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(a\333r\335 kontrol\237ndeki yeri)Tj
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(Ahmet BA\336KENT (*), Acar AREN (**), \334brahim Ali \205ZEM\334R (*))Tj
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(S.B. G\232ztepe E\333itim ve Ara\337t\335rma Hastanesi 3. Genel )Tj
21.74219 0.00001 TD
(C)Tj
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(errahi Klini\333i*; 1. Genel Cerrahi Klini\333i**)Tj
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56.693 134.89 m
538.583 134.89 l
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(Cerrahi)Tj
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538.583 748.351 l
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(\205ZET)Tj
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(P)Tj
0.61091 0.00001 TD
0 Tc
0.108 Tw
(ostoperatif a\333r\335n\335n azalt\335lmas\335 t\237m ameliyatlar i\215in \232nemli)Tj
24.14205 0 TD
(-)Tj
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0.013 Tc
0.112 Tw
(dir. Hem hasta memnuniyeti a\215\335s\335ndan hem de iyi hekimlik)Tj
0 -1.11111 TD
0 Tc
0.011 Tw
(a\215\335s\335ndan! Postoperatif a\333r\335n\335n azalt\335lmas\335 en az invaziv ve en)Tj
0 -1.11112 TD
0.016 Tc
0.109 Tw
(az komplikasyonla yap\335lmal\335d\335r. Operabl meme kanserinde)Tj
0 -1.11111 TD
0 Tc
0.084 Tw
[(cerrahi giri\337imin ba\337l\335ca amac\335,)-334(kanserli organ\335 ortadan kal-)]TJ
T*
0.011 Tc
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(d\335rmak, ya\337am kalitesini art\335rmak ve en \232nemlisi sa\333kal\335m\335)Tj
T*
0.007 Tc
0.118 Tw
(uzatmakt\335r. \334leri evre olmayan bir \215ok tip meme kanserinde)Tj
0 -1.11112 TD
0 Tc
0 Tw
(ameliyat \337ifa sa\333layabilir. )Tj
0 -2.22222 TD
0.021 Tw
(Bu \215al\335\337mada, operabl meme kanserli hastalar\335n lokal cerrahi)Tj
0 -1.11111 TD
(tedavisinde, bupivakain infiltrasyonu ile lokal ve topikal anes-)Tj
T*
0.001 Tc
0.124 Tw
(tezinin postoperatif a\333r\335 \337iddeti \237zerindeki etkilerinin ara\337t\335)Tj
24.75305 0 TD
0 Tc
(-)Tj
-24.75305 -1.11111 TD
0 Tw
(r\335lmas\335 ama\215lanm\335\337t\335r. )Tj
0 -2.22222 TD
0.098 Tw
(Ya\337 ortalamas\335 48,5 (31-81) olan 33 bayan hastaya modifiye)Tj
0 -1.11111 TD
0.015 Tw
(radikal mastektomi ve level l ve ll aksiller lenf nodu diseksiyo)Tj
24.75297 0 TD
(-)Tj
-24.75297 -1.11112 TD
0.045 Tw
(nu uyguland\335. Randomize, \215ift k\232r, klinik \215al\335\337ma planlanarak)Tj
0 -1.11111 TD
0.029 Tw
(peroperatif 17 hastaya bupivakain infiltre edildi, bu hastalara)Tj
T*
0.021 Tw
[(ihtiyaca g\232re postoperatif metamizol yap\335l\335rken,)-271(di\333er 16 kon-)]TJ
T*
0.011 Tc
0.113 Tw
(trol hasta grubuna rutin metamizol uyguland\335. Postoperatif)Tj
T*
0 Tc
0.02 Tw
[(a\333r\335 basit tan\335mlay\335c\335 skor (BTS) ve viz\237el analog skala)-270((VAS))]TJ
T*
0.005 Tw
(ile \232l\215\237ld\237. Postoperatif analjezi gruplar\335 Mann-Witney U tes)Tj
24.75299 0 TD
(-)Tj
-24.75299 -1.11111 TD
0.009 Tc
0.116 Tw
(ti ile kar\337\335la\337t\335r\335ld\335. T\237m olgularla teke tek g\232r\237\337me ortam\335)Tj
T*
0.004 Tc
0.121 Tw
(sa\333land\335. Hastalarla yap\335lan VAS ve BTS sorgulamalar\335 so)Tj
24.75305 0.00001 TD
0 Tc
(-)Tj
-24.75305 -1.11112 TD
0.094 Tw
(nu\215lar\335 ortalama olarak belirtildi. Postoperatif 1., 6., 18. sa-)Tj
0 -1.11111 TD
0.015 Tc
0.11 Tw
(atlerdeki a\333r\335 hissi kendi aras\335nda ve postoperatif analjezi)Tj
T*
0 Tc
0 Tw
(gruplar\335 Mann-Witney U testi ile kar\337\335la\337t\335r\335ld\335. )Tj
0 -2.22223 TD
0.034 Tw
(T\237m\232r 15 (% 45) hastada sol, 18 (% 55)'inde sa\333 meme loka-)Tj
0 -1.11111 TD
0.05 Tw
(lizasyonunda idi, 26 (% 79)'si )Tj
12.46071 0.00001 TD
(i)Tj
0.27783 0.00001 TD
(nvaziv duktal, 5 (% 15)'i inva-)Tj
-12.73854 -1.11113 TD
0.048 Tw
[(ziv lobuler, 1 (% 3)'i m\237sin\232z)-299(ve)-298(1 (% 3)'i anaplastik b\237y\237k T)]TJ
0 -1.11111 TD
0.125 Tw
[(h\237crali kars\335nom)-375(idi. Level 1 ve ll d\237zeyde ortalama 9,1 \(2-)]TJ
T*
0.003 Tc
0.122 Tw
(21\) lenf nodu \215\335kart\335ld\335. Bupivakain infiltrasyonu yap\335lan ve)Tj
T*
0 Tc
0.001 Tw
(yap\335lmayan gruplar aras\335nda bupivakain infiltrasyonu yap\335lan)Tj
0 -1.11112 TD
0.004 Tc
0.121 Tw
(grup lehine 1., 6., 18. saatlerde VAS i\215in ileri derecede an-)Tj
0 -1.11111 TD
0 Tc
0.079 Tw
(laml\335 fark (VAS p<0.01) ve BTS i\215inse anlaml\335 fark (p<0.05))Tj
T*
0 Tw
(bulundu. )Tj
0 -2.22222 TD
0.117 Tw
(Peroperatif lokal ve )Tj
8.59865 0 TD
[(b\232lgesel)-367(bupivakain uygulamas\335n\335n pos-)]TJ
-8.59865 -1.11112 TD
0.041 Tw
(toperatif a\333r\335 \337iddetinin azalt\335lmas\335nda etkin bir y\232ntem oldu-)Tj
0 -1.11111 TD
0 Tw
(\333u sonucuna var\335ld\335.)Tj
ET
Q
q
BT
/F3 1 Tf
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0 Tr
0 0 0 1 k
-0.005 Tc
0 Tw
(Anahtar kelimeler:)Tj
ET
Q
q
BT
/F2 1 Tf
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0 Tr
0 0 0 1 k
-0.005 Tc
0 Tw
(Mastektomi, bupivakain, postoperatif a\333r\335)Tj
ET
Q
q
BT
/F0 1 Tf
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0 Tr
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0 Tw
(SUMMARY)Tj
-9.67981 -2.22222 TD
-0.0001 Tc
(T)Tj
0.66691 0.00001 TD
0 Tc
(he role of local bupivacaine application on postoperative)Tj
4.02938 -1.11112 TD
(pain management after mastectomy)Tj
ET
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q
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0 Tr
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(Pain management is very important after all surgical admissi-)Tj
