Araştırma Makalesi
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Akciğer rezeksiyonu yapılan hastaların postoperatif taburculuk süresini etkileyen ağrı skoru ve diğer faktörler: retrospektif çalışma

Yıl 2022, , 44 - 49, 24.03.2022
https://doi.org/10.47582/jompac.1070406

Öz

Amaç: Birçok faktör hastaların cerrahi sonrası hastane yatış sürelerini etkilemekle birlikte bunlardan en önemlisi postoperatif ağrıdır. Bu çalışmamızdaki birincil amacımız torakotomi ile akciğer rezeksiyonu yapılan hastaların postoperatif taburculuk süresi ile postoperatif ilk 24 saatlik vizuel analog skala (VAS) ağrı skorları arasındaki ilişkiyi araştırmaktır. İkincil olarak bu hastalarda taburculuk gününü, VAS skorları ve göğüs tüpü çekilme zamanını etkileyen parametreleri tespit etmektir.
Gereç ve Yöntem: Çalışmamız, üçüncü basamak göğüs hastalıkları ve göğüs cerrahisi merkezi olan hastanemizde Şubat 2021 ve Ağustos 2021 tarihleri arasında elektif olarak göğüs cerrahisi ameliyatı olan hastalar postoperatif olarak incelenmiştir. 18-75 yaş arası, ASA I-II-III risk grubunda olan, vücut kitle indeksi (VKİ) 18,5-35 kg/m2 aralığında olan, torakotomi ile akciğer malignitesi sebebiyle rezeksiyon uygulanmış hastalar çalışmamıza dâhil edilmiştir. Hastaların anestezi kayıtlarından ve dosyalarından yandaş hastalıklar, tanılar, yapılan ameliyat, ameliyat tipi, ameliyat süresi, intraoperatif komplikasyonlar, intraoperatif kan ürünü transfüzyonu öyküsü, postoperatif gelişmiş komplikasyonlar, postoperatif 24 saatlik VAS skorları, yatış süreleri, ve göğüs tüpü kalış süreleri gibi veriler kaydedilmiştir.
Bulgular: Şubat 2021-Ağustos 2021 tarihleri arasında genel anestezi altında elektif torakotomi ve akciğer rezeksiyonu yapılan toplam 104 hasta çalışmaya dahil edildi. Taburcu olma süresi ile göğüs tüpü çekilme süresi arasında pozitif ve istatistiksel olarak anlamlı bir ilişki bulundu (p < 0,001). Taburculuk süreleri ile VAS skorları arasında istatistiksel olarak anlamlı bir ilişki bulunamadı (p=0,553). VAS skorları ile göğüs tüpü çekilme zamanı arasında istatistiksel olarak anlamlı bir ilişki de bulunamadı. Taburculuk günü ile yaş (p=0,027) ve taburculuk günü ile operasyon süresi (p < 0,001) arasında düşük derecede pozitif yönlü istatistiksel olarak anlamlı korelasyon bulundu. Taburculuk günü ile VKİ arasında düşük derecede negatif yönlü istatistiksel olarak anlamlı bir korelasyon bulundu (p=0,017).
Sonuç: Göğüs tüpü çekilme zamanının uzaması taburculuk süresinin uzaması ile doğrudan ilişkili iken, VAS skorları ile taburculuk süresi ve göğüs tüpü çekilme zamanı arasında anlamlı bir korelasyon gözlenmemiştir. Ayrıca, yaş ve operasyon süresi de taburculuk süresinin uzaması ile ilişkili bulunmuştur. Bu konuda yapılacak prospektif kapsamlı çalışmalar göğüs cerrahisi sonrası taburculuk süresini etkileyen faktörlerin açığa kavuşturulmasında faydalı olacaktır.

