Levent GÜNDOST, Kemalettin KOLTKA, Nükhet SIVRIKOZ, Özlem TURHAN, Dilek HÜNDÜR, Hacer Ayşen YAVRU, Emre ÇAMCI

Laparoskopik kolesistektomilerde paravertebral blok ve intravenöz analjezik yöntemlerin postoperatif ağrı yönetimi ile opioid tüketimine etkileri

Amaç: Primer olarak genel anestezi altında yapılan elektif laparoskopik kolesistektomilerde (LK) preoperatif torakal paravertebral blok (TPVB) uygulamasının postoperatif analjezi üzerindeki etkisini görmektir.Gereç ve Yöntem: Üniversite etik kurul onayı ve hasta onamları alındıktan sonra, elektif laparoskopik kolesistektomi planlanan, 18–70 yaş aralığında ve ASA I-III olan 78 hasta çalışmaya dahil edildi. Hastalar; preoperatif ultrasonografi(USG) eşliğindeTPVB uygulanan (Grup 1) 38 hasta ve uygulanmayan (Grup 2) 40 hasta olarak randomize edildi. Her iki gruba postoperatifdönemde HKA (CADD-Legacy®) uygulandı. Hastalara Grup 1’de USG eşliğinde preoperatif unilateral T6 seviyesinden TPVB uygulandı. Postoperatif ilk 24 saatte her iki grubun istirahat ve hareket visüel analog skala (VAS) skorları, postoperatif kullanılantramadol miktarı, bulantı kusma insidansları, gaz-gayta çıkışı, mobilizasyon, beslenme ve taburculuk saatleri kaydedildi.Bulgular: Postoperatif istirahat ve hareket sırasında 4., 6., 12., 18. ve 24. saatte bakılan VAS skorları ve postoperatif tramadol tüketimi Grup 1’de anlamlı derecede düşük saptandı. Grup 2’deki hastaların %77.5’inin intraoperatif en az bir doz ek fentanil ihtiyacı olduğu, bu grupta hastaların kusma oranının anlamlı derecede daha fazla olduğu, gaz-gayta çıkışı, beslenme ve mobilizasyonsaatlerinin daha geç saatlerde olduğu gözlemlendi. Her iki grubun taburculuk saatleri arasında anlamlı fark olmadığı saptandı.Sonuç: Bu çalışmada LK’lerde TPVB uygulamasının, postoperatif analjezik etkinlik sağladığı, intraoperatif ve postoperatif opioid ihtiyacını azalttığı gözlemlendi.

Effects of paravertebral block and intravenous analgesic methods on postoperative pain management and opioid consumption in laparoscopic cholecystectomies

Objectives: The aim of this study was to evaluate the efficiency of a thoracic paravertebral block (TPVB) for postoperative analgesia in cases of a laparoscopic cholecystectomy performed under general anesthesia. Methods: A total of 78 patients aged 18–70 years, with an American Society of Anesthesiologists classification of I-III who were to undergo an elective laparoscopic cholecystectomy were enrolled. The patients were randomly separated into 2 groups: Group 1 (38 patients) received a TPVB performed unilaterally at T6 before surgery and Group 2 (40 patients) received only general anesthesia. Postoperatively, both groups received patient-controlled analgesia with an infusion pump. Visual analog scale (VAS) scores at rest and with movement were recorded during the first 24 hours after surgery. Tramadol consumption during the first 24 hours, nausea and vomiting rate, time to first passage of bowel gas and defecation, nutrition, mobilization, and discharge were also noted. Results: The patients who received an ultrasonography-guided TPVB had significantly lower postoperative VAS scores at rest and on movement at 4, 6, 12,18, and 24 hours and significantly lower levels of postoperative tramadol consumption. It was observed that 77.5% of the patients in Group 2 needed at least 1 dose of additional fentanyl intraoperatively. Group 2 had a significantly higher vomiting rate and it was observed that the time of first bowel gas and defecation, nutrition, and mobilization was later. There was no significant difference between groups in the discharge time. Conclusion: Preoperatively performed TPVB provided efficient analgesia after a laparoscopic cholecystectomy. A TPVB can also reduce perioperative and postoperative opioid requirements.

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