TÜLÜN ÖZTÜRK, İSMET TOPÇU, Sadık YALDIZ, Alper ÖZBAKKALOĞLU, Kıvanç AŞIK, EMİN ALP YENTÜR

Torakotomi sonrası postoperatif ağrı kontrolünde torakal epidural ve paravertebral bloğun karşılaştırılması

Amaç: Bu randomize, kontrollü, kör çalışmada, torasik paravertebral analjezinin torokotomi sonrası postoperatif ağrı, hemodinamikler ve solunum hızı üzerine etkileri, epidural analjezininki ile karşılaştırıldı.Gereç ve Yöntem: Elektif açık akciğer cerrahisi planlanan 35 adult hasta prospektif olarak bu çalışmaya alındı. Operasyondan 1 saat önce, 18 hastaya epidural kateter (grup ED), 17 diğer hastaya ultrason rehberliğinde paravertebral kateter (grup PV) takıldı. Standart genel anestezi uygulandı. Anestezinin sonunda, tüm hastalar postoperatif analajezi için epidural veya paravertebral kateter aracılığı ile %0.1 levobupivakain ve morpfin 0.1 mg mL-1 aldılar. Tramadol ile hasta kontrollü analjezi rejimi 24 saat için ayarlandı. Yirmi dört saat içinde kullanılan lokal anestezik+morfin ve tramadol tüketimi (total sunulan+ total istek) kaydedildi. VAS ağrı skoru, sedasyon skoru, yan etkiler ve hemodinamikler (kan basıncı, kalp atım hızı, solunum sayısı), postoperatif 1, 2, 3, 4, 6, 12 ve 24. saatlerde kör bir gözlemci tarafından değerlendirildi.Bulgular: Sunum ve hastanın istek sayıları Grup PV' de (26.8±1.3 and 33.1±4.5), Grup ED' dekinden (25.1±3.5 and 32.5±4.3) istatistiksel olarak anlamlı değildi. VAS skorları PV grup ve ED grupları arasında anlamlı olarak farklı değildi (p=0.3). Grup PV'de 3 hasta, grup ED' de 5 hasta antiemetik ilaç gerektirdi (p>0.05). 1. saatte PV grubunda sedasyon, ED grubundakinden daha düşük idi (p=0.001). ED grubunda 5 (%28) hastada hipotansiyon gelişti (p=0.02).Sonuç: Torakotomi sonrası ağrı gidermede, %0.1 levobupivakain ve 0.1 mg mL-1 morfin ile paravertebral blok alternatif olabilir

Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomy

Objectives: In the present randomized, controlled, and blinded study, the effects of thoracic paravertebral analgesia were compared to those of epidural analgesia on postoperative pain, hemodynamics, and respiration rate following thoracotomy.Methods: Patients scheduled for elective open-lung surgery were included. One hour prior to surgery, thoracic epidural catheters were used in 18 patients (ED group), and ultrasound-guided paravertebral catheters were used in 17 patients (PV group). Standard general anesthesia was administered to all. Following anesthesia, postoperative analgesia of levobupivacaine 0.1% and morphine 0.1 mg mL-1 was administered via catheter. Patient-controlled analgesia (PCA) regime with tramadol was initiated, and amounts of local anesthetics and tramadol demanded and delivered within the first 24 hours were recorded. Visual analog scale (VAS) pain score, sedation score, side effects, and vital signs (blood pressure, heart rate, and respiratory rate) were assessed by an observer blinded to patient data at 1, 2, 3, 4, 6, 12, and 24 hours.Results: Differences in PCA bolus demands and deliveries were not statistically significant between the PV group (26.8±1.3 and 33.1±4.5) and the ED group (25.1±3.5 and 32.5±4.3). Neither were differences in VAS scores statistically significant (p=0.3). Rates of sedation among the PV group were lower than those of the ED group at 1 hour (p=0.001). Five patients in the ED (%28) group experienced hypotension (p=0.02).Conclusion: Paravertebral block with levobupivacaine 0.1% and morphine 0.1 mg mL-1 may be an alternative form of pain relief following thoracotomy

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