Nükhet SİVRİKOZ, Ebru EMRE DEMİREL, Özlem TURHAN, Dilan BÜYÜK, Zerrin SUNGUR

Meme Koruyucu Cerrahi’lerde Torakal Paravertebral ve Erektör Spina Plan Bloğunun Postoperatif Opioid Tüketimi ve Analjezi Etkinliğinin Karşılaştırılması

Meme koruyucu cerrahi (MKC) erken evre meme kanserlerinde sıklıkla uygulanır. Torakal paravertebral blok (TPVB) meme cerrahileri ağrı yönetiminde etkinliği kabul edilmiş bir yöntemdir. Son yıllarda yeni tanımlanan Erektör Spina Plan Bloğu (ESPB) güvenli, kolay ve benzer analjezik etkileri olan yöntem olarak gündeme gelmiştir. Çalışmamız MKC’lerde TPVB ve ESPB’nin opioid tüketimi ve analjezi etkinliğini karşılaştırmaktadır. Gözlemsel, prospektif olarak Grup P(TPVB)’de 43 ve Grup E(ESPB)’de 42 olmak üzere toplam 85 hasta ile tamamlandı. Bloklar ameliyat öncesinde ultrasonografi altında 20 ml %0.375 bupivakain ile T4 vertebra seviyesinden yapıldı. Birincil sonuç postoperatif 24 saat morfin tüketimi, ikincil sonuçlar postoperatif 0. ve 30. dk, 1., 4., 6., 12. ve 24. saat ağrı skorları, kurtarma analjezi gereksinimi, blok uygulama süreleri ve bulantı kusma yan etkileriydi. Morfin tüketimi Grup P’de (17,582,29 mg) Grup E’den (18,962,67 mg) daha düşüktü. (p=0.012) Tüm zamanlarda istirahat ve hareket ağrı skorları benzerdi. Grup P’de iki hastada, Grup E’de beş hastada kurtarma analjezisi yapıldı. (p>0.05) Blok uygulama süresi Grup P’de (78,6210,93 sn), Grup E’ye göre (57,177,84 sn) daha uzundu. (p<0.001) Grup P’de beş hastada (%11.6) Grup E’de ise yedi (%16.7) hastada bulantı görüldü. (p>0.05) MKC’lerde TPVB ve ESPB benzer analjezik etkinlik sağlamıştır. Ancak ESPB daha kolay uygulanabilir olmasıyla iyi bir alternatiftir.

Anahtar Kelimeler:

Postoperatif ağrı, Sinir blok, Torakal duvar

Effects of Paravertebral and Erector Spina Plane Block on Postoperative Opioid Consumption and Pain in Breast Conserving Surgery

Breast conserving surgery (BCS) is frequently performed in early stage breast cancers. Thoracic paravertebral block (TPVB) is an accepted method in the pain management of breast surgery. In recent years, newly defined ESPB has come to the fore as a safe, easy method with similar analgesic effects. Our study is to compare opioid consumption and analgesia effectiveness of TPVB and ESPB in BCS. The observational prospective study was completed with a total of 85 patients, 43 in Group P(TPVB) and 42 in Group E(ESPB). Blocks were applied at the T4 level with 20 ml of 0.375% bupivacaine under ultrasonography preoperatively. The primary outcome was morphine consumption at postoperative 24 hours, secondary outcomes were postoperative pain scores at 0 and 30 minutes, 1, 4, 6, 12 and 24 hours, need for rescue analgesia, block application times, and nausea-vomiting side effects.Morphine consumption was lower in Group P (17.582.29 mg) than in Group E (18.962.67 mg). (p=0.012) Pain scores at rest and at movement were similar at all times. Rescue analgesia was performed in two patients in Group P and in five patients in Group E. (p>0.05) Block application time was longer in Group P (78.6210.93 seconds) than Group E (57.177.84 seconds). (p<0.001) Nausea was observed in five (11.6%) patients in Group P and in seven (16.7%) patients in Group E. (p>0.05) TPVB and ESPB provided similar analgesic efficacy in BCS. However, ESPB is a good alternative as it is easier to implement.

Keywords:

Postoperative pain, Nerve Block, Thoracic wall,

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