The effect of ultrasonography guided preemptive paravertebral blocking in thoracic surgery

Öz

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.

 

Anahtar Kelimeler

• Thoracal paravertebral blok,pain,thoracotomy,thoracoscopy

Toraks cerrahisinde ultrasonografi eşliğinde yapılan preemptif torakal paravertebral bloğun etkinliği

Öz

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.

 

Anahtar Kelimeler

• Torakal paravertebral blok,ağrı,torakotomi,videotorakoskopi

Kaynakça

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