0 -1.11111 TD
0.122 Tw
(ons for patients and for medical practitioners. Pain reducing)Tj
T*
0.118 Tw
(or painlessness is provide patient pleasure and confidence to)Tj
T*
0 Tw
(surgeon. Cure could be obtained by local and/or systemic ways)Tj
0 -1.11112 TD
0.05 Tw
(in operable breast cancers. The purpose of operation is provi-)Tj
0 -1.11111 TD
0.066 Tw
(de tumorectomy and prevent to local recurrence in these pati-)Tj
T*
0.094 Tw
(ents. If the patient has not distant metastases operation could)Tj
T*
0.014 Tw
(be provide cure. In this study we aimed to evaluate to effects of)Tj
T*
0.004 Tc
0.116 Tw
(local Bupivacaine application on postoperative pain control)Tj
T*
-0.005 Tc
0 Tw
(with comparing the conventional pain management technique. )Tj
0 -2.22222 TD
0 Tc
0.048 Tw
(Prospective, randomised, double blind, clinical study planned)Tj
0 -1.11111 TD
0.056 Tw
(on 33 women (31-81 years old, mean age 48.5) who are divi)Tj
24.75299 0 TD
(-)Tj
-24.75299 -1.11112 TD
0.053 Tw
(ded into two groups. Modified radical mastectomy and level l)Tj
0 -1.11111 TD
0.056 Tw
(and ll axillary lymphatic dissection are performed to all pati-)Tj
T*
0.063 Tw
(ents. Peroperative intracutaneous Bupivacaine injected along)Tj
T*
0.037 Tw
(the incision borders to 17 patients and if it needed postopera)Tj
24.75299 0 TD
(-)Tj
-24.75299 -1.11112 TD
0.005 Tc
0.12 Tw
(tive intramuscular metamizole applied (Bupivacaine group).)Tj
0 -1.11111 TD
0 Tc
0.052 Tw
(16 patients took only postoperative intramuscular metamizole)Tj
T*
0.037 Tw
((control group). Postoperative pain measured via \322simple de)Tj
24.75297 0 TD
(-)Tj
-24.75297 -1.11111 TD
0 Tw
(finite scor (SDS)\323 and \322visual analogue scala (VAS)\323.)Tj
0 -2.22223 TD
0.044 Tw
(Tumours are at left breast in 15 (45 %), at right in 18 (55 %))Tj
0 -1.11111 TD
0.094 Tw
(patients. Histopathologic classification of cancers of patients)Tj
T*
0.072 Tw
(are; invasive ductal carcinoma in 5 (15 %) patients, invasive)Tj
T*
0.01 Tw
(lobular carcinoma in 1 (3 %) patients, musinous carcinoma in)Tj
-0.0001 Tc
(1)'
0.86931 0 Td
0 Tc
0.119 Tw
((3 %) patients, and anaplastic carcinoma in 1 (3 %) pati)Tj
23.88369 0.00001 TD
(-)Tj
-24.753 -1.11112 TD
0.051 Tw
(ents. Level I and ll axillary lymph node dissections are provi-)Tj
0 -1.11111 TD
0.012 Tc
0.113 Tw
(ded mean 9,1 (range 2-21) node extraction. Evaluations of)Tj
T*
0 Tc
0.063 Tw
(groups via SDS and VAS score systems are appeared statisti)Tj
24.75298 0.00001 TD
(-)Tj
-24.75298 -1.11112 TD
0.075 Tc
0.081 Tw
(cally significant differences between the two groups)Tj
T*
0 Tc
0.125 Tw
((p<0.001). Pain sensations in postoperative 1, 6, 18)Tj
ET
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q
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/F2 1 Tf
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0 Tr
0 0 0 1 k
0 Tc
0 Tw
(th)Tj
ET
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q
BT
/F2 1 Tf
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0 Tr
0 0 0 1 k
0 Tc
0 Tw
(hours)Tj
-22.80776 -1.11111 TD
0.015 Tw
(are compared with Mann-Whitney U test. Patients pain sensa-)Tj
T*
0.045 Tw
(tions are significantly low in postoperative 1, 6, 18)Tj
ET
Q
q
BT
/F2 1 Tf
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0 Tr
0 0 0 1 k
0 Tc
0 Tw
(th)Tj
ET
Q
q
BT
/F2 1 Tf
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0 Tr
0 0 0 1 k
0 Tc
0.045 Tw
(hours in)Tj
-21.73487 -1.11111 TD
0.017 Tc
0.108 Tw
(Bupivacaine group, according to either SDS or VAS score)Tj
T*
0 Tc
0 Tw
(systems (for SDS p<0.05, for VAS p<0.001). )Tj
0 -2.22223 TD
0.033 Tw
(Peroperative local bupivacaine injection is an effective posto-)Tj
0 -1.11111 TD
0 Tw
(perative pain management technique for mastectomies.)Tj
ET
Q
q
BT
/F3 1 Tf
9 0 0 9 311.811 149.0672 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(Key words: )Tj
ET
Q
q
BT
/F2 1 Tf
9 0 0 9 355.3015 149.0672 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(Mastectomy, bupivacaine, postoperative pain)Tj
ET
0 0 0 0 k
56.693 789.197 127.559 10.173 re
f
Q
q
BT
/F2 1 Tf
8 0 0 8 57.6929 792.4114 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(G\232ztepe T\335p Dergisi 21(2):72-75, 2006)Tj
ET
0 0 0 0 k
56.693 92.168 12.921 12.714 re
f
Q
q
BT
/F0 1 Tf
10 0 0 10 57.6929 96.4236 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(72)Tj
ET
0 0 0 0 k
470.551 788.1971 68.027 11.1729 re
f
Q
q
BT
/F0 1 Tf
9 0 0 9 471.551 791.6577 Tm
0 Tr
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0 Tc
0 Tw
(ISSN 1300-526X)Tj
ET
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(A)Tj
0.7219 0.00001 TD
0 Tc
0.042 Tw
(meliyat olmu\337 bir hastada postoperatif a\333r\335n\335n gideril-)Tj
-0.7219 -1.30001 TD
0.028 Tw
(mesi, yan etkileri olmaks\335z\335n postoperatif analjezi yapa-)Tj
0 -1.3 TD
-0.0001 Tc
(r)Tj
0.33288 0.00001 TD
0 Tc
0.051 Tw
(ak morbiditenin azalt\335lmas\335n\335 ama\215lar. Postoperatif a\333-)Tj
-0.33288 -1.30001 TD
0.052 Tw
(r\335n\335n azalt\335lmas\335 en az invaziv ve en az komplikasyonla)Tj
0 -1.3 TD
0.009 Tc
0.116 Tw
(yap\335lmal\335d\335r. Operabl meme kanserinde cerrahi giri\337i-)Tj
0.0072 Tc
(min)'
1.95246 0 Td
0.007 Tc
0.118 Tw
[(ba\337l\335ca amac\335,)-375(kanserli organ\335 ortadan kald\335rmak,)]TJ
-1.95246 -1.3 TD
0 Tc
0 Tw
[(ya\337am kalitesini art\335rmak ve en \232nemlisi sa\333kal\335m\335)-251(uzat-)]TJ
T*
0.012 Tc
0.113 Tw
(makt\335r. A\333r\335n\335n kontrol\237, cerrahi giri\337im ge\215irmi\337 bir)Tj
T*
0 Tc
0 Tw
(hastan\335n tedavisinin ayr\335lmaz bir par\215as\335d\335r. )Tj
