Postoperative analgesia management in thoracic surgery: our two-year experience

Öz

Aim: BThoracic surgery is one of the most painful surgical procedures. Pain after thoracic surgery can cause respiratory complications, such as atelectasis and pneumonia; longer hospital stays; reduced quality of life and chronic persistent postoperative pain. We aimed to retrospectively analyze our postoperative analgesia practices and results in patients undergoing thoracic surgery through anesthesia and pain follow-up forms. Material and Methods: In our study, we retrospectively scanned 563 patients who underwent thoracic surgery and were followed up with postoperative analgesia between June 2019 and June 2021. Postoperative analgesia method applied to the patients, visual analog scale (VAS) scores, additional applied analgesia and complications were evaluated. Results: 28.42% of the patients were women. The most common surgery was lung resections with a rate of 64.30%. Patient-controlled analgesia (PCA) was administered thoracic paravertebral block (TPVB) + intravenously in 458 (81.35%) patients and by epidural route in 105 (18.65%) patients. The VAS scores were 4.1 at the postoperative 1st hour, 1.9 at 24th hour and 1.1 at 48th hour for TPVB + intravenous PCA. For epidural PCA, VAS scores were 3.9 at the first hour, 1.9 at 24th hour, and 1.4 at 48th hour. Side-effect rates were evaluated as 6.99% in patients who underwent TPVB + intravenous PCA and 37.14% in patients who underwent epidural PCA. Conclusion: Malignancy surgery is frequently performed in our clinic. In these patients, similar analgesic results were obtained for the combination of TPVB and intravenous analgesia, and thoracic epidural analgesia (TEA) administered with elastomeric infusion. Although the complication rates were lower in the group treated with TPVB and intravenous analgesia, they were found to be within clinically acceptable limits in both groups. We think that the choosing analgesia protocols and algorithms according to the experience of the clinicians and the surgical procedure will provide effective analgesia

Anahtar Kelimeler

• toraks cerrahisi
• postoperatif ağrı
• hasta kontrollü analjezi yönetimi
• postoperatif ağrıhasta kontrollü analjezi yönetimi

Toraks cerrahisinde postoperatif analjezi yönetimi: iki yıllık deneyimlerimiz

Öz

Amaç: Toraks cerrahisi, en ağrılı cerrahi prosedürlerden biri olarak kabul görmektedir. Toraks cerrahisinden sonra gelişen ağrı; atelektazi ve pnömoni gibi solunum komplikasyonları, daha uzun hastane yatış süreleri, yaşam kalitesinin azalması ve ağrının postoperatif kronik ağrıya dönüşmesi gibi olumsuz sonuçlara neden olabilir. Toraks cerrahisi geçiren hastalarda postoperatif analjezi uygulamalarımızı ve sonuçlarını retrospektif olarak incelemeyi amaçladık. Gereç ve Yöntemler: Çalışmamız, Haziran 2019 ve Haziran 2021 tarihleri arasında toraks cerrahisi geçiren ve postoperatif analjezi takibi yapılan 563 hastaya ait verinin retrospektif olarak incelenmesi ile yapıldı. Hastalara uygulanan postoperatif analjezi yöntemi, vizüel analog skala (VAS) skorları, uygulanan ek analjezi tedavisi ve gelişen komplikasyonlar değerlendirildi. Bulgular: Hastaların %28,42’si kadın olup, en sık uygulanan cerrahi %64,30 oranla akciğer rezeksiyonlarıydı. Hasta kontrollü analjezi (HKA) , 458 (%81,35) hastada intravenöz, 105 (%18,65) hastada epidural yol ile uygulanmıştı. Intravenöz HKA için VAS skor ortalamaları postoperatif 1. saatte 4,1, 24. saatte 2,0 ve 48. saatte 1,2 idi. Epidural HKA için ise 1.saatte 3,9, 24.saatte 2,0 ve 48.saatte 1,4 olarak değerlendirilmiştir. Intravenöz HKA uygulanan hastalarda yan etki oranları %6,99, epidural HKA uygulanan hastalarda %37,14 olarak değerlendirilmiştir. Sonuç: Kliniğimizde sıklıkla malignite cerrahisi yapılmaktadır. Bu hastalarda torasik paravertebral blok (TPVB) ve intravenöz analjezi kombinasyonu ile elastomerik infüzyonla uygulanan torasik epidural analjezide benzer analjezik sonuçlar elde edilmiştir. Komplikasyon oranları TPVB ve intravenöz analjezi kombinasyonu yapılan grupta daha az olmakla birlikte her iki grupta da klinik olarak kabul edilebilir sınırlarda olarak bulunmuştur. Analjezi protokollerinin ve algoritmaların klinisyenlerin deneyimi ve uygulanan cerrahi işleme göre belirlenmesinin etkin analjezi sağlayacağını düşünmekteyiz.

Anahtar Kelimeler

• toraks cerrahisi
• postoperatif ağrı
• hasta kontrollü analjezi yönetimi

Kaynakça

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