The effect of ultrasonography guided preemptive paravertebral blocking in thoracic surgery

Abstract

Objective: Currently, thoracic paravertebral block (TPVB) is one of the regional anesthesia methods frequently used in the acute treatment of thoracotomy pain. In this clinical study, it was aimed to investigate the effects of TPVB on opioid drug consumption, postoperative pain, complications and patient satisfaction during surgery.

Material and Methods: Twenty-five patients aged 18-65 years who underwent elective thoracic surgery were included in the study. Thoracotomy (TH group) was performed in 14 patients and videothoracoscopy (VATS group) was performed in 11 patients. Additional opioid drug requirements and the operation time of the groups were recorded during the surgery. Furthermore, Visual Analogue Scale (VAS) values ​​at the 0-1-2-6-12-24 hours, nausea-vomiting, hypotension and other complications within 24 hours were recorded, postoperatively. In addition, "Patient Satisfaction Scale" (PSS) was applied in the postoperative period.

Results: The values of the amount of opioid drug use, VAS score, PSS score, postoperative complication type were not different between thoracotomy and thoracoscopy patients in the study. However, the duration of the operation was found to be shorter in the TH group. On the other hand, a negative correlation was found between all VAS score values ​​and the PSS scores.

Conclusion: At the end of this study, it was thought that TPVB procedure could be a good option for reduction of postoperative pain, patient comfort and reduction of complications in patients who will undergo either thoracotomy or videothoracoscopy.

 

Keywords

• Thoracal paravertebral blok,pain,thoracotomy,thoracoscopy

Toraks cerrahisinde ultrasonografi eşliğinde yapılan preemptif torakal paravertebral bloğun etkinliği

Abstract

Amaç: Günümüzde torakotomi ağrısının akut tedavisinde sık kullanılan bölgesel anestezi yöntemlerinden biri torakal paravertebral blok (TPVB) uygulamasıdır. Bu klinik çalışmada, toraks cerrahisinde ultrasonografi eşliğinde “preemptif” yapılan TPVB’un, ameliyat esnasında opioid ilaç tüketimi, ameliyat sonrası ağrı, komplikasyon ve hasta memnuniyeti üzerine etkilerini araştırması amaçlandı.

Gereç ve Yöntemler: Elektif toraks cerrahisi geçirecek 18-65 yaş arası 25 hasta çalışmaya alındı ve 14 hastaya torakotomi (TKT grubu), 11 hastaya torakoskopi (TKS grubu) uygulandı. Grupların operasyon süreleri ve ameliyat esnasında ek opioid ilaç ihtiyaçları kaydedildi.  Ameliyat sonrası dönemde ağrıya yönelik 0-1-2-6-12-24. saatlerdeki “Görsel Analog Ölçeği” (VAS) değerleri, 24 saat içindeki bulantı-kusma, hipotansiyon ve diğer komplikasyonlar kaydedildi. Ayrıca hastalara ameliyat sonrası dönemde “Hasta Memnuniyet Ölçeği” (HMÖ) uygulandı.

Bulgular: Çalışmada torakotomi ile videotorakoskopi uygulanan hastalar arasında opioid ilaç kullanımı miktarı, VAS puanı, HMÖ puanı, ameliyat sonrası komplikasyon türü bakımından anlamlı bir fark bulunmadığı saptandı. Ancak operasyon süresi bakımından TKS grubunda sürenin daha kısa olduğu bulundu. Diğer yandan tüm VAS puanı değerleri ile HMÖ sonuçları arasında da negatif korelasyon tespit edildi.

Sonuçlar: Çalışma sonunda TPVB işleminin gerek torakotomi gerekse videotorakoskopi yapılacak hastalarda ameliyat sonrası ağrının azaltılmasında, hasta konforunun sağlanmasında ve komplikasyonların azaltılmasında oldukça iyi bir seçenek olabileceği düşünüldü.