Kaynakça

  • Sun K, Liu D, Chen J, et al. Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery: A retrospective study. Sci Rep. 2020; 10: 795.
  • Marshall K, McLaughlin K. Pain Management in Thoracic Surgery. Thorac Surg Clin. 2020; 30: 339-46.
  • Liu X, Song T, Xu HY, Chen X, Yin P, Zhang J. The serratus anterior plane block for analgesia after thoracic surgery: A meta-analysis of randomized controlled tri. Medicine. 2020; 99: e20286.
  • Razi SS, Stephens-McDonnough JA, Haq S, et al. Significant reduction of postoperative pain and opioid analgesics requirement with an Enhanced Recovery After Thoracic Surgery protocol. J Thorac Cardiovasc Surg. 2021; 161: 1689-701.
  • Zengin M, Baldemir R, Ulger G, Sazak H, Alagoz A. Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery. Cureus. 2021; 13: e15614-e.
  • Luketich JD, Land SR, Sullivan EA, et al. Thoracic Epidural Versus Intercostal Nerve Catheter Plus Patient-Controlled Analgesia: A Randomized Study. Ann Thorac Surg. 2005; 79: 1845-50.
  • Aydın G, Gençay I, Çolak S, Günal N, Özpolat B. Toraks cerrahisinde ultrasonografi eşliğinde yapılan preemptif torakal paravertebral bloğun etkinliği. Turk J Clin Lab. 2017; 8: 160-7.
  • Nagaraja PS, Ragavendran S, Singh NG, et al. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth. 2018; 21: 323-7.
  • Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012; 116: 248-73.
  • Zengin M, Baldemir R, Ülger G, Sazak H, Alagöz A. Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy. Anatolian Curr Med J. 2022; 4: 70-5.
  • Khalil AE, Abdallah NM, Bashandy GM, Kaddah TAH. Ultrasound-Guided Serratus Anterior Plane Block Versus Thoracic Epidural Analgesia for Thoracotomy Pain. J Cardiothorac Vasc Anesth. 2017; 31: 152-8.
  • Miniksar ÖH, Katar MK. Acute postoperative pain and opioid consumption after laparoscopic cholecystectomy is associated with body mass index: a retrospective observational single-center study. J Health Sci Med. 2022; 5: 1-6.
  • Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001; 90: 261-9.
  • Kara KA, Caner T. Comparison of pain in the early post-operative period using VAS score in patients after cardiac surgery who had minimally invasive incisions vs. full median sternotomy. Ann Ital Chir. 2019; 90: 3-9.
  • Markham T, Wegner R, Hernandez N, et al. Assessment of a multimodal analgesia protocol to allow the implementation of enhanced recovery after cardiac surgery: Retrospective analysis of patient outcomes. J Clin Anesth. 2019; 54: 76-80.
  • Güven BB, Ertürk T, Ersoy A. Postoperative analgesic effectiveness of bilateral erector spinae plane block for adult cardiac surgery: a randomized controlled trial. J Health Sci Med. 2022; 5: 150-5.
  • Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019; 55: 91-115.
  • Asban A, Xie R, Abraham P, Kirklin JK, Donahue J, Wei B. Reasons for extended length of stay following chest tube removal in general thoracic surgical patients. J Thorac Dis. 2020; 12: 5700-8.
  • Cerfolio RJ, Bryant AS, Skylizard L, Minnich DJ. Optimal technique for the removal of chest tubes after pulmonary resection. J Thorac Cardiovasc Surg. 2013; 145: 1535-9.
  • Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg. 2008; 135: 269-73.
  • Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017; 118: 317-34.
  • Canet J, Gallart L, Gomar C, et al. Prediction of Postoperative Pulmonary Complications in a Population-based Surgical Cohort. Anesthesiology. 2010; 113: 1338-50.

Pain score and other factors affecting the postoperative discharge time of patients who underwent lung resection: a retrospective study

Yıl 2022, , 44 - 49, 24.03.2022
https://doi.org/10.47582/jompac.1070406

Öz

Aim: Many factors affect the hospitalization period of patients after surgery. One of the most important of them is postoperative pain. Our study aims to investigate the relationship between the postoperative discharge time and the postoperative 24-hour visual analog scale (VAS) pain scores of patients who underwent thoracotomy and lung resection. Additionally, we also want to identify the parameters that affect the day of discharge, VAS scores, and chest tube removal time of these patients.
Material and Method: Data of patients who underwent elective thoracic surgery between February 2021 and August 2021 in a tertiary chest disease and thoracic surgery center were analyzed patients aged between 18 and 75 years, in the ASA I-II-III risk group, with a body mass index (BMI) in the range of 18.5-35 kg/m2, who underwent thoracotomy and resection due to lung malignancy. Following data were extracted co-morbidities, diagnoses, performed surgery, type of surgery, duration of surgery, intraoperative complications, intraoperative blood product transfusion history, postoperative advanced complications, postoperative 24-hour VAS, length of stay, and length of chest tube stay.
Results: A total of 104 patients who underwent elective thoracotomy and lung resection under general anesthesia between February 2021 and August 2021 were included in the study. There was a positive and highly statistically significant correlation between discharge time and chest tube removal time (p < 0.001). There was no statistically significant correlation between discharge times and VAS scores (p=0.553). Additionally, there was no statistically significant correlation between VAS scores and chest tube removal time. Discharge time had a low positive and statistically significant correlation with age (p=0.027), and with the duration of the operation (p < 0.001). There was a low degree of negative statistically significant correlation between discharge day and BMI (p=0.017).
Conclusion: While the prolonged chest tube withdrawal time was directly related to the longer discharge time, the VAS scores have no significant correlation with the discharge time and the chest tube removal time. Additionally, age and operation time were also found to be associated with prolonged discharge time. Prospective comprehensive studies on this subject will be useful in clarifying the factors affecting the discharge time after thoracic surgery.