0 -2.6 TD
0.028 Tw
(A\333r\335, operatif stres cevab\335n\335n meydana gelmesini ve de-)Tj
0 -1.3 TD
0.102 Tw
(vam etmesine katk\335da bulunabilir. A\333r\335n\335n neden oldu-)Tj
T*
0.028 Tw
[(\333u refleks cevaplar;)-278(solunum fonksiyonlar\335n\335n azalmas\335,)]TJ
T*
0.017 Tw
(kardiyak talebi art\335rmas\335, ba\333\335rsak motilitesini azaltmas\335)Tj
-0.0001 Tc
(ve)'
1.21136 0 Td
0 Tc
0.018 Tw
(kas iskelet spazm\335na sebep olmas\335 nedeni ile progno-)Tj
-1.21136 -1.3 TD
-0.0001 Tc
(zu)Tj
1.30681 0 Td
0 Tc
0.113 Tw
(olumsuz y\232nde etkileyebilir )Tj
ET
Q
q
BT
/F1 1 Tf
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0 Tr
0 0 0 1 k
0 Tc
0 Tw
((1))Tj
ET
Q
q
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/F1 1 Tf
10 0 0 10 197.6142 553.0211 Tm
0 Tr
0 0 0 1 k
-0.0001 Tc
(.)Tj
0.61286 0 Td
0 Tc
0.113 Tw
(A\333r\335n\335n giderilmesi)Tj
-14.60499 -1.3 TD
0.04 Tc
0.085 Tw
(i\337lemi; iyile\337meyi h\335zland\335r\335rken en az yan etki ve)Tj
0 -1.30001 TD
0.023 Tc
0.102 Tw
(komplikasyon sa\333layan, en hesapl\335 ve etkili analjezi)Tj
0 -1.3 TD
0 Tc
0 Tw
(y\232ntemi olarak tan\335mlan\335r )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 164.0455 516.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((2))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 173.3697 514.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
(.)Tj
-11.56768 -2.6 TD
0.006 Tc
0.119 Tw
(Operabl meme kanserinde hem lokal hem de sistemik)Tj
0 -1.3 TD
0.026 Tc
0.099 Tw
[(tedaviler uygulan\335r. Ameliyat\335n ba\337l\335ca amac\335,)-376(lokal)]TJ
T*
0 Tc
0.12 Tw
(hastal\335\333\335 ortadan kald\335rmak ve lokal n\237ks\237 \232nlemektir.)Tj
T*
0.123 Tw
(Sistemik metastazlar\335 olmayan hastalarda ameliyat \337ifa)Tj
T*
0.038 Tw
(sa\333layabilir. Operabl meme kanserli hastalarda lokal te)Tj
22.2444 0 TD
(-)Tj
-22.2444 -1.3 TD
0.009 Tw
(davinin ama\215lar\335 optimum lokal kontrol sa\333lamak, pato)Tj
22.2444 0 TD
(-)Tj
-22.2444 -1.3 TD
0.004 Tw
(lojik evreleme yapabilmek ve m\237mk\237n olan en uzun ya-)Tj
T*
0.035 Tw
(\337ama \337ans\335n\335 yakalayabilmektir. Evre I ve evre II meme)Tj
T*
0.015 Tw
(kanserlerinde \232nce retrospektif \215al\335\337malar ve daha sonra)Tj
T*
0.006 Tc
0.119 Tw
(da prospektif \215al\335\337malar radikal mastektomi, modifiye)Tj
T*
0.002 Tc
0.122 Tw
(radikal mastektomi, basit mastektomiyle birlikte nodal)Tj
T*
0 Tc
0.024 Tw
(irradyasyon ya da geni\337 lokal eksizyonla birlikte meme-)Tj
T*
0.01 Tc
0.115 Tw
(ye irradyasyonun ayn\335 derecede lokal kontrol ve ayn\335)Tj
T*
0.024 Tc
0.101 Tw
(derecede ya\337ama uzunlu\333u sa\333lad\335\333\335n\335 kan\335tlam\335\337t\335r.)Tj
T*
0 Tc
0.108 Tw
[(Bundan sonra)-358(da hangi ameliyat\335n daha iyi oldu\333u ko-)]TJ
T*
0.011 Tc
0.114 Tw
(nusunda cerrahlarda tart\335\337ma iste\333i kalmam\335\337t\335r. Yine)Tj
T*
0.026 Tc
0.099 Tw
[(de,)-375(her hastaya uygun standart bir ameliyat olamaz.)]TJ
T*
0 Tc
0.009 Tw
(Hastan\335n klinik de\333erlendirilmesi, histolojik tan\335 ve has-)Tj
T*
0.079 Tw
(tan\335n mastektomi fikrine reaksiyonu, kararda rol oynar.)Tj
T*
0 Tw
(Baz\335 hastaya ameliyat tipini se\215me hakk\335 verilebilir )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 265.6665 243.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((3))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 274.9908 241.021 Tm
0 Tr
0 0 0 1 k
0 Tc
(.)Tj
-21.72979 -2.6 TD
0.009 Tc
0.116 Tw
(Bu \215al\335\337mada, operabl meme kanserli hastalar\335n lokal)Tj
0 -1.3 TD
0 Tc
0.05 Tw
(cerrahi tedavisinde, bupivakain infiltrasyonu ile yap\335lan)Tj
T*
0.024 Tw
(peroperatif lokal ve topikal anestezinin postoperatif a\333r\335)Tj
T*
0 Tw
(\337iddeti \237zerindeki etkilerini ara\337t\335rmay\335 ama\215lad\335k. )Tj
ET
Q
q
BT
/F0 1 Tf
10 0 0 10 57.6929 150.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(MATERYAL ve METOD)Tj
ET
Q
q
BT
/F1 1 Tf
9 0 0 9 57.6929 127.021 Tm
0 Tr
0 0 0 1 k
0.014 Tc
0.111 Tw
(SSK \334stanbul E\333itim Hastanesi 1. Genel Cerrahi Klini\333i'ne)Tj
28.23535 69.087 TD
-0.0001 Tc
(A)Tj
0.7219 0.00001 TD
0 Tc
0.04 Tw
(ral\335k 2000 ile Temmuz 2001 tarihleri aras\335nda memede kitle)Tj
-0.7219 -1.11111 TD
-0.0001 Tc
(s)Tj
0.38891 0.00001 TD
0 Tc
0.023 Tw
(ebebi ile ba\337vurup, meme kanseri tan\335s\335 konan 33 hasta \215al\335\337-)Tj
-0.38891 -1.11112 TD
0.037 Tw
(maya dahil edildi. Hastalara Madden Auchincloss tekni\333i mo-)Tj
0 -1.11111 TD
0.038 Tw
[(difiye radikal mastektomi \(level I)-287(ve )-1(II)-288(d\237zey aksiller lenf no-)]TJ
T*
0.009 Tc
0.115 Tw
(du disseksiyonu\) yap\335ld\335. Hastalar rasgele se\215ildi. Hastalara)Tj
T*
0 Tc
0.067 Tw
[(\215al\335\337man\335n detaylar\335 anlat\335larak onay al\335nd\335.)-317(\202al\335\337maya al\335nan)]TJ
T*
0.068 Tw
[(33 hasta iki gruba ayr\335ld\335.)-318(Grup 1\325de)-318(17 hastaya lokal aneste-)]TJ
T*
0.125 Tw
[(zik uyguland\335, Grup 2\325de)-375(16 hastaya lokal anestezi uygulan-)]TJ
-0.0001 Tc
(m)'
0.77788 0.00001 TD
0 Tc
0 Tw
(ad\335.)Tj
-0.77788 -2.22223 TD
-0.0001 Tc
(G)Tj
0.72191 0.00001 TD
0 Tc
0.019 Tw
(enel anestezi alt\335nda kanser olan meme dokusu pektoral kas-)Tj
-0.72191 -1.11112 TD
0.088 Tw
(lar\335n fasyas\335 ile birlikte rezeke edildikten sonra ayn\335 insizyon)Tj
0 -1.11111 TD
0.01 Tw
(ile aksiller ven bulundu, n. thorasicus longus ve n. thoracodor-)Tj
T*
0.082 Tw
[(salis korunarak aksilla lenf nodu level I)-332(ve II)-332(d\237zeyde diseke)]TJ
T*
0.008 Tc
0.117 Tw
(edildi. Kanama kontrol\237nden sonra grup 1\325deki hastalara n.)Tj
T*
0 Tc
0.043 Tw
(thorasicus longus ve n. thoracodorsalis'lar\335n aksiller ven alt\335n-)Tj
T*
0.038 Tw
(dan perin\232ral 20 ml % 1\325lik bupivakain sol\237syonu 1'er ml, in-)Tj
T*
0.125 Tw
(terkostal aral\335klara 1'er ml olmak \237zere 10 ml infiltre edildi,)Tj
T*
(kalan bupivakain 1/1 serum fizyolojik ile suland\335r\335larak yara)Tj
T*
0.095 Tw
(kenarlar\335na injekte edildi. Aksillaya hemovak dren konularak)Tj
T*
0.093 Tw
(cilt primer kapat\335ld\335. Hemovak dren kapal\335 tutularak yakla\337\335k)Tj
0 -1.11112 TD
0.018 Tc
0.107 Tw
[(30 dk)-375(sonra a\215\335ld\335. Hastalara postoperatif analjezik ihtiya\215)]TJ
0 -1.11111 TD
0.012 Tc
0.113 Tw
[(olunca 2 ml 1 graml\335k metimazol im.)-376(uyguland\335. \334lk 1 saat)]TJ
T*
0 Tc
0.122 Tw
[(i\215inde 30 dk)-372(arayla tansiyon arteryel ve nab\335z takibi yap\335ld\335.)]TJ
T*
0.097 Tw
(Grup 2\325deki 16 hastaya lokal anestezik uygulamaks\335z\335n anal-)Tj
T*
0.089 Tw
(jezi ihtiya\215lar\335 oldu\333u andan itibaren 4-6 saat arayla metami-)Tj
0 -1.11112 TD
0 Tw
[(zol 1 gr,)-250(2 ml'lik ampullerden im.)-250(uyguland\335.)]TJ
0 -2.22222 TD
0.013 Tc
0.112 Tw
(Basit Tan\335mlay\335c\335 A\333r\335 Skalas\335 (BTS), BTS \237\215 noktal\335 a\333r\335)Tj
0 -1.11111 TD
0 Tc
0.024 Tw
[(skalas\335 olarak tan\335mlam\335\337t\335r;)-274("hafif", "orta", "\337iddetli" noktala-)]TJ
T*
0.047 Tc
0.078 Tw
(r\335ndan olu\337an bu skalad\335r. Viz\237el Analog Skala (VAS),)Tj
T*
0.004 Tc
0.121 Tw
(BTS'ye bir grafik \237zerinde iki uca "a\333r\335 yok, "olabilecek en)Tj
T*
0.007 Tc
0.118 Tw
(k\232t\237 a\333r\335" noktalar\335n\335n eklenmesiyle olu\337an skalad\335r. Hasta-)Tj
T*
0 Tc
0.032 Tw
[(lar\335n)-283(VAS ve BTS de\333erleri ortalama olarak belirtildi)-282(ve)-283(post-)]TJ
T*
0.001 Tw
(operatif 1., 6., 18. saatlerdeki a\333r\335 hissi kendi aras\335nda ve post)Tj
24.75297 0 TD
(-)Tj
-24.75297 -1.11112 TD
0.018 Tw
(operatif analjezi gruplar\335 Mann-Witney U testi ile kar\337\335la\337t\335r\335l-)Tj
0 -1.11111 TD
0 Tw
(d\335. )Tj
ET
Q
q
BT
/F0 1 Tf
10 0 0 10 311.811 365.804 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(BULGULAR)Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 311.811 339.804 Tm
0 Tr
0 0 0 1 k
0.001 Tc
0.124 Tw
(\202al\335\337maya al\335nan 33 hastan\335n ya\337 ortalamas\335 48.5 \(31-)Tj
0 -1.3 TD
0 Tc
0.054 Tw
[(81\)\325dir. Lezyonlar\335n)-304(15\325i)-304(sol memede, 18'i sa\333 mem)-1(ede)]TJ
T*
0.125 Tw
(lokalize idi. Hastalar\335n 26 (% 79)'s)Tj
14.52291 0 TD
-0.0001 Tc
Tj
0.65271 0 Td
(i)Tj
0.27804 0.00001 TD
0 Tc
(nvaziv duktal, 5'i)Tj
-15.45366 -1.30001 TD
0.002 Tc
0.123 Tw
[(invaziv lobuler, bir)-1(i m\237sin\232z)-375(ve biri de)-375(a)-1(naplastik b\237-)]TJ
0 -1.3 TD
0 Tc
0.097 Tw
[(y\237k T h\237creli karsinom)-347(idi. Aksiller lenf nodu diseksi-)]TJ
T*
0.012 Tw
(yonu ile level l ve ll'de ortalama 9,1 (3-21) lenf nodu \215\335-)Tj
T*
0.095 Tw
(kart\335ld\335. Hastalar\335n postoperatif hastanede yat\335\337 s\237releri)Tj
T*
0.013 Tw
(1. grupta 4.1 (3-7) g\237n, 2. grupta 5.4 (4-7) g\237n olup ara-)Tj
T*
0.014 Tc
0.111 Tw
(lar\335nda anlaml\335 fark bulunma)Tj
12.3598 0.00001 TD
0 Tw
<64DD>Tj
1.18089 0.00001 TD
0.111 Tw
((p>0.05). 1. grupdaki)Tj
-13.54069 -1.30001 TD
0 Tc
0.059 Tw
(hastalarda VAS ve BTS de\333erleri, 2. gruba g\232re istatis)Tj
22.24442 0 TD
(-)Tj
-22.24442 -1.30001 TD
0.051 Tw
[(tiksel olarak anlaml\335 d\237\337\237kt\237 (p<0.01).)-301(1. ve 2. gruplar\335)]TJ
0 -1.3 TD
0.115 Tw
(aras\335nda 1. grup lehine 1., 6., 18. saatlerde istatistiksel)Tj
T*
0.079 Tw
[(olarak (p<0.05) anlaml\335 fark bulundu. Yine,)-329(1. grup le-)]TJ
T*
0.013 Tw
(hine VAS i\215in ileri derecede anlaml\335 fark (VAS p<0.01))Tj
T*
0 Tw
[(ve BTS i\215in)-250(ise anlaml\335 fark (p<0.05) bulundu.)]TJ
ET
0 0 0 0 k
56.693 789.197 453.543 10.173 re
f
Q
q
BT
/F2 1 Tf
8 0 0 8 57.6929 792.4114 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(A. Ba\337kent ve ark., Lokal bupivakain uygulan\335m\335n\335n mastektomi sonras\335 a\333r\335 kontrol\237ndeki yeri)Tj
ET
0 0 0 0 k
525.657 92.168 12.921 12.714 re
f
Q
q
BT
/F0 1 Tf
10 0 0 10 526.6566 96.4236 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(73)Tj
ET
Q
endstream
endobj
5 0 obj
<<
/Length 11726
>>
stream
/GS0 gs
q
0 0.89 595 841 re
W n
1 g
0 841.89 0 0 re
f
Q
/GS1 gs
q
0 0 0 0 k
56.693 119.055 481.89 637.796 re
f
Q
q
BT
/F0 1 Tf
10 0 0 10 57.6929 748.021 Tm
0 Tr
0 0 0 1 k
-0.0001 Tc
(T)Tj
0.66692 0.00001 TD
0 Tc
0 Tw
(ARTI\336MA)Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 57.6929 722.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
(P)Tj
0.55591 0.00001 TD
0.074 Tw
(ostoperatif a\333r\335 ciddi bir sorundur. Hastan\335n ameliyat-)Tj
-0.55591 -1.30001 TD
0.111 Tw
[(tan memnuniyeti,)-361(postoperatif a\333r\335 d\237zeyi ile yak\335ndan)]TJ
0 -1.3 TD
0.019 Tw
(ilintilidir. Her t\237rl\237 ameliyat i\215in postoperatif analjeziye)Tj
T*
0.074 Tw
(gereksinim vard\335r. Bunlar\335n yollar\335 farkl\335 olabilir; siste-)Tj
T*
0.001 Tc
0.123 Tw
(mik parenteral, lokal fiziksel, lokal parenteral ve hatta)Tj
T*
0 Tc
0.044 Tw
[(hipnotik y\232ntemlerdir.)-295(A\333r\335n\335n kontrol\237, cerrahi giri\337im)]TJ
T*
0.001 Tw
(ge\215irmi\337 bir hastan\335n tedavisinin ayr\335lmaz bir par\215as\335d\335r.)Tj
T*
0.042 Tw
(Ameliyat olmu\337 bir hastada postoperatif a\333r\335n\335n gideril-)Tj
T*
0.117 Tw
(mesi, yan etkileri olmaks\335z\335n postoperatif morbiditenin)Tj
T*
0 Tw
(azalt\335lmas\335n\335 ama\215lar. )Tj
0 -2.6 TD
-0.005 Tc
0.066 Tw