 

Keywords

• Torakal paravertebral blok,ağrı,torakotomi,videotorakoskopi

References

1. 1. Muehling BM, Halter GL, Schelzig H, et al. Reduction of postoperative pulmonary complications after lung surgery using a fast track Cclinical pathway. Eur J Cardiothorac Surg 2008; 34: 174-80.
2. 2. Davis R, Myles P, Graham J. A comparison of the analgesic efficacy and side-effects of paravertebral block vs epidural block for thoracotomy. A systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 2006; 96: 418.
3. 3. Pluijms W, Steegers M, Verhagen A, Scheffer G, Wilder‐Smith O. Chronic post-thoracotomy pain: a retrospective study. Acta AnaesthesiolScand 2006; 50: 804-8.
4. 4. Kotze A, Scally A, Howell S. Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression. Br J Anaesth 2009; 103: 626-36.
5. 5. Romero A, Garcia JEL, Joshi GP. T The state of the art in preventing postthoracotomy pain. Semina Thorac Cardiovasc Surg 2013; 2013: 116-24.
6. 6. Yeung JH, Gates S, Naidu BV, Wilson MJ, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016; 2: CD009121.
7. 7. Komatsu T, Sowa T, Kino A, Fujinaga T. The importance of pleural integrity for effective and safe thoracic paravertebral block: a retrospective comparative study on postoperative pain control by paravertebral block. Interact Cardiovasc Thorac Surg. 2015; 20: 296-9.
8. 8. Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001; 95: 771-80.

9. 9. Sabanathan S, Smith PJB, Pradhan GN, Hashimi H, Eng J-B, Mearns AJ. Continuous intercostal nerve block for pain relief after thoracotomy. Ann Thorac Surg 1995; 59: 1261-3.
10. 10. Ng A, Swanevelder J. Pain relief after thoracotomy: is epidural analgesia the optimal technique? Br J Anaesth 2007; 98: 159-62.
11. 11. Davies R, Myles P, Graham J. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials. Br J Anaesth 2006; 96: 418-26. Erratum in Br J Anaesth. 2007; 99: 768.
12. 12. Lönnqvist P, Mackenzie J, Soni A, Conacher I. Paravertebral blockade. Failure rate and complications. Anaesthesia 1995; 50: 813-5.
13. 13. Richardson J, Sabanathan S, Jones J, Shah R, Cheema S, Mearns A. A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses. Br J Anaesth 1999; 83:387-92.
14. 14. Naja Z, Lönnqvist PA. Somatic paravertebral nerve blockade. Incidence of failed block and complications. Anaesthesia 2001; 56: 1181-201.
15. 15. Komatsu T, Kino A, Inoue M, Sowa T, Takahashi K, Fujinaga T. Paravertebral block for video-assisted thoracoscopic surgery: analgesic effectiveness and role in fast-track surgery. Int J Surg 2014; 12: 936-9.
16. 16. Komatsu T, Sowa T, Takahashi K, Fujinaga T. Paravertebral block as a promising analgesic modality for managing post-thoracotomy pain. Ann Thorac Cardiovasc Surg 2014; 20: 113-6.
17. 17. Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993; 56: 1285-9.
18. 18. Giudicelli R, Thomas P, Lonjon T, et al. Video-assisted minithoracotomy versus muscle-sparing thoracotomy for performing lobectomy. Ann Thorac Surg1994; 58: 712-8.
19. 19. Demmy TL, Curtis JJ. Minimally invasive lobectomy directed toward frail and high-risk patients: a case-control study. Ann Thorac Surg 1999; 68: 194-200.
20. 20. Yim AP. VATS major pulmonary resection revisited--controversies, techniques, and results. Ann Thorac Surg 2002; 74: 615-23.
21. 21. Reading AE. Testing pain mechanisms in persons in pain. In, Wall PD, Melzack R, eds., Textbook of Pain, Edinburgh, Churchill Livingstone, 1984, pp 195-204.