Özet:

Purpose: In post-cezarine postoperative pain treatment, there are a variety of multi-modal analgesic strategies that aim to reduce the opioid need and thus reduce the incidence of opioid-related side effects. This study aimed at comparing the reduction in the need for tramadol and the quality of the analgesy in the four different multi-modal analgesic strategies applied in patients with general anesthesia and caesarine. Method: A total of 160 patients under general anesthesia were included in one of the following groups as backward: only tramadol-based patient-controlled analgesia, tramadol-based patient-controlled analgesia plus diclofenac fitil, tramadol-based patient-controlled analgesia plus diclofenac fitil plus parasetamol and tramadol-based patient-controlled analgesia plus diclofenac plus transversus abdominis plan block. Visual analog scale scores and tramadol use were recorded by monitoring in 2, 4, 8, 12 and 24 hours. Results: In the second, fourth and eighth hours, the patient-controlled analgesic group used only tramadol had significantly higher visual analog scale scales than all other groups (p<0,05). In the twenty-fourth hour, the transversus abdominis plan block group had lower scores than both the tramadol-based patient-controlled analgesic group and tramadol-based patient-controlled analgesic plus the diclofenac group (p<0,01 and p=0,014). The cumulative consumption of tramadol was the highest in the patient-controlled analgesic group on the basis of tramadol, while the lowest in all time points in the transversus abdominis plan group (p<0,05), the consumption of the remaining two groups was similar (p>0,05). Result: Patient-controlled analgesis based on tramadol alone under general anesthesia does not provide effective post-cezarine pain control. The multi-modal analgesic protocol based on the Transversus abdominis plan block appears to have the most manifest opioid protective effect, while parasetamol does not provide additional benefits.

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