Evaluation Of Multimodal Approach For Postoperative Pain At The patients Who Underwent Flank Incision In The Urology Operating Room

OBJECTIVE: In this study, we studied subcutaneous (sc) morphine in combination with multimodal analgesia for postoperative pain control after radical nephrectomy and pyeloplasty with flank incision. METHODS: 49 ASA I-III patients (aged between 18-85 years) undergoing radical nephrectomy and pyeloplasty with flank incision were included in this prospective, randomized study. Patients were divided into 2 groups [Group O (n= 25) and Group M (n= 24)] and received standard general anaesthesia. Tramadol 100 mg and parasetamol 100 mg were given intravenously before fascia closure and levobupivacaine %0,25, 20 ml was injected locally to surgical incision in all patients. Patients in Group M were also received 0,1 mg/kg morphine subcutaneously. Patient-controlled analgesia (PCA) with tramadol was used for postoperative pain control in both groups. Postoperative pain scores (VAS), vital parameters, side effects, the need for rescue analgesia during 24 hours postoperatively as well as patient satisfaction were recorded. RESULTS: Groups were comparable with respect to demographic data, ASA status, and duration of surgery. There were no significant differences between the groups in postoperative PCA tramadol consumption, rescue analgesia, side effects and vital parameters. Postoperative pain scores (VAS) in Group M were significantly lower at 30, 45, 60 minutes, and 2 hours compared to Group O. CONCLUSION: In patients undergoing radical nephrectomy and pyeloplasty with flank incision, subcutaneous morphine in combination with multimodal analgesia decreases early postoperative pain scores compared to multimodal analgesia alone.