Evaluation Of Multimodal Approach For Postoperative Pain At The patients Who Underwent Flank Incision In The Urology Operating Room

Abstract

Objective: In this study, we evaluated subcutaneous (sc) morphine in combination with multimodal analgesia for postoperative pain control after radical nephrectomy and pyeloplasty with flank incision. Methods:Forty-nine patients under The American Society of Anesthesiologists Physical Status classification (ASA) I-III aged 18-85 years undergoing radical nephrectomy and pyeloplasty with flank incision were included in this prospective, randomised study. The patients were divided into two groups (Group O [n=25] and Group M [n=24]) and received standard general anaesthesia. Tramadol (100 mg) and paracetamol (100 mg) were given intravenously before fascia closure and 20 mL of 0.25% levobupivacaine was injected locally at surgical incisions in all patients. Patients in Group M also received 0.1 mg kg -1 morphine subcutaneously. Patient-controlled analgesia (PCA) with tramadol was used for postoperative pain control in both groups. Postoperative pain scores (VAS), vital parameters, side effects, the need for rescue analgesia during 24 hours postoperatively, and patient satisfaction were recorded.Results: Groups were comparable with respect to demographic data, ASA status, and duration of surgery. There were no significant differences between the groups in postoperative PCA tramadol consumption, rescue analgesia, side effects, or vital parameters. Postoperative pain scores (VAS) in Group M were significantly lower at 30, 45, 60, and 120 minutes compared to Group O (p<0.05). Conclusion:In patients undergoing radical nephrectomy and pyeloplasty with flank incision, subcutaneous morphine in combination with multimodal analgesia decreases early postoperative pain scores compared to multimodal analgesia alone.Key Words: Subcutaneous, morphine, postoperative pain, flank incision Abstract O (n=24). Anaesthesia induction in the patients that did not undergo premedication was performed with intravenous (iv) 0.5 mg atropine, iv 2 mg kg -1 propofol, iv 1 µg kg -1 remifentanil for 30-60 seconds (sec) and iv 0.6 mg kg -1 rocuronium, and maintenance was provided by O 2 , air, and sevoflurane and iv infusion of 0.25 µg kg -1 min -1 remifentanil. Before the closure of fascia after the procedure, sc 0.1 mg kg -1 morphine was administered through the deltoid muscle in the patients in Group M. No additional procedure was performed in the patients in Group O. Then, during the closure of the fascia at the end of surgery, 100 mg tramadol and 1 g/100 mL paracetamol was administered in all patients by slow infusion (not shorter than 20 min.). During skin closure, incision line was infiltrated by 20 mL of 0.25% levobupivacaine. Decurarization was provided by iv 0.5 mg atropine and iv 1.0 mg neostigmine. Postoperative pain was controlled in all patients by patient-controlled analgesia (PCA) (tramadol PCA; 4 amp tramadol 100 mg/100 mL in 0.9% NaCl, bolus 20 mg, lock time 15 min., 4-hour limit: 200 mg). In the postoperative period, iv 1 g/100 mL paracetamol was administered by slow infusion (not shorter than 20 min) within the first 24 hours rep...