Kaynakça

  • Sun K, Liu D, Chen J, et al. Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery: A retrospective study. Sci Rep. 2020; 10: 795.
  • Marshall K, McLaughlin K. Pain Management in Thoracic Surgery. Thorac Surg Clin. 2020; 30: 339-46.
  • Liu X, Song T, Xu HY, Chen X, Yin P, Zhang J. The serratus anterior plane block for analgesia after thoracic surgery: A meta-analysis of randomized controlled tri. Medicine. 2020; 99: e20286.
  • Razi SS, Stephens-McDonnough JA, Haq S, et al. Significant reduction of postoperative pain and opioid analgesics requirement with an Enhanced Recovery After Thoracic Surgery protocol. J Thorac Cardiovasc Surg. 2021; 161: 1689-701.
  • Zengin M, Baldemir R, Ulger G, Sazak H, Alagoz A. Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery. Cureus. 2021; 13: e15614-e.
  • Luketich JD, Land SR, Sullivan EA, et al. Thoracic Epidural Versus Intercostal Nerve Catheter Plus Patient-Controlled Analgesia: A Randomized Study. Ann Thorac Surg. 2005; 79: 1845-50.
  • Aydın G, Gençay I, Çolak S, Günal N, Özpolat B. Toraks cerrahisinde ultrasonografi eşliğinde yapılan preemptif torakal paravertebral bloğun etkinliği. Turk J Clin Lab. 2017; 8: 160-7.
  • Nagaraja PS, Ragavendran S, Singh NG, et al. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth. 2018; 21: 323-7.
  • Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012; 116: 248-73.
  • Zengin M, Baldemir R, Ülger G, Sazak H, Alagöz A. Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy. Anatolian Curr Med J. 2022; 4: 70-5.
  • Khalil AE, Abdallah NM, Bashandy GM, Kaddah TAH. Ultrasound-Guided Serratus Anterior Plane Block Versus Thoracic Epidural Analgesia for Thoracotomy Pain. J Cardiothorac Vasc Anesth. 2017; 31: 152-8.
  • Miniksar ÖH, Katar MK. Acute postoperative pain and opioid consumption after laparoscopic cholecystectomy is associated with body mass index: a retrospective observational single-center study. J Health Sci Med. 2022; 5: 1-6.
  • Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001; 90: 261-9.
  • Kara KA, Caner T. Comparison of pain in the early post-operative period using VAS score in patients after cardiac surgery who had minimally invasive incisions vs. full median sternotomy. Ann Ital Chir. 2019; 90: 3-9.
  • Markham T, Wegner R, Hernandez N, et al. Assessment of a multimodal analgesia protocol to allow the implementation of enhanced recovery after cardiac surgery: Retrospective analysis of patient outcomes. J Clin Anesth. 2019; 54: 76-80.
  • Güven BB, Ertürk T, Ersoy A. Postoperative analgesic effectiveness of bilateral erector spinae plane block for adult cardiac surgery: a randomized controlled trial. J Health Sci Med. 2022; 5: 150-5.
  • Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019; 55: 91-115.
  • Asban A, Xie R, Abraham P, Kirklin JK, Donahue J, Wei B. Reasons for extended length of stay following chest tube removal in general thoracic surgical patients. J Thorac Dis. 2020; 12: 5700-8.
  • Cerfolio RJ, Bryant AS, Skylizard L, Minnich DJ. Optimal technique for the removal of chest tubes after pulmonary resection. J Thorac Cardiovasc Surg. 2013; 145: 1535-9.
  • Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg. 2008; 135: 269-73.
  • Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017; 118: 317-34.
  • Canet J, Gallart L, Gomar C, et al. Prediction of Postoperative Pulmonary Complications in a Population-based Surgical Cohort. Anesthesiology. 2010; 113: 1338-50.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Research Articles [en] Araştırma Makaleleri [tr]
Yazarlar

Gülay Ülger

Musa Zengin

Funda İncekara 0000-0003-1788-4191

Ramazan Baldemir 0000-0003-3661-4277

Hilal Sazak

Ali Alagöz

Yayımlanma Tarihi 24 Mart 2022
Yayımlandığı Sayı Yıl 2022

Kaynak Göster

AMA Ülger G, Zengin M, İncekara F, Baldemir R, Sazak H, Alagöz A. Pain score and other factors affecting the postoperative discharge time of patients who underwent lung resection: a retrospective study. J Med Palliat Care / JOMPAC / Jompac. Mart 2022;3(1):44-49. doi:10.47582/jompac.1070406

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