(\202al\335\337mam\335za lokal anestezik olarak bupivakain kullan\335l-)Tj
0 -1.3 TD
0.01 Tw
(d\335. \202\237nk\237 lidokain gibi amid tipi bir anestezik olan bupi-)Tj
T*
0.021 Tw
(vakain 4 kat daha etkilidir. Postoperatif d\232nemde 6 saate)Tj
T*
0.017 Tw
(kadar toksik bir bulgu vermeksizin yeterli analjezi sa\333lar)Tj
0 -1.30001 TD
0.047 Tw
[(ve alerjik reaksiyonlar\335 \215ok nadirdir.)-293(Analjezi y\232ntemin-)]TJ
0 -1.3 TD
0.118 Tw
(de ise klinik yarar\335 g\232z \232n\237nde bulundurularak olabile-)Tj
0 -1.30001 TD
0.097 Tw
(cek en basit lokal ve topikal anesteziyi tercih ettik. Pek)Tj
0 -1.3 TD
0.059 Tw
(\215ok yay\335nda g\232sterildi\333i gibi bu y\232ntem yeterli bir post-)Tj
T*
0.045 Tw
(operatif analjezi sa\333lar. Hasta a\215\335s\335ndan minimal risk ta-)Tj
T*
0.034 Tw
(\337\335r ve uygulamas\335 kolayd\335r )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 166.5707 464.6611 Tm
0 Tr
0 0 0 1 k
-0.005 Tc
0 Tw
((4,5,8,9))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 193.5351 462.0211 Tm
0 Tr
0 0 0 1 k
-0.0051 Tc
(.)Tj
0.52399 0 Td
-0.005 Tc
0.034 Tw
(\202al\335\337mam\335zda ameli-)Tj
-14.10821 -1.3 TD
0.104 Tw
(yat sahas\335n\335n ve derinin bupivakain ile lokal anestezisi-)Tj
T*
0.105 Tw
(nin, postoperatif analjezi gereksinimine g\232re metamizol)Tj
T*
0.024 Tw
(ile birlikte kullan\335lmas\335n\335n tek ba\337\335na kullan\335lan metami)Tj
22.24441 0 TD
0 Tc
(-)Tj
-22.24441 -1.3 TD
-0.005 Tc
0 Tw
(zole g\232re a\333r\335 \337iddetini daha \215ok azaltt\335\333\335n\335 g\232rd\237k.)Tj
0 -2.6 TD
0 Tc
0.101 Tw
(Zaman aral\335klar\335n\335n saptanmas\335nda metamizol ve bupi-)Tj
0 -1.3 TD
0.096 Tw
(vakainin etki s\237resine paralel olarak klinik \215al\335\337ma yo-)Tj
T*
0.083 Tw
[(\333unlu\333unu en az etkilemesi g\232z \232n\237ne al\335nd\335.)-333<82616CDDDF6D61>-1(-)]TJ
T*
0.023 Tc
0.102 Tw
(m\335zda uygulanan % 5 yo\333unlu\333unda lokal anestezik)Tj
T*
0.034 Tc
0.091 Tw
(konsantrasyonu literat\237r g\232z \232n\237ne al\335narak se\215ildi)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 57.6929 321.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((5,10,11))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 87.0171 319.021 Tm
0 Tr
0 0 0 1 k
-0.0001 Tc
(.)Tj
0.53016 0 Td
0 Tc
0.03 Tw
(Plazma lokal anestezik konsantrasyonunu \232l\215\237-)Tj
-3.46258 -1.3 TD
0.004 Tc
0.121 Tw
(lememesine kar\337\335n bu dozun toksik olmad\335\333\335 d\237\337\237n\237l-)Tj
T*
0 Tc
0.01 Tw
(d\237. Daha \232nceki benzer \215al\335\337malarda benzer konsantras)Tj
22.24441 0 TD
(-)Tj
-22.24441 -1.30001 TD
0.005 Tc
0.12 Tw
(yonda ve vol\237mde lokal anestezik plazma konsantras-)Tj
0 -1.3 TD
0.021 Tc
0.104 Tw
(yonu toksik olmayan d\237zeylerdeydi )Tj
ET
Q
q
BT
/F2 1 Tf
10 0 0 10 214.5505 267.021 Tm
0 Tr
0 0 0 1 k
0.021 Tc
0.104 Tw
(\(farkl\335 anatomik)Tj
-15.68576 -1.3 TD
0 Tc
0.122 Tw
(b\232lgelerde de olmas\335na kar\337\335n kar\337\335la\337t\335r\335labilecek ab-)Tj
T*
0 Tw
(sorbsiyon karakteristiklerine sahipti\))Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 208.4864 243.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((9,12))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 227.8106 241.021 Tm
0 Tr
0 0 0 1 k
0 Tc
(.)Tj
-17.01177 -2.6 TD
0.006 Tc
0.118 Tw
(Modifiye radikal mastektomi; meme, pektoralis major)Tj
0 -1.3 TD
0 Tc
0.028 Tw
(kas\335n fasyas\335, pektoralis min\232r kas\335 ve aksiller lenf nod-)Tj
T*
0.062 Tw
(lar\335n \215\335kart\335lmas\335d\335r. Modifiye radikal mastektomi stan)Tj
22.24441 0.00001 TD
(-)Tj
-22.24441 -1.30001 TD
0.047 Tw
(dart olarak kabul edilmi\337tir. Modifiye radikal mastekto)Tj
22.2444 0.00001 TD
(-)Tj
-22.2444 -1.30001 TD
0.02 Tw
(minin iki ayr\335 tipinden s\232z edilmektedir. Patey tekni\333in-)Tj
0 -1.3 TD
0.0044 Tc
(de)Tj
1.3277 0 Td
0.004 Tc
0.121 Tw
(yaln\335z pektoralis major kas\335 yerinde b\335rak\335l\335r. Auc)Tj
20.91658 0.00001 TD
0 Tc
(-)Tj
-22.24428 -1.30001 TD
0.011 Tc
0.113 Tw
[(hinclous-Madden )-1(tekni\333inde )-1(i)1(s)1(e)1( p)1(e)1(k)1(t)1(o)1(r)1(a)1(l)1(i)1(s)1( m)1(a)1(j)1(o)1(r)1( k)1(a)1(s)1]TJ
0 -1.3 TD
0 Tc
0 Tw
(ile birlikte pektoralis min\232r kas\335 da yerinde b\335rak\335l\335r )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 267.6404 126.6612 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((13))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 280.9646 124.021 Tm
0 Tr
0 0 0 1 k
0 Tc
(.)Tj
3.08464 62.40001 TD
0.0021 Tc
(K)Tj
0.72408 0.00001 TD
0.002 Tc
0.123 Tw
(lini\333imizde genel olarak operabl meme kanserlerinin)Tj
-0.72408 -1.30001 TD
0.006 Tc
0.119 Tw
(lokal cerrahi tedavisinde iki y\232ntem uygulanmaktad\335r;)Tj
0 -1.3 TD
0 Tc
(b)Tj
0.52234 0.00001 TD
0.022 Tc
0.103 Tw
[(irincisi konservatif meme cerrahisi,)-375(ikincisi radikal)]TJ
-0.52234 -1.30001 TD
0 Tc
0.106 Tw
(cerrahidir. Radikal cerrahi olarak klini\333imizin konsepti)Tj
0 -1.3 TD
0.002 Tc
0.123 Tw
(olan Auchinclous-Madden tekni\333inde modifiye radikal)Tj
T*
0 Tc
0.073 Tw
(mastektomidir. \202al\335\337mam\335za cerrahi giri\337im olarak mo-)Tj
T*
0.051 Tw
(difye radikal mastektomi aksiller lenf nodu diseksiyonu)Tj
T*
0 Tw
((level I ve II) se\215ildi.)Tj
0 -2.6 TD
0.008 Tc
0.117 Tw
(Postoperatif a\333r\335 s\237bjektif bir kavramd\335r ve \232l\215\237lmesi)Tj
0 -1.3 TD
0 Tc
0.07 Tw
(zordur. Kullan\335lan y\232ntem uygulamas\335 kolay, yans\335z ve)Tj
T*
0.001 Tc
0.124 Tw
(anla\337\335l\335r olmal\335d\335r )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 388.4381 607.6611 Tm
0 Tr
0 0 0 1 k
0.001 Tc
0 Tw
