=15) ketorolak, skupina 3 (n=14) kombinacijo 0,25% levobupivakaina in ketorolaka ter skupina 4 (n=15) placebo- 0,9% NaCl. Po lokalni infiltraciji je bil vložen perforiran kateter nad mišično fascijo po celotni dolžini operativne rane ter po zašitju kože priklopljen na elastomersko črpalko za 48-urno dovajanje neprekinjene izbrane infuzije s hitrostjo 5 ml/h. Porodnice so redno dobivale paracetamol 1 g intravensko na 6 ur ter piritramid za zadovoljivo lajšanje pooperativne bolečine. Primarni izhod je bil skupna poraba piritramida v mg za 24 in 48 ur. REZULTATI: 59 porodnic je zaključilo raziskavo, ena porodnica (skupina 0,25% levobupivakain plus ketorolak) je bila izključena iz raziskave zaradi naključne prezgodnje ločitve katetra z elastomerske črpalke; eni porodnici (skupina ketorolak) je bil kateter iz rane predčasno odstranjen zaradi potrebe po ponovnem operativnem posegu. Raziskava je pokazala, da sta skupini porodnic, ki sta dobivali preko neprekinjene infuzije v rano nesteroidno protivnetno zdravilo, potrebovali statistično značilno manj opiatnega analgetika piritramida v 24 in 48 urah po carskem rezu. ZAKLJUČKI: Raziskava nakazuje možnost, da bi uporaba protivnetnih zdravil za neprekinjeno infuzijo preko katetra v rano za pooperativno analgezijo po carskem rezu lahko imela superiorni učinek v primerjavi z lokalnim anestetikom INTRODUCTION: Continuous wound infusion of local anaesthetics and non-steroidal antiinflammatory drugs might be an effective part of multimodal analgesia after caesarean section, but studies have shown conflicting results. In double blind, prospective randomised controlled trial, we investigated if there is any difference in total piritramid consumption between four different groups with wound infusion for post-caesarean section analgesia. PATIENTS AND METHODS: After National Ethics Committee Approval and patients written consent, we randomised 61 parturients for non-emergency Caesarean Section to one of four groups to receive different substance for continuous wound infusion for 48 h after Caesarean Section: group 1 (n=15) received 0.25% levobupivacaine; group 2 (n=15) ketorolac; group 3 (n=14) 0.25% levobupivacaine plus ketorolac and group 4 (n=15) placebo- 0.9% NaCl. After local infiltration, a multi-holed catheter was placed above the fascia and, after closing the skin, connected to elastomeric pump to run 5 mL/h for 48 h. Postoperatively patients received regular paracetamol 1 g intravenously every 6 hours and piritramid as required for adequate pain relief. The primary outcome was total amount of piritramid in mg for 24 and 48 h. RESULTS: Fifty-nine parturients completed the study. One parturient (levobupivacaine plus ketorolac group) was excluded after early disconnection the catheter from the device; one parturient (ketorolac group) was excluded for reoperation and removal the in-wound cathehter. Our trial discovered, that both groups with ketorolac in-wound infusion, needed statistical significant less piritramid in 24 and 48 hours for post caesarean section analgesia. CONCLUSION: Our study suggests that local infiltration and continuous in-wound infusion with non-steroidal anti-inflammatory drug might have superior efficacy over local anaesthetic in-wound infusion in reduction of opioid consumption for post- caesarean section analgesia. carski rez pooperativna analgezija kateter v rani levobupivakain ketorolak paracetamol caesarean section postoperative analgesia in-wound catheter levobupivacaine ketorolac paracetamol true true false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2017-12-05 00:00:19 2019-02-26 13:52:33 2022-08-01 17:00:06 2019-12-19 03:18:37 2019 0 Maribor 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 298945792 URN:SI:UM:DK:ELMMPXSS DOK_Wagner_-_Kovacec_Jozica_2019.pdf DOK_Wagner_-_Kovacec_Jozica_2019.pdf 1 8C855D590374ECDA59E5B6103B0C17C0 d3474161a94216cfaa0086407aa7f5e0a71811f45ddfcebcf3f9ec987165653b 9a9e0c68-7c10-11eb-bb7a-00155d0001ca 20.500.12556/dkum/6fc75ccb-09c2-40cb-a94b-6913e14ea9a0 https://dk.um.si/Dokument.php?lang=slv&id=132570 Medicinska fakulteta 0 0 0