Tarık PURTULOĞLU, Ali SIZLAN, Abdülkadir ATIM

Posttorakotomi ağrı yönetimi

Torakotomi sonrası etkin ağrı tedavisi, bozulan akciğer fonksiyonlarının düzeltilerek çok ciddi olabilen pulmoner komplikasyonlardan kaçınmayı sağlamakta olup aynı zamanda stres yanıtın azaltılmasında, mortalite ve morbidite üzerinde de diğer majör cerrahilere göre çok daha etkindir. Pulmoner fonksiyonlardaki iyileşmenin gecikmesi 24–72 saate kadar sürebilmekte hatta bu süreç bir haftaya kadar uzayabilmektedir. Bu fonksiyon kaybının yanında göğüs duvarı mekanikleri de değişmekte, etkisiz göğüs genişlemesi atelektazi, ventilasyon/perfüzyon uyumsuzluğu, hipoksemi ve infeksiyonlara zemin hazırlamaktadır. Etkin ağrı tedavisi sayesinde derin solunumla fonksiyonel rezidüel kapasitenin sürdürülmesi, etkili öksürüğün yapılabilmesi, erken mobilizasyon ile daha hızlı iyileşme ve daha kısa hastanede kalış süresi sağlanabilmektedir. Bu uygun tedavi sürecini sağlayan en etkin ağrı tedavi yöntemi halen yaygın şekilde "gold standart" olarak kabul edilen torakal epidural analjezidir. Bazı otörler tarafından paravertebral bloğun en az torakal epidural analjezi kadar etkin olduğu, hatta daha fazla avantajlarının da bulunduğuna inanılmaktadır. Bununla birlikte ağrı yönetiminde benimsenen tek yöntemin yeterli olmadığı, sürecin sözlü bilgi aktarımı gibi preemptif yöntemlerle başlayan, peroperatif tekniklerle devam eden ve postoperatif rehabilitasyonu da kapsayan multimodal bir yaklaşım kullanımının en akılcı ve uygun yöntem olacağı da şüphesizdir.

Postthoracotomy pain management

Thoracotomy pain relief is a serious obstacle to the development of severe pulmonary complications while allowing the improvement in lung function deteriorated after the operation. At the same time reducing the stress response, it is more effective than other major surgeries on morbidity and mortality. Improvement in pulmonary function can be delayed until 24-72 hours even this process can take up to a week. In addition to this loss of function, the mechanics of the chest wall is changing, ineffective breast enlargement lay the groundwork for atelectasis, ventilation/perfusion mismatch, hypoxemia, and infections. Through the effective treatment of pain maintaining functional residual capacity with deep breathing, effective coughing can be made, with early mobilization faster recovery and shorter hospital stay can be achieved. The most effective method of pain treatment that providing the this appropriate courses of treatment is thoracal epidural analgesia which is still widely accepted as the "gold standard" . By some authors are also believed that paravertebral block at least as effective as thoracal epidural analgesia, even in the presence of more advantages. However, in management of pain the adopted only one method is not enough, It is doubtless that the use of a multimodal approach which is beginning with preemptive methods such as verbal knowledge transfer, continuing with peroperative techniques and including postoperative rehabilitation will be the most rational and convenient method.

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