Ömer ÖZSANCAKTAR, Başak AKÇA, Meral KANBAK, AYSUN ANKAY YILBAŞ, FİLİZ ÜZÜMCÜGİL, ERKAN DİKMEN, Bilge ÇELEBİOĞLU

TORAKOTOMİ SONRASI YARA YERİNE UYGULANAN LOKAL ANESTEZİK İNFÜZYONUNUN POSTOPERATİF AĞRIYA ETKİSİNİN İNCELENMESİ: RETROSPEKTİF GÖZLEMSEL BİR ÇALIŞMA

Amaç: Torakotomi,en ağrılı cerrahi işlemlerden bir tanesidir. Ağrının oluşmasında cerrahi kesinin yanısıra, kostaların ve interkostal sinirlerin zedelenmesi, insizyon komşuluğundaki göğüs duvar yapılarının inşamasyonu, pulmoner parankim ya da plevranın hasarı ve drenaj tüpünün yerleşimi rol oynamaktadır. Post-torakotomi ağrısı, etkin tedavi edilmediğinde pulmoner fonksiyonları önemli ölçüde etkilemekte, morbidite artışına neden olmaktadır. Torakotomi ağrısının tedavisinde analjezikler, epidural ilaç infüzyonu, interkostal sinir blokajı ve insizyon bölgesine lokal anestezik (LA) infüzyonu gibi yöntemler kullanılmaktadır. Bu çalışmada amacımız; torakotomi uygulanan hastalarda yalnızca morŞn kullanılarak hasta kontrollü analjezi (HKA) uygulaması ve morŞn HKA ile birlikte yara yerine devamlı lokal anestezik infüzyonu yapılmasının hastaların postoperatif ilk 48 saatte ağrı skorları, opioid kullanım dozları ve opioid yan etkilerinin görülme oranı, ek analjezik gereksinimleri, arteriyel kan gazları, yoğun bakım ve hastanede kalış süreleri üzerine etkilerini retrospektif olarak karşılaştırmaktır. Yöntem: Çalışmaya etik kurul izni ve hasta onamları alındıktan sonra sadece morŞn HKA uygulanan 28 hasta (Grup M), morŞn HKA ve LA infüzyonu uygulanan 32 (GrupLA) olmak üzere toplam 60 hasta dahil edilmiştir. DemograŞk veriler (yaş, cinsiyet, ağırlık, mevcut komorbiditeler), klinik veriler (anestezi-cerrahi süresi, cerrahinin tipi ve torakotomi tarafı) ve postoperatif bakım verileri, ağrı tedavisi (kullanılan analjezik ilaçlar, bolus morŞn dozları, ağrı skorları, opioid tüketimi, ek analjezik ihtiyacı), yoğun bakım ve hastane yatış süresi ve arteriyel kan gazı sonuçları değerlendirilmiştir. İstatistiksel değerlendirme SPSS 22 programı kullanılarak yapıldı. p

EVALUATION OF THE EFŞCACY OF LOCAL ANESTHETIC WOUND INFUSION ON POSTOPERATIVE PAIN AFTER THORACOTOMY: A RETROSPECTIVE OBSERVATIONAL STUDY

Objective: Thoracotomy is one of the most painful surgical procedures. Surgical incision, pulmonary parenchymal, costal and pleural injury, intercostal neural damage, inşammation of thoracic wall structures in incision neighborhood or placement of chest tube may contribute to this pain. Post thoracotomy pain affects pulmonary functions and leads to morbidities unless treated effectively. Opioid and non-opioid analgesics, epidural infusion ,patient-controlled analgesia (PCA), intercostal nerve blockade and local anesthetic wound infusions could be used in postoperative pain management after thoracotomy. The purpose of the study is to compare the pain scores, opioid consumptions and opioid side effects, additional analgesic requirements, duration of ICU and hospital stay, arterial blood gas analysis of patients in postoperative 48 hours after thoracotomy. Method: After obtaining ethic committee approval and patient informed consent, a total of 60 patients, of whom 28 received iv morphine PCA (group Control C) and 32 received morphine PCA and local anesthetic wound infusion(group LA), were included in the study. Demographic parameters (age, gender, weight, American Society of Anaesthesiology (ASA) score, comorbidities), clinical parameters (duration of anesthesia and surgery, type of surgical procedure, endotracheal tube size, side of thoracotomy incision) and postoperative management, pain management (analgesic drugs used, bolus morphine dosages, pain scores, opioid consumptions and opioid side effects, additional analgesic requirements), duration of ICU and hospital stay, arterial blood gas analysis of patients were recorded. Statistical analysis was performed using SPSS version 22. It was accepted to be signiŞcant if p

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