Torakotomi Sonrası Ağrı Yönetiminde Üç Farklı İntratekal Morfin Dozunun Karşılaştırılması: Retrospektif Bir Analiz

Abstract

Torakotomi sonrası etkili postoperatif ağrı kontrolü, hasta konforunun artırılması, solunum fonksiyonunun desteklenmesi ve pulmoner komplikasyonların azaltılması açısından kritik öneme sahiptir. İntratekal (İT) morfin, multimodal analjezi protokollerinin sık kullanılan bir bileşeni olmakla birlikte, en uygun doz konusunda belirsizlik sürmektedir. Bu retrospektif gözlemsel çalışma, 1 Ocak 2019–1 Temmuz 2020 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi’nde torakotomi geçiren 60 hastada intravenöz hasta kontrollü analjezi (PCA) ile birlikte uygulanan farklı İT morfin dozlarının analjezik etkinliğini ve yan etki profilini değerlendirmiştir. Hastalar İT morfin uygulanmayan kontrol grubuna veya 3 μg/kg, 5 μg/kg ya da 8 μg/kg İT morfin uygulanan gruplara ayrılmıştır. Postoperatif ağrı skorları, opioid tüketimi, ek analjezik gereksinimi ve yan etkiler gruplar arasında karşılaştırılmıştır. Daha yüksek İT morfin dozları daha düşük ağrı skorları ve azaltılmış opioid gereksinimi ile ilişkili bulunmuş; ancak bu analjezik fayda, bulantı, kusma, pruritus ve kabızlık gibi yan etkilerde doza bağlı artışla birlikte ortaya çıkmıştır. Genel olarak 5 μg/kg dozunun, 48 saate kadar etkili analjezi sağlarken yan etki sıklığını sınırlayan en dengeli seçenek olduğu görülmüştür. Sonuç olarak, torakotomi sonrası postoperatif analjezi için 5 μg/kg İT morfin dozu, 48 saate kadar süren ağrı kontrolü ve düşük yan etki profili ile etkinlik ve güvenlik açısından en uygun seçenek olarak görünmektedir.

Keywords

• intratekal morfin
• torakotomi
• postoperatif analjezi
• hasta kontrollü analjezi
• yan etkiler

Comparison of three different intrathecal morphine doses in post-thoracotomy pain management: A retrospective analysis

Abstract

Effective postoperative pain control following thoracotomy is essential to optimise patient comfort, support respiratory function, and reduce pulmonary complications. Intrathecal (IT) morphine is frequently incorporated into multimodal analgesic strategies, yet its optimal dose remains uncertain. This retrospective observational study evaluated the analgesic efficacy and side-effect profile of varying IT morphine doses combined with intravenous patient-controlled analgesia (PCA) in 60 patients who underwent thoracotomy at Ondokuz Mayıs University Medical Faculty Hospital between 1 January 2019 and 1 July 2020. Patients received either no IT morphine (control) or IT morphine at doses of 3 μg/kg, 5 μg/kg, or 8 μg/kg. Postoperative pain scores, opioid consumption, additional analgesic requirements, and adverse effects were compared across groups. Higher IT morphine doses were associated with lower pain scores and reduced opioid requirements; however, these benefits were accompanied by a dose-dependent increase in side effects such as nausea, vomiting, pruritus, and constipation. Overall, the 5 μg/kg dose appeared to offer the most favourable balance, providing effective analgesia for up to 48 hours while limiting adverse effects. IT morphine at a dose of 5 μg/kg therefore seems to represent the optimal balance of efficacy and safety for postoperative analgesia after thoracotomy, offering sustained pain relief for up to 48 hours with a low side-effect profile.

Keywords

• Intrathecal morphine
• thoracotomy
• postoperative analgesia
• patient-controlled analgesia
• adverse effects

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