Laminektomilerde esmolol infüzyonunun intraoperatif ve postoperatif etkilerinin değerlendirilmesi

Aim: Administration of tramadol with intravenouse PCA is a routine process in postoperative pain relief after laminectomy. Esmolol attenuates the hemodynamic response to laryngoscopy and intubation. Also esmolol is reported to reduce the anesthetic and analgesic requirement. In this study, we aimed to evaluate the intraoperative and postoperative effects of esmolol infusion at laminectomy. And also we aimed to evaluate the effects of esmolol infusion on postoperative tramadol consumption.Material and Method: After approval of Faculty Ethical Commitee and patient consent, aged 18-65, ASA I-II, 60 patients who are undergoing laminectomy were included. Patients randomly divided into two groups:Group I patients were recieved propofol+vecuronium+fentanyl (2 µg kg-1)+ desflurane (%3-6) for general anesthesia and received 1 mg kg-1 iv. boluse tramadol for postoperative analgesia 45 minutes before the end of the operation. PCA tramadol iv. ( 500 mg tramadol in 100 cc isotonic saline, PCA demand dose 0.2 mg kg-1, 15 min. lockout time) was started after the operation.Group II patients were recieved propofol+vecuronium+fentanyl (2 µg kg-1)+ desflurane (%3-6) and 500 µg kg-1min-1 esmolol bolus followed by an esmolol infusion of 100-125 µg kg-1min-1 for general anesthesia. 1 mg kg-1 iv. boluse tramadol given for postoperative analgesia 45 minutes before the end of the operation and PCA tramadol iv. (500 mg tramadol in 100 cc isotonic saline, PCA demand dose 0.2 mg kg-1, 15 min. lockout time ) was started after the operation. Intravenouse PCA tramadol was started after the end of the operation. All patients were recieved metoklopramide (10 mg) and dexamethasone (8 mg) for antiemesis.Intraoperative systolic, diastolic and mean blood pressures, heart rate, and endtidal desflurane consantrations and postoperative systolic and diastolic blood pressures, pain (VAS) scores, sedation (Ramsey scores), total tramadol consumption and side effects were recorded.Results: Demografic data, operation times, hemodynamic parameters, sedation scores, VAS scores and side effects of the groups were similar. Total tramadol consumption was recorded as 231.77±110.81 mg in group I and 83.67±57.98 mg in group II for 24 hours. Total tramadol consumption was significantly lower in group II than group I (p<0.001). Side effects were similar between the groups.Conclusion: We concluded that the application of intraoperative esmolol infusion reduces tramadol requirement, end-tidal desflurane consantration and the need for anesthesia without changes in hemodynamic parameters and side effects.Key Words: Laminectomy, Patient Controlled Analgesia, Tramadol, Esmolol, Postoperative Analgesia