((14))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 401.8089 605.0211 Tm
0 Tr
0 0 0 1 k
0.001 Tc
0.124 Tw
[(.)-375(Basit tan\335mlay\335c\335 skor)-1(u)-375(Keel, 4)]TJ
-8.99979 -1.3 TD
0 Tc
0.057 Tw
[(noktal\335 a\333r\335 skalas\335 olarak tan\335mlam\335\337t\335r;)-307("hafif", "orta",)]TJ
T*
0.061 Tw
("\337iddetli", "\215ok \337iddetli" noktalar\335ndan olu\337an bu skala-)Tj
T*
0.011 Tc
0.114 Tw
(n\335n \215ok \337iddetli noktas\335 nadir g\232r\237ld\237\333\237 i\215in pek \215ok)Tj
T*
0.008 Tc
0.116 Tw
(ara\337t\335rmac\335 taraf\335ndan kullan\335lmaz )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 457.9463 555.6611 Tm
0 Tr
0 0 0 1 k
0.008 Tc
0 Tw
((15))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 471.5444 553.0211 Tm
0 Tr
0 0 0 1 k
0.0085 Tc
(.)Tj
0.63337 0 Td
0.008 Tc
0.116 Tw
(Hewer ve ark.)Tj
-16.60671 -1.3 TD
0.006 Tc
0.118 Tw
(bu skalay\335 narkotik analjeziklerin etkinli\333ini \232l\215mekte)Tj
0 -1.30001 TD
0.009 Tc
0 Tw
(kulland\335lar )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 359.8641 529.6611 Tm
0 Tr
0 0 0 1 k
0.009 Tc
0 Tw
((16))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 373.475 527.0211 Tm
0 Tr
0 0 0 1 k
0.0089 Tc
(.)Tj
0.63378 0 Td
0.009 Tc
0.116 Tw
(Basitli\333i avantaj\335 olan bu testin deza-)Tj
-6.80018 -1.3 TD
0 Tc
0.111 Tw
(vantaj\335 duyarl\335l\335\333\335n olmamas\335d\335r. A\333r\335n\335n hissedilmedi-)Tj
0 -1.30001 TD
0.073 Tw
(\333i durumlar skalada bulunmaz ve \215ok \337iddetli k\335sm\335 \215\335)Tj
22.24442 0.00001 TD
(-)Tj
-22.24442 -1.30001 TD
0.005 Tc
0.12 Tw
[(kart\335l\335rsa sadece \237\215 noktadan olu\337ur.)-375(Clarke ve Spear,)]TJ
0 -1.3 TD
0 Tc
0.064 Tw
(\232l\215\237lmesi zor olan subjektif durumlarda ve iyilik halin-)Tj
T*
0.002 Tc
0.123 Tw
(de duyarl\335 bir y\232ntem oldu\333unu, basit tan\335mlay\335c\335 a\333r\335)Tj
T*
0 Tc
0.036 Tw
(skalas\335 ile iyi korelasyonu oldu\333u g\232sterdiler )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 496.1357 451.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((24))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 509.4599 449.021 Tm
0 Tr
0 0 0 1 k
-0.0001 Tc
(.)Tj
0.53569 0 Td
0 Tc
0 Tw
(Berry)Tj
-20.30058 -1.3 TD
0.018 Tw
(ve Huskisson)Tj
5.37856 0 TD
(,)Tj
0.51821 0 TD
(100'er hastadan olu\337an deneysel bir \215al\335\337-)Tj
-5.89677 -1.3 TD
0.056 Tw
(ma yaparak VAS\325n\335n basit tan\335mlay\335c\335 skalaya g\232re da)Tj
22.2444 0 TD
(-)Tj
-22.2444 -1.3 TD
0.075 Tw
(ha uniform bir da\333\335l\335m g\232sterdi\333ini buldu )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 485.1954 412.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((14))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 498.5196 410.021 Tm
0 Tr
0 0 0 1 k
-0.0001 Tc
(.)Tj
0.57525 0 Td
0 Tc
0 Tw
(Hastala-)Tj
-19.24611 -1.3 TD
0.005 Tc
0.12 Tw
(r\335n % 73'\237 VAS ile basit tan\335mlay\335c\335 skalaya aras\335nda)Tj
T*
0 Tc
0.036 Tw
(korelasyon g\232sterdi. Bu durum VAS\325\335n daha duyarl\335 ol-)Tj
T*
0.093 Tw
[(du\333unu g\232sterdi.)-343(\202al\335\337mam\335zda en kolay y\232ntem se\215il-)]TJ
T*
0.018 Tc
0.107 Tw
(di. Hastay\335 bilgilendirirken basit tan\335mlay\335c\335 skordan)Tj
T*
0 Tc
0.028 Tw
(faydalan\335ld\335. \334statisti\333i verileri g\237venilir ve daha duyarl\335)Tj
T*
0.095 Tw
(hale getirmek i\215in n\237merik komponenti olan VAS kul-)Tj
T*
0 Tw
(lan\335ld\335. )Tj
0 -2.6 TD
(Elektif )Tj
3.08684 0 TD
(olgu)Tj
1.77783 0 TD
0.116 Tw
(larda VAS ve BTS skorlar\335)Tj
11.29314 0 TD
0 Tw
(n\335n)Tj
1.64372 0 TD
(postoperatif)Tj
-17.80153 -1.30003 TD
0.039 Tw
(a\333r\335 \232l\215\237m\237nde g\237venirli\333i ve do\333rulu\333u ispatlanm\335\337t\335r.)Tj
0 -1.3 TD
0.07 Tw
[(Ancak,)-320(Narch'i ve ark.\325n\335n yapm\335\337 oldu\333u akut kolesis-)]TJ
T*
0.007 Tc
0.118 Tw
(tit ve akut appendisit olgular\335nda intraperitoneal lokal)Tj
T*
0 Tc
0.097 Tw
(anestezik uygulamas\335 sonras\335 a\333r\335 kontrol\237nde VAS ve)Tj
T*
0.023 Tc
0.102 Tw
(BTS farkl\335 \215\335km\335\337t\335r. VAS ve BTS skorlar\335n\335n di\333er)Tj
T*
0.001 Tc
0.124 Tw
(ara\337t\335rmalardan farkl\335 olmas\335n\335n nedeni)Tj
16.17154 0.00001 TD
[(,)-376(bu \215al\335\337malar\335)]TJ
-16.17154 -1.30001 TD
0.01 Tc
0.115 Tw
(akut kolesistit ve akut appendisit gibi akut kar\335n sen-)Tj
0 -1.3 TD
0 Tc
0.107 Tw
(dromlar\335nda kullan\335lmas\335d\335r )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 428.3519 191.6612 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((17))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 441.6762 189.021 Tm
0 Tr
0 0 0 1 k
0 Tc
(.)Tj
0.60658 0.00001 TD
0.107 Tw
(Bu durum)Tj
4.13418 0.00001 TD
(,)Tj
0.60659 0.00001 TD
(akut infla-)Tj
-18.33387 -1.30002 TD
0.044 Tw
(masyonun n\232ronal duyarl\335l\335\333\335 art\335rd\335\333\335 d\237\337\237ncesini do\333)Tj
22.2444 0.00001 TD
(-)Tj
-22.2444 -1.30001 TD
0.006 Tc
0.119 Tw
[(rulayabilir. Ayr\335ca,)-376(lokal anesteziklerin periferik)-375(nosi-)]TJ
0 -1.3 TD
0.002 Tc
0.123 Tw
(sept\232rler \237zerindeki akut inflamatuar etkisi )Tj
18.18067 0.00001 TD
0 Tw
(birincil)Tj
3.28124 0.00001 TD
(hi)Tj
0.78241 0.00001 TD
0 Tc
(-)Tj
-22.24433 -1.30002 TD
0.067 Tw
(peraljezinin tetiklenmesi \237zerine oldu\333unu da d\237\337\237nd\237-)Tj
0 -1.3 TD
0 Tw
(rebilir.)Tj
ET
0 0 0 0 k
411.024 789.197 127.559 10.173 re
f
Q
q
BT
/F2 1 Tf
8 0 0 8 412.0237 792.4114 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(G\232ztepe T\335p Dergisi 21(2):72-75, 2006)Tj
ET
0 0 0 0 k
56.693 92.168 12.921 12.714 re
f
