Publication: Torakotomi Sonrası Epidural Blok ile Tek Doz Paravertebral Blok Analjezisinin Karşılaştırılması
Abstract
Amaç: Bu prospektif, randomize, kontrollü çalışmada, torokotomi sonrası torasik epidural analjezi (EA) ile torasik paravertebral blok analjezisinin (PA) postoperatif ağrı ve hemodinamik parametreler üzerine olan etkileri karşılaştırıldı.Gereç ve Yöntem: Elektif akciğer cerrahisi planlanan 11'i kadın, 33'ü erkek toplam 44 olgu prospektif olarak bu çalışmaya alındı. Olgular rastgele iki gruba ayrıldı. Postoperatif analjezi, EA grubunda, anestezi öncesi torakotomi için planlanan insizyon hattının bir seviye altından yerleştirilen epidural katater ile ve PA grubunda, ameliyat bitiminde ekstübasyon öncesi T5-T8 aralıklarından yapılan paravertebral blok ile sağlandı. EA olgularına 25 µg fentanil ile % 0.125 Bupivakain 7,5 ml bolus verildi. PA grubunda ise % 0.125 Bupivakain 25?g fentanil ile üç seviyeden toplam 15 ml tek enjeksiyonda verildi. Vizüel Analog Skala (VAS) ağrı skoru, hemodinamik değerler (ortalama kan basıncı, kalp atım hızı) ve arteriyel kan gazı değerleri postoperatif 1, 2, 3, 5, 8, 12 ve 24. saatlerde değerlendirildi. Bulgular: Grupların başlangıç ile postoperatif VAS skor ölçümleri arasında istatistiksel olarak anlamlı farklılık saptanmadı (p>0.05). Her iki grupta takip sürelerine göre VAS ölçümleri incelendiğinde hem epidural hem de paravertebral grupta postoperatif ilk 3 saatte anlamlı bir fark yoktu (p>0.05). Her 2 grupta da herhangi bir yan etki veya komplikasyon kaydedilmedi. Sonuç: Paravertebral blok; uygulama kolaylığı, yan etki ve komplikasyon oranlarının düşüklüğü ve benzer ağrı kontrolü sağlaması nedeniyle epidural bloğa iyi bir alternatif olabilir
Comparison of Epidural and Single-Shot Paravertebral Block Analgesia After Thoracotomy Objective: In this prospective, randomized and controlled trial, the effects of thoracic epidural analgesia (EA) and thoracic paravertebral block analgesia (PA) on postoperative pain and hemodynamic parametres after thoracotomy were compared. Material and Method: : A total of of 44 patients (11 women and 33 men) who were scheduled for elective open lung surgery were included in this study. The cases were randomly divided into two groups. Postoperative analgesia was performed with an epidural catheter placed below the level of the incision line planned for thoracotomy (T5-6 or T6–7), before anesthesia in the EA group and it was performed with thoracic paravertebral block before extubation at the end of the operation in the PA group. In the EA group. 25 μg of fentanyl+0.125% of bupivacaine 7.5 ml of bolus were delivered into the epidural space, while in the PA group 0.125% bupivacaine and 25 μg fentanyl were delivered into three levels (T5-T8) as single injections for a total amount of 15 ml. Visual analogue scale (VAS) scores for pain, and also hemodynamic values (mean arterial blood pressure, heart rate) and arterial blood gas values were recorded at postoperative 1, 2, 3, 5, 8, 12 and 24. hours. Results: There was no statistically significant difference between baseline and postoperative VAS scores between the groups and when VAS measurements were compared according to the follow-up periods in both groups, there was no significant difference in the first three hours in both the epidural and paravertebral groups (p>0,05). There were no side effects or complications in both groups (p>0,05). Conclusion: Paravertebral block may be a good alternative to the epidural block because of ease of application, low side effect profile and complication rates and similar pain control.
Comparison of Epidural and Single-Shot Paravertebral Block Analgesia After Thoracotomy Objective: In this prospective, randomized and controlled trial, the effects of thoracic epidural analgesia (EA) and thoracic paravertebral block analgesia (PA) on postoperative pain and hemodynamic parametres after thoracotomy were compared. Material and Method: : A total of of 44 patients (11 women and 33 men) who were scheduled for elective open lung surgery were included in this study. The cases were randomly divided into two groups. Postoperative analgesia was performed with an epidural catheter placed below the level of the incision line planned for thoracotomy (T5-6 or T6–7), before anesthesia in the EA group and it was performed with thoracic paravertebral block before extubation at the end of the operation in the PA group. In the EA group. 25 μg of fentanyl+0.125% of bupivacaine 7.5 ml of bolus were delivered into the epidural space, while in the PA group 0.125% bupivacaine and 25 μg fentanyl were delivered into three levels (T5-T8) as single injections for a total amount of 15 ml. Visual analogue scale (VAS) scores for pain, and also hemodynamic values (mean arterial blood pressure, heart rate) and arterial blood gas values were recorded at postoperative 1, 2, 3, 5, 8, 12 and 24. hours. Results: There was no statistically significant difference between baseline and postoperative VAS scores between the groups and when VAS measurements were compared according to the follow-up periods in both groups, there was no significant difference in the first three hours in both the epidural and paravertebral groups (p>0,05). There were no side effects or complications in both groups (p>0,05). Conclusion: Paravertebral block may be a good alternative to the epidural block because of ease of application, low side effect profile and complication rates and similar pain control.