The comparison of the efficacy of preemptive oral pregabalin- tramadol combination and parasetamol tramadol combination usage on the postoperatif tramadol consumption in breast reduction operation

The Comparison of The Efficacy of Preemptive Oral Pregabalin- Tramadol Combination and Parasetamol Tramadol Combination Usage on The Postoperatif Tramadol Consumption in Breast Reduction OperationPurpose: In our study we aimed to compare the efficacy of preemptive oral tramadol-pregabalin and tramadol-parasetamol combination usage on the postoperatif tramadol consumption in patients undergoing breast reduction operation.Material and Methods: In our study ASA I-II, aged 18-65, 60 patients who are undergoing breast reduction were included. Patients randomly divided into three groups. Each of the groups were received 35 mg drop tramadol one hour before the operation. In addition to this, to Group I (n=20) patients 75 mg tablet pregabalin and to Group II (n=20) patients 500 mg tablet parasetamol were given, and Group III (n=20) patients accepted as control group. 30 minutes before the end of operation 1mg/kg i.v. tramadol and 10mg metoklopramid HCL were administred, and tramadol infusion as intravenous patient controlled analgesia (PCA) application (300 mg diluated with 0.09% 100cc SF, 0.2 mg/kg PCA, 15 min locked in time) was started postoperatively to all groups. Peroperative haemodynamic parameters, extubation, open eyes time, response time to the verbal stimuli, postoperative 24 hour pain scores (Verbal Rating Scale, Visvisual Analogue Scale), total tramadol consumption, additional analgesic requirement and side effects were recorded and evaluated.Results: Demographic features of the groups were similar and peroperative haemodynamic parameters were not clinically different significantly. Postoperative extubation, disillusion, response time to the verbal stimuli, postoperative pain scores, total tramadol consumption, and additional analgesic requirement of groups were similar. Beside of this postoperative 24. hour Verbal Rating Scale value was lower in group I than the other groups (p=0.023).Although there was no signifcantly difference of total tramadol consumption between the groups, if we considerate total tramadol consumption as less and equal to 120 mg and over 120 mg, total tramadol consumption of Group I was lower than other groups. In addition to this postoperative 12. hour additional analgesic requirement was higher in Group II than Group I and Group III. In compration of side effects at postoperative 5. minute diplopia was higher in Group II than Group I and Group III (p=0.020) and dizziness value was lower in Group I than Group II and G group III (p=0.045).Conclusion: Application of preempitive oral low dose tramadol (35 mg), tramadol-parasetamol and tramadol-pregabalin, in patients undergoing breast reduction operation did not affect intraoperative haemodynami significantly as clinically, and when combined with postoperatif PCA also does not cause any differences among postoperative pain scores, 24 hours total tramadol consumption and additional analgesia requirement except 24. hour. We concluded that use of tramadol-pregabalin or tramadol-parasetamol is not superior to single oral tramadol usage.Key Words: Preemptive analgesia, pregabalin, tramadol drop, patient controlled analgesia