ﻣﻘﺎﻳﺴﺔ وﺿﻌﻴﺖ ﺑﻲ دردي ﺑﻌﺪ از ﻋﻤﻞ ﺟﺮاﺣﻲ ﻫﻤﻮروﺋﻴﺪﻛﺘﻮﻣﻲ ﺑﺎ اﺳﺘﻔﺎده از دو روش ژل ﻟﻴﺪوﻛﺎﺋﻴﻦ ﻣﻮﺿﻌﻲ و ژل ﻟﻮﺑﺮﻳﻜﺎﻧﺖ ﻗﺒﻞ از ﻋﻤﻞ

omparison of Post Operative Analgesia with Preoperative Topical Lidocaine Gel and Lubricant gel in Hemorrhoidectomy Operation

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺑﺎ ﺗﻮﺟـﻪ ﺑﻪ ﺍﻫﻤﻴﺖ ﺑﻲ ﺩﺭﺩﻱ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺩﺭ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﻧﺎﺣﻴﻪ ﺁﻧﻮﺭﮐﺘﺎﻝ ﮐﻪ ﺑﺴﻴﺎﺭ ﺩﺭﺩﻧﺎﮎ ﻣﻲ ﺑﺎﺷﻨﺪ ﻭ ﻧﻈﺮ ﺑﻪ ﺍﻫﻤﻴـﺖ ﻣـﻮﺿﻮﻋﺎﺗﻲ ﻣﺜﻞ ﺍﻓـﺰﺍﻳﺶ ﺭﺿﺎﻳﺖ ﺑﻴﻤـﺎﺭﺍﻥ ﻭ ﮐﺎﻫﺶ ﻋـﻮﺍﺭﺽ ﺩﺍﺭﻭﻳﻲ ﻧﺎﺷﻲ ﺍﺯ ﻣﺼﺮﻑ ﺑﻴﺶ ﺍﺯ ﺣﺪ ﻣﺨﺪﺭﻫﺎ ﻭ ﺩﺍﺭﻭﻫﺎﻱ ﺿﺪ ﺩﺭﺩ ﻭ ﺑﻪ ﺟﻬﺖ ﺁﺷﻨﺎﻳﻲ ﺑﺎ ﺭﻭﺵ ﻫﺎﻱ ﻣـﺆﺛﺮ ﺩﺭ ﺍﻳﻦ ﺯﻣﻴﻨﻪ، ﻣﻄﺎﻟﻌﻪ ﺍﻱ ﺑﻪ ﻣﻨﻈﻮﺭ ﻣﻘﺎﻳﺴﻪ ﻭﺿﻌﻴﺖ ﺑﻲ ﺩﺭﺩﻱ ﺑﻌﺪ ﺍﺯﻋﻤﻞ ﻫﻤﻮﺭﻭﺋﻴﺪﮐﺘﻮﻣﻲ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺩﻭ ﺭﻭﺵ ﮊﻝ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ ﻣﻮﺿﻌﻲ ﻭ ﮊﻝ ﻟﻮﺑﺮﻳﻜﺎﻧﺖ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ، ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻓﻮﻕ ﺗﺨﺼﺼﻲ 501 ﺩﺭ ﺳﺎﻝ 1386 -85 ﺍﻧﺠﺎﻡ ﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺻﻮﺭﺕ ﮐﺎﺭﺁﺯﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ ﺩﻭ ﺳﻮﮐﻮﺭ ﺑﻪ ﻣﻨﻈﻮﺭ ﺍﺭﺯﻳﺎﺑﻲ ﺷﺪﺕ ﺩﺭﺩ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ، ﺩﺭ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺟﻬﺖ ﺍﻧﺠﺎﻡ ﻫﻤﻮﺭﻭﺋﻴﺪﮐﺘﻮﻣﻲ ﮐﺎﻧﺪﻳﺪ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺍﻟﮑﺘﻴـﻮ ﺗﺤﺖ ﺑﻴﻬـﻮﺷﻲ ﻋﻤـﻮﻣﻲ ﺑﻮﺩﻧﺪ ﻭ ﺑﻪ ﺻﻮﺭﺕ ﺗﺨﺼﻴﺺ ﺗﺼﺎﺩﻓﻲ ﺑﻪ ﺩﻭ ﮔﺮﻭﻩ 45 ﻧﻔﺮﻩ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺩﻭ ﺍﻳﻨﭻ ﮊﻝ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ ﻣﻮﺿﻌﻲ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﻭ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺩﻭ ﺍﻳﻨﭻ ﮊﻝ ﻟﻮﺑﺮﻳﻜﺎﻧﺖ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﺗﻘﺴﻴﻢ ﺷﺪﻩ ﺑﻮﺩﻧﺪ، ﺍﻧﺠﺎﻡ ﺷﺪ. ﺍﻃﻼﻋﺎﺕ ﻻﺯﻡ ﺑﺎ ﺭﻭﺵ ﻣﺸﺎﻫﺪﻩ، ﺟﻤﻊ ﺁﻭﺭﻱ ﻭ ﺑﺎ ﺁﺯﻣﻮﻥ ﻫﺎﻱ ﺁﻣﺎﺭﻱ -Chi squareﻭ Mann-Whitney U ﻭ T-Student ﻧﺘﺎﻳﺞ ﻣﻮﺭﺩ ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﺁﻣﺎﺭﻱ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ ﺍﺯﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﮔﺮﻭﻩ ﻫﺎﻱ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺍﺯ ﻟﺤﺎﻅ ﻋﻮﺍﻣﻞ ﻣﺆﺛﺮ ﺑﺮ ﭘﺎﺳﺦ ﺩﻫﻲ ﺑﻪ ﺩﺍﺭﻭﻫﺎ ﻣﺜﻞ ﺳﻦ، ﺟﻨﺲ ﻭ ﻭﺯﻥ، ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﻧﺪﺍﺭﻧﺪ )P>0.05(. ﻫﻤﭽﻨﻴﻦ ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻖ ﻧﺸﺎﻥ ﺩﺍﺩ، ﺑﺮﺍﻱ ﮔﺮﻭﻫﻲ ﻛﻪ ﮊﻝ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ ﻣﻮﺿﻌﻲ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻩ ﺑﻮﺩ، ﺷﺪﺕ ﺩﺭﺩ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ، ﮐﻤﺘﺮ ﺍﺯ ﮔﺮﻭﻫﻲ ﺑﻮﺩ ﮐﻪ ﮊﻝ ﻟﻮﺑﺮﻳﻜﺎﻧﺖ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻩ ﺑﻮﺩ )P<0.05(. ﻣﺪﺕ ﺯﻣﺎﻥ ﺑﺪﻭﻥ ﺩﺭﺩ ﺑﻮﺩﻥ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ، ﺩﺭ ﮔﺮﻭﻫﻲ ﮐﻪ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﺍﺯ ﮊﻝ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ ﻣﻮﺿﻌﻲ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻩ ﺑﻮﺩ، ﻃﻮﻻﻧﻲ ﺗﺮ ﺍﺯ ﮔﺮﻭﻫﻲ ﺑﻮﺩ ﻛﻪ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﮊﻝ ﻟﻮﺑﺮﻳﻜﺎﻧﺖ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻩ ﺑﻮﺩ )P<0.05(. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﮊﻝ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ ﻣﻮﺿﻌﻲ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻫﻤﻮﺭﻭﺋﻴﺪﮐﺘﻮﻣﻲ ﺑﻄﻮﺭ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﺑﺎﻋﺚ ﮐﺎﻫﺶ ﺷﺪﺕ ﺩﺭﺩ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﻣﻲ ﺷﻮﺩ ﻭ ﺍﻳﻦ ﺩﺭ ﺣﺎﻟﻲ ﺍﺳﺖ ﮐﻪ ﻫﻴﭽﮕﻮﻧﻪ ﻋﺎﺭﺿﻪ ﻧﺎﺷﻲ ﺍﺯ ﺍﻓﺰﺍﻳﺶ ﮐﺎﺭﺑﺮﺩ ﻣﺨﺪﺭ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺑﺮ ﺑﻴﻤﺎﺭ ﺗﺤﻤﻴﻞ ﻧﺸﺪﻩ ﺍﺳﺖ. ﻫﻤﭽﻨﻴﻦ ﻣﺪﺕ ﺯﻣﺎﻧﻲ ﮐﻪ ﺩﺭ ﺩﻭﺭﺓ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﻃﻮﻝ ﻣﻲ ﮐﺸﺪ ﺗﺎ ﺑﻴﻤﺎﺭ درخواست ضد درد كند بطور برجسته اي در گروه استفاده از ژل ليدوكائين موضعي طولان يتر مي باشد. لذا م يتوان ازكاربرد ژل ليدوكائين مؤثر استفاده كرد. (Preemptive Analgesia) موضعي در اعمال جراحي هموروئيدكتومي بعنوان يك روش ضد درد ترجيحي

ntroduction & Objective: Because of too sever pain accompanying a hemorrhoidectomy operation; this double blind clinical trial study was done for comparison of post operative analgesia in patients which used preoperative topical lidocaine jel with those that used preoprative lubricant gel. Materials & Methods: Two group 45 patients were candidated for elective hemorrhoidectomy under general anesthesia, and they were randomly divided into two groups, one group received preoprative topical lidocaine jel and second group received preoperative lubricant gel. Then gathered data was analyzed with Chi-square and Mann-Whitney U and T-Student test by SPSS 13 software. The results were evaluated as the mean ± SD and considered statistically significant for P<0.05. Results: The two groups showed similar results for demographic parameters such as age, weight and sex (P>0.05). In the preoperative lidocaine jel group severity of postoperative pain was lower (P<0.05) similarly, the time of free pain period in the preoperative lidocaine jel group was longer (P<0.05). Conclusions: The use of preoperative lidocaine jel in hemorrhoidectomy operation can decrease the severity of pain and can cause longer postoperative free pain period in patients.