Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Ekstra 1, Perikardiyum 6, Kalın Bağırsak 4 Noktalarına Preoperatif Akupunktur İğnesi ve Kapsikum Plasteri Uygulamalarının Preoperatif Anksiyete, Postoperatif Bulantı-Kusma ve Analjezik Tüketimine Etkisi
The Effects of Preoperative Acupuncture Needle and Capsicum Plaster Applications of Extra 1, Pericardium 6 and Large Intestine 4 Points on Preoperative Anxiety, Postoperative Nausea- Vomiting and Analgesic Consumption
Hilal AYOĞLUa, Ülkü BAYARb, Levent ATİKc, Yetkin ÖZERa, Abdullah ACARa, Işıl Özkoçak TURANa
aAnesteziyoloji ve Reanimasyon AD, bKadın Hastalıkları ve Doğum AD, cPsikiyatri AD, Zonguldak Karaelmas Üniversitesi Tıp Fakültesi, Zonguldak
Turkiye Klinikleri J Med Sci. 2009;29(5):1063-70
Article Language: TR
Full Text
ÖZET
 Amaç: Akupunktur noktalarından perikard 6 (P 6), ekstra 1 (E 1) ve kalın bağırsak 4 (Li 4) noktalarının sırasıyla postoperatif bulantı-kusmayı azalttığı, sedasyon sağladığı ve analjezik etkisi olduğu bilinmektedir. Bu noktalara preoperatif iğneleme ya da kapsikum plasteri ile akupunktur uygulamalarının preoperatif anksiyete, postoperatif bulantı-kusma ve analjezik tüketimine etkilerini araştırdık. Gereç ve Yöntemler: Laparoskopik jinekolojik operasyon planlanan 60 olgu dört gruba ayrıldı. Operasyondan önceki gün olgulara Durumluk-Sürekli Kaygı-Envanter testi (STAI) uygulandı. Preoperatif dönemde grup I'e P6, Li4 ve E1 noktalarına kuru iğneleme, grup II'ye aynı noktalara kapsikum plasterler, grup III'e 0.07 mg kg-1 midazolam intramusküler ve akupunktur noktası olmayan noktalara plasebo plasterler ve grup IV'e de akupunktur noktası olmayan noktalara plasebo plasterler uygulandı. Operasyondan hemen önce STAI testi tekrarlandı. Standart genel anestezi sonrasında postoperatif hasta kontrollü analjezi yöntemi ile tramadol uygulandı. Postoperatif görsel ağrı skoru (GAS), analjezik tüketimi, bulantı- kusma kaydedildi. Bulgular: STAI'nın durumluk kaygı düzeyini gösteren bir gün önceki değerleri ile operasyondan hemen önceki değerleri karşılaştırıldığında, grup I ve grup II'nin değerlerinde, grup III'deki değerlerden daha fazla azalma olduğu gözlendi (p< 0.05). Bulantı kusma sıklığı grup I ve grup II'de daha düşüktü (p< 0.05). Postoperatif analjezik tüketimi grup I ve grup IV'de grup II ve grup III'te olduğundan daha azdı (p< 0.05). GAS değerleri açısından gruplar arasında fark gözlenmedi. Sonuç: Preoperatif E1, Li4, P6 noktalarına iğneleme yapılması ile kapsikum plasteri uygulamalarının preoperatif anksiyeteyi ve postoperatif bulantı kusma sıklığını azalttığı, postoperatif analjezik tüketimine etkili olmadığı düşünüldü. Kapsikum plasterlerinin noninvaziv olması nedeni ile iğnelemenin olası yan etkilerine karşı iyi bir alternatif akupunktur yöntemi olabileceği kanısına varıldı.

Anahtar Kelimeler: Akupunktur, kapsikum, anksiyete, analjezi, postoperatif bulantı kusma
ABSTRACT
 Objective: The acupuncture points pericardium 6 (P 6), extra 1 (E 1), and large intestine 4 (Li 4) are known to reduce postoperative nausea and vomiting, and to provide sedation and analgesia, respectively. We investigated the effects of preoperative application of acupuncture needle or capsicum plaster on these points on preoperative anxiety, postoperative nausea and vomiting, and analgesic consumption. Material and Methods: Sixty cases undergoing laparoscopic gynecological operations were divided into four groups. The day before the operation, State Trait Anxiety Inventory (STAI) was given to all cases. The participants were divided into four groups regarding the preoperative application of the following: dry needle at points P 6, Li 4 and E1 in group I; capsicum plaster application at the same points in group II; 0.07 mg kg-1 midazolam im and plasebo plaster application at different non acupunctural points (sham) in group III and only placebo plaster usage at sham points in group IV. STAI was repeated immediately before the operation. After standard general anesthesia, tramadol was administered with postoperative patient controlled analgesia method. Postoperative visual pain score (VAS), analgesic consumption, and nausea and vomiting were recorded. Results: The decrease in the preoperative day 1 STAI scores compared to immediate preoperative scores in group I and group II was significantly higher than the decrease in group III (p< 0.05). Nausea and vomiting rates were lower in group I and II (p< 0.05). The postoperative analgesic consumption of group I and group IV were lower than that of group II and group III (p< 0.05). There was no significant difference between the study groups regarding VAS scores. Conclusion: Preoperative acupuncture needle and capsicum plaster application at P 6, E1, and Li 4 points were found to be effective in reducing preoperative anxiety and postoperative nausea and vomiting, but thought to be non effective on postoperative analgesic consumption. Noninvasive capsicum plasters are concluded to be a good alternative method for needles that may cause side effects.

Keywords: Acupuncture; capsicum; anxiety; analgesia; postoperative nausea and vomiting

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