Torakotomi sonrası devamlı intraplevral ve ekstraplevral analjezi

SüleymanDemirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 2005 Haziran; 12(2) Torakotomi sonrası devamlı intraplevral ve ekstraplevral analjezi Cemalettin Aydın, Sadık Özmen Özet Çalışmamızda torakotomi sonrası analjezi ve etkin akciğer fonksiyonlarının korunması amacıyla devamlı intraplevral ve ekstraplevral blok sonuçlarını karşılaştırmayı amaçladık. Çalışma American Society of Anesthesiologists (ASA) I-II'ye giren, elektif torakotomi planlanan toplam 29 olguda yapıldı. Premedikasyon 10 mg diazepam + 0.5 mg atropin İntra Muskuler (İM), anestezi indüksiyonu 1 mg/kg meperidin + 5 mg/kg tiopenton + 0.5 mg/kg atrakuryum ve anestezi idamesi % 1.5 - 2 Volüm/dk isofluran + % 50 O2/N2O ile sağlandı. Anestezi öncesi kontrol değeri için arteriyel kan örneği alınarak pH, pCO2, pO2 ölçümleri yapıldı. Grup I'de (n:15) intraplevral blok, Grup II'de (n:14) ekstraplevral blok için operasyon bitiminde % 0.5 konsantrasyonda 20 ml bupivakain bolus tarzında uygulandı. Postoperatif 1. saatten 48. saate kadar % 0.25 konsantrasyonda bupivakain 0.5 mg/kg/saat dozda sürekli infüzyon şeklinde verildi. Postoperatif 1., 4., 8., 12., 16., 20., 24., 48. saatlerde pH, pCO2, pO2 ölçümleri kaydedildi. Analjezi Visüel Analog Skala (VAS) ile değerlendirildi. Çalışmamızda postoperatif semi-fowler pozisyonda yatırdığımız iki grup olgularımızda da benzer analjezik etkinlik sağlandı. pH, pCO2, pO2 değerlerinde istatistiksel olarak anlamlı düşmeler oldu. Ancak bu sonuçlar kabul edilebilir fizyolojik sınırlarda bulundu. VAS skorları 30'un altında gerçekleşti ve gruplar arasında fark yoktu. Sonuç olarak intraplevral ve ekstraplevral bloğun; postoperatif torakotomi analjezisi için etkin, güvenli, postoperatif solunum mekaniğinde düzelme sağlayabilen bir yöntem olduğunu düşünüyoruz. Anahtar kelimeler: İntraplevral blok, ekstraplevral blok, torakotomi, postoperatif analjezi Abstract Postthoracotomy Contınous Intrapleural And Extrapleural Analgesıa We proposed to compare the results of intra and extrapleural blockage for postthoracotomy analgesia and providing the effective respiratory functions. Twenty nine cases who were evaluated as ASA I-II and applied elective thoracotomy were included in the study. Premedication were done with diazepam 10 mg IM + atropine sulphate 0.5 mg IM 20 minutes prior to the operation. Anaesthesia was induced with meperedine 1 mg/kg + thiopentone 5 mg/kg and atracurium 0.5 mg/kg IV was administrated to achieve muscle relaxation. Anaesthesia was maintained by using 1.5-2 % Volume/min isoflurane + 50 % nitrous oxide (N2O) and oxygen (O2). pH, pCO2 and pO2 values were measured before anaesthesia as control values via radial artery. At the end of the operation 0.5 % bupivacaine 20 ml was injected as a bolus dose with the intrapleural catheter in group I (n: 15) and with the extrapleural catheter in group II (n: 14). In the postoperative period bupivacaine was continuously applied from postoperative first hour up to 48th hour with a dose of 0.5 mg/kg/h. pH, pCO2 and pO2 values were recorded in postoperative 1th, 4th, 8th, 12th, 16th, 20th, 24th and 48th hours. Analgesia was evaluated with Visual Analogue Scale (VAS). It was found that analgesic effects of intra and extrapleural blockage were similar. Although there were statistically significant reduced in pH, pCO2 and pO2 values, there was not a significant between groups. The VAS scores were below 30 and there was no significant difference between groups. As a result, we may say that intrapleural and extrapleural blockage in providing analgesia of postthoracotomy pain was to be similar. Key words: Intrapleural blockage, extrapleural blockage, thoracotomy, postoperative analgesia.

Anahtar Kelimeler:

Ýntraplevral blok, ekstraplevral blok, torakotomi, postoperatif analjezi

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