Q
q
BT
/F0 1 Tf
10 0 0 10 57.6929 96.4236 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(74)Tj
ET
Q
endstream
endobj
6 0 obj
<<
/Length 13358
>>
stream
/GS0 gs
q
0 0.89 595 841 re
W n
1 g
0 841.89 0 0 re
f
Q
/GS1 gs
q
0 0 0 0 k
56.693 201.26 481.89 555.591 re
f
Q
q
BT
/F1 1 Tf
10 0 0 10 57.6929 748.021 Tm
0 Tr
0 0 0 1 k
0.0125 Tc
<82>Tj
0.67952 0.00001 TD
0.013 Tc
0.112 Tw
(al\335\337mam\335zda kontrol grubunda ve \215al\335\337ma grubunda)Tj
-0.67952 -1.30001 TD
0 Tc
0.084 Tw
(gereksinime g\232re metamizol\237n se\215ilmesinin nedeni ise,)Tj
0 -1.3 TD
-0.0001 Tc
(k)Tj
0.49993 0.00001 TD
0 Tc
0.051 Tw
(linik kullan\335m\335n\335n \215ok uygun olu\337u, yan etkilerinin ih-)Tj
-0.49993 -1.30001 TD
0.105 Tw
(mal edilebilecek kadar az, ucuz ve yayg\335n kabul g\232ren)Tj
0 -1.3 TD
0.02 Tw
(bir ila\215 oldu\333u i\215indir. Verili\337 y\232ntemi olarak parenterel)Tj
T*
0.039 Tw
[(y\232ntemin tercih edilmesinin nedeni,)-289(plazma konsantras-)]TJ
T*
0.045 Tw
(yonunda ve biyoyararlan\335m\335nda ki\337isel farklar\335 minima-)Tj
-0.0001 Tc
(le)'
1.03666 0 Td
0 Tc
0.065 Tw
(indirmektir. Postoperatif a\333r\335 \337iddetinin ba\337lang\335\215 hi-)Tj
-1.03666 -1.3 TD
0.012 Tc
0.112 Tw
(potezi hastan\335n ya\337\335, cinsiyeti, ta\337\335d\335\333\335 risk fakt\232rleri,)Tj
T*
0.009 Tc
0.116 Tw
(daha \232nce ge\215irdi\333i ameliyatlar, peroperatif ve posto-)Tj
T*
0 Tc
0 Tw
(peratif komplikasyonlarla ili\337kisi olmad\335\333\335 saptand\335.)Tj
0 -2.6 TD
0.034 Tw
(\334ntraplevral bupivakain uygulanan mastektomili 15 has-)Tj
0 -1.3 TD
0.059 Tw
[(tal\335k bir seride,)-310(kontrol grubunda bu y\232ntemin postope-)]TJ
T*
0.075 Tw
(ratif analjezide daha etkin oldu\333u savunulmaktad\335r )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 267.6403 568.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((49))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 280.9645 566.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
(.)Tj
-22.32716 -1.3 TD
0.1 Tw
(Selim meme kitlelerinin ektripasyonunda lokal bupiva-)Tj
T*
0.011 Tc
0.114 Tw
(kain infiltrasyonu ile postoperatif analjezide etkin bir)Tj
0 -1.30001 TD
0 Tc
0 Tw
(y\232ntem oldu\333unu savunmu\337lard\335r )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 194.6119 529.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((19))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 207.9361 527.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
(.)Tj
-15.02432 -2.6 TD
0.04 Tw
(Paravertebral blokaj)Tj
8.1189 0.00001 TD
[(,)-290(meme cerrahisinde genel anestezi-)]TJ
-8.1189 -1.30001 TD
0.019 Tc
0.106 Tw
(ye iyi bir alternatiftir. Coveney'in yapt\335\333\335 \215al\335\337mada,)Tj
0 -1.3 TD
0 Tc
0.088 Tw
(145 olgudan sadece % 15\325inde genel anesteziye ge\215me)Tj
T*
0.019 Tw
[(gere\333i duyulmu\337tur. Bu tekni\333in)-269(ayn\335 zamanda postope-)]TJ
T*
0.04 Tw
(ratif a\333r\335n\335n azalt\335lmas\335nda etkin bir y\232ntem oldu\333u ifa-)Tj
T*
0.005 Tw
(de edilmektedir )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 122.7657 438.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((20))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 136.0899 436.0211 Tm
0 Tr
0 0 0 1 k
-0.0001 Tc
(.)Tj
0.50477 0 Td
0 Tc
0 Tw
(Greengrass)Tj
4.49704 0 TD
(,)Tj
0.50498 0 TD
0.005 Tw
(yapm\335\337 oldu\333u bupiva-)Tj
-13.34649 -1.3 TD
0.089 Tw
(kain ile paravertebral blokaj\335n ambulatuar meme cerra)Tj
22.2444 0 TD
(-)Tj
-22.2444 -1.3 TD
0.002 Tc
0.123 Tw
(hisinde uygun bir teknik oldu\333unu savunmaktad\335r )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 267.5832 412.6611 Tm
0 Tr
0 0 0 1 k
0.002 Tc
0 Tw
((21))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 280.9653 410.021 Tm
0 Tr
0 0 0 1 k
0 Tc
(.)Tj
-22.32724 -1.3 TD
0.121 Tw
[(Pasqualicci ve ark.,)-371(preoperatif verilen bupivacaine'nin)]TJ
T*
0.098 Tw
(postoperatif a\333r\335 \237zerine daha etkin oldu\333unu g\232sterdi-)Tj
T*
0.011 Tc
0 Tw
(ler )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 72.3201 373.6611 Tm
0 Tr
0 0 0 1 k
0.011 Tc
0 Tw
((22))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 85.9993 371.021 Tm
0 Tr
0 0 0 1 k
0.011 Tc
(.)Tj
0.63596 0 Td
0.114 Tw
(O'Hanlon ve ark. g\237n\237birlik uygulad\335klar\335 74)Tj
-3.4666 -1.3 TD
0.026 Tc
0.099 Tw
(hastal\335k meme biyopsili hastalar\335nda; preoperatif ve)Tj
T*
0.02 Tc
0.105 Tw
(postoperatif bupivakain infiltrasyonu ile postoperatif)Tj
T*
0 Tc
0.079 Tw
[(a\333r\335da fark olmad\335\333\335n\335 ve preoperatif uygulaman\335n her)-1(-)]TJ
T*
0 Tw
[(hangi bir avantaj\335 olmad\335\333\335n\335)-250(belirtmi\337lerdir )]TJ
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 235.6934 321.6611 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
((23))Tj
ET
Q
q
BT
/F1 1 Tf
10 0 0 10 249.0176 319.021 Tm
0 Tr
0 0 0 1 k
0 Tc
(.)Tj
-19.13247 -2.6 TD
0.015 Tc
0.11 Tw
(Bu \215al\335\337ma)Tj
4.73479 0 TD
0 Tc
(,)Tj
0.64042 0.00001 TD
0.015 Tc
(postoperatif a\333r\335 yo\333unlu\333u ve s\237resinin)Tj
-5.37521 -1.30002 TD
0 Tc
0.033 Tw
(azalmas\335nda bupivakainin lokal uygulamas\335n\335n etkin ol-)Tj
0 -1.3 TD
[(du\333unu g\232sterdi;)-282(18 saat sonras\335n\335n \215al\335\337maya al\335nmas\335)-1(-)]TJ
T*
0.002 Tc
0.123 Tw
[(n\335n nedeni,)-375(bu d\232nem sonras\335n\335n postoperatif a\333r\335 a\215\335-)]TJ
T*
0 Tc
0.051 Tw
(s\335ndan klinik anlam ta\337\335mad\335\333\335n\335n daha \232nceki \215al\335\337ma-)Tj
T*
0.042 Tw
[(larda g\232sterilmesidir.)-293(Bunlar\335n yan\335 s\335ra,)-292(preoperatif ya-)]TJ
