Serbülent Gökhan BEYAZ, Orhan TOKGÖZ, Belkıs TANRIVERDİ

Effects of parasternal block and local anaesthetic infiltration by levobupivacaine on postoperative pain and pulmonary functions after off-pump coronary artery bypass graft surgery

Amaç: Bu çalışmada açık kalp ameliyatı sonrası levobupivakain parasternal blok ve lokal anestezik infiltrasyonunun ağrı ve solunum fonksiyonları üzerine olan etkileri araştırıldı.Çalışma planı: Bu ileriye dönük, randomize ve çift kör çalışma, 1 Şubat 2008 ile 1 Aralık 2008 tarihleri arasında yapıldı. Koroner arter bypass greftleme ameliyatı uygulanan ASA III-IV grubu toplam 20 hasta, (12 erkek, 8 kadın; ort. yaş 59.35; dağılım 18-69 yıl) Levobupivakain grubu (Grup LB, n=11) veya Plasebo grubuna (Grup P, n=9) dahil edildi. Grup LB'ye, rutin uygulamaya ek olarak %0.25'lik levobupivakain (1.35 mg/kg) sternumun her iki tarafına lokal infiltrasyon şeklinde uygulandı. Plasebo grubuna ise ilave lokal anestezi yapılmadı. Tüm hastaların ameliyat sonrası sözel değerlendirme skalası (SDS) skoru, morfin tüketimi ve solunum fonksiyonları değerlendirildi.Bulgular: Ekstübasyon sonrası farklı saatlerde bakılan SDS skorları ve yakınmalar grup LB'de, grup P'den anlamlı olarak düşük bulundu (p

Pompasız koroner arter bypass greftleme cerrahisinden sonra levobupivakainle parasternal blok ve lokal anestezik infiltrasyonunun ameliyat sonrası ağrı ve akciğer fonksiyonları üzerine etkileri

Background: In this study, the effects of levobupivacaine parasternal block and local anesthetic infiltration on postoperative pain and pulmonary functions after open heart surgery, were investigated.Methods: This prospective, randomized, double-blinded study was performed between 1 February 2008 and 1 December 2008. A total of 20 ASA III-IV patients (12 males, 8 females; mean age 59.35; range 18 to 69 years) who underwent coronary artery bypass graft surgery, were included in either the Levobupivacaine group (Group LB, n=11) or Placebo group (Group P, n=9). Group LB patients received 0.25% levobupivacaine (1.35 mg/kg) locally infiltrated in both sides of the sternum in addition to routine procedures. The placebo group received no additional local anesthesia. Postoperative verbal rating skala (VRS) scores, morphine consumption and pulmonary functions were evaluated in all patients.Results: Less complaints and lower VRS scores were observed in group LB compared to group P at different hours following extubation (p

PDF

___

1) Cheng DC, Karski J, Peniston C, Asokumar B, Raveendran G, Carroll J, et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial. J Thorac Cardiovasc Surg 1996;112:755-64.
2) Higgins TL. Pro: early endotracheal extubation is preferable to late extubation in patients following coronary artery surgery. J Cardiothorac Vasc Anesth 1992;6:488-93.
3) Mueller XM, Tinguely F, Tevaearai HT, Revelly JP, Chioléro R, von Segesser LK. Pain location, distribution, and intensity after cardiac surgery. Chest 2000;118:391-6.
4) Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology 2006;105:794 800.
5) McDonald SB, Jacobsohn E, Kopacz DJ, Desphande S, Helman JD, Salinas F, et al. Parasternal block and local anesthetic infiltration with levobupivacaine after cardiac surgery with desflurane: the effect on postoperative pain, pulmonary function, and tracheal extubation times. Anesth Analg 2005;100:25-32.
6) Chaney MA. How important is postoperative pain after cardiac surgery? J Cardiothorac Vasc Anesth 2005;19:705-7.
7) Power I. Recent advances in postoperative pain therapy. Br J Anaesth 2005;95:43-51.
8) Montes FR, Sanchez SI, Giraldo JC, Rincón JD, Rincón IE, Vanegas MV, et al. The lack of benefit of tracheal extubation in the operating room after coronary artery bypass surgery. Anesth Analg 2000;91:776-80.
9) Coriat P, Beaussier M. Fast-tracking after coronary artery bypass graft surgery. Anesth Analg 2001;92:1081-3.
10) McLeod GA, Gennery BA, Brennan NE. Levobupivacaine: improved safety for obstetric anesthesia. Adv Anesth 2001;18; 65-6.
11) McLeod GA, Burke D. Levobupivacaine. Anaesthesia 2001; 56:331-41.
12) Bartholdy J, Sperling K, Ibsen M, Eliasen K, Mogensen T. Preoperative infiltration of the surgical area enhances postoperative analgesia of a combined low-dose epidural bupivacaine and morphine regimen after upper abdominal surgery. Acta Anaesthesiol Scand 1994;38:262-5.
13) Johansson B, Glise H, Hallerbäck B, Dalman P, Kristoffersson A. Preoperative local infiltration with ropivacaine for postoperative pain relief after cholecystectomy. Anesth Analg 1994;78:210-4.
14) Hannibal K, Galatius H, Hansen A, Obel E, Ejlersen E. Preoperative wound infiltration with bupivacaine reduces early and late opioid requirement after hysterectomy. Anesth Analg 1996;83:376-81.
15) Bamigboye AA, Hofmeyr GJ. Local anaesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief. Cochrane Database Syst Rev 2009:CD006954.
16) Dierking GW, Ostergaard E, Ostergård HT, Dahl JB. The effects of wound infiltration with bupivacaine versus saline on postoperative pain and opioid requirements after herniorrhaphy. Acta Anaesthesiol Scand 1994;38:289-92.
17) Ng A, Swami A, Smith G, Robertson G, Lloyd DM. Is intraperitoneal levobupivacaine with epinephrine useful for analgesia following laparoscopic cholecystectomy? A randomized controlled trial. Eur J Anaesthesiol 2004; 21:653-7.
18) Alessandri F, Lijoi D, Mistrangelo E, Nicoletti A, Ragni N. Effect of presurgical local infiltration of levobupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynecological surgery. Acta Obstet Gynecol Scand 2006;85:844-9.
19) Papagiannopoulou P, Argiriadou H, Georgiou M, Papaziogas B, Sfyra E, Kanakoudis F. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg Endosc 2003;17:1961-4.
20) Concha M, Dagnino J, Cariaga M, Aguilera J, Aparicio R, Guerrero M. Analgesia after thoracotomy: epidural fentanyl/ bupivacaine compared with intercostal nerve block plus intravenous morphine. J Cardiothorac Vasc Anesth 2004;18:322-6.
21) Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology 1994;81:737-59.
22) Miguel R, Hubbell D. Pain management and spirometry following thoracotomy: a prospective, randomized study of four techniques. J Cardiothorac Vasc Anesth 1993;7:529-34.