T*
0.023 Tw
(p\335lacak lokal anestezinin di\333er gruplarla kar\337\335la\337t\335r\335laca)Tj
22.2444 0.00001 TD
(-)Tj
3.16741 53.3 TD
-0.0001 Tc
Tj
0.4999 0.00001 TD
Tj
0.56809 0 Td
0 Tc
0.04 Tw
(ba\337ka bir \215al\335\337man\335n daha etkili sonu\215lar \215\335kartaca\333\335-)Tj
-1.06799 -1.30001 TD
0 Tw
(n\335 d\237\337\237n\237yoruz.)Tj
ET
Q
q
BT
/F0 1 Tf
10 0 0 10 311.811 709.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(KAYNAKLAR)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 687.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0.064 Tw
(1. Kehlet H:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 356.8894 687.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0.064 Tw
(General vs regional anesthesia. In: Rogers M, Tinker J,)Tj
-5.6348 -1.125 TD
0.006 Tc
0.119 Tw
(Covino B, Longnecker DE (eds). Principles of Anesthesiology. CV)Tj
T*
0 Tc
0 Tw
(Mosby, St louis:1218-1238, 1993.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 660.021 Tm
0 Tr
0 0 0 1 k
0.008 Tc
0 Tw
(2.)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 320.9315 660.021 Tm
0 Tr
0 0 0 1 k
0.007 Tc
0.117 Tw
(Postoperatif a\333r\335, tedavi \232nerileri. Edi. Kehlet. 1.st edi. \334stanbul,)Tj
-1.14006 -1.125 TD
0 Tc
0 Tw
(T\237rkiye Roche 1994.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 642.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0.038 Tw
(3. Alican F:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 354.5012 642.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0.038 Tw
(Meme Kanseri De\333i\337en Kavramlar ve G\237ncel Tedaviler:)Tj
-5.33627 -1.125 TD
0 Tw
(\334stanbul Afa matbaac\335l\335k, 1.bs ;s:50-51, 1996.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 624.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0.053 Tw
(4. Covino BG:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 363.7501 624.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0.053 Tw
(Comperative Clinical Pharmacology of local anesthe-)Tj
-6.49239 -1.125 TD
0 Tw
(tic agents. Anaesthesiology 35:158, 1987.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 606.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0.028 Tw
(5. Spielman FJ, Hulka JF, Osthaimer GW, et al:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 480.7175 606.021 Tm
0 Tr
0 0 0 1 k
0 Tc
0 Tw
(Pharmacokinetics)Tj
-21.11331 -1.125 TD
0.057 Tw
(and pharmacodynamics of local analgesia for laparoscopic tubal liga-)Tj
T*
0 Tw
(tions. Am J Obstet Gynecol 146:821-4, 1983.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 579.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.025 Tw
(6. Ereng\237l A:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 360.4127 579.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.025 Tw
(Anestezyoloji ve reanimasyon. 2.bs. \334stanbul, nobet t\335p)Tj
-6.07521 -1.125 TD
0 Tw
(kitapevi, 1992.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 561.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.051 Tw
(7. Sayek \334: )Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 351.2598 561.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.051 Tw
(Temel Cerrahi 1. G\237ne\337 Kitapevi 2. bask\335 Ankara; s:837-)Tj
-4.9311 -1.125 TD
0 Tw
(2, 1996.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 543.0211 Tm
0 Tr
0 0 0 1 k
0.011 Tc
0.114 Tw
(8. Dahl JB, Moiniche S, Kehlet H:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 438.8996 543.0211 Tm
0 Tr
0 0 0 1 k
0.011 Tc
0.114 Tw
(Wound infiltration with local)Tj
-15.88607 -1.125 TD
0 Tc
0.065 Tw
(anesthetics for postoperative pain relief. Acta Anaesthesiology Scand)Tj
T*
0 Tw
(38:7-14, 1994.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 516.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.098 Tw
(9. Joris J, Thiry E, Paris P, et al:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 432.4018 516.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.098 Tw
(Pain after laparoscopic cholecy-)Tj
-15.07385 -1.125 TD
0.011 Tc
0.114 Tw
(stectomy: Characteristics and affect of intraperitoneal bupivacaine.)Tj
T*
0 Tc
0 Tw
(Anaesth Analg 81:379-81, 1995.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 489.0211 Tm
0 Tr
0 0 0 1 k
0.009 Tc
0.116 Tw
(10. Kayaalp O:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 369.4673 489.0211 Tm
0 Tr
0 0 0 1 k
0.009 Tc
0.116 Tw
(Rasyonel tedavi y\232n\237nden t\335bbi farmakoloji. 5.bs.)Tj
-7.20704 -1.125 TD
0 Tc
0 Tw
(Feryal Matbaac\335l\335k limited \337irketi Ankara 2:1691-712, 1965-82, 1990.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 471.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.013 Tw
(11. Orak\215\335 V, Erta\337 E, \336are M, et al:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 438.7314 471.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.013 Tw
(Video laparoskopinin diagnos-)Tj
-15.86505 -1.125 TD
0.047 Tw
(tik ama\215l\335 olarak akut bat\335n, asit etyolojisi, kronik akci\333er hastal\335klar\335)Tj
T*
0.009 Tw
(tan\335s\335 ve malignite evrelemesindeki etkinli\333inin ara\337t\335r\335lmas\335. End Lap)Tj
T*
0 Tw
(ve Minimal \334nvaziv Cerrahi 3:41-48, 1996.)Tj
ET
Q
q
BT
/F0 1 Tf
8 0 0 8 311.811 435.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.053 Tw
(12. Covino BG:)Tj
ET
Q
q
BT
/F1 1 Tf
8 0 0 8 367.7557 435.0211 Tm
0 Tr
0 0 0 1 k
0 Tc
0.053 Tw
(Systemic toxicity of local anesthetic agents. Anaest-)Tj
-6.99309 -1.125 TD
0 Tw
(hesiol Analg 57:387, 1978.)Tj
ET
Q
q
BT
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