Torakotomi Sonrası Yara Yerine Lokal Anestezik İnfüzyonunun Postoperatif Ağrıya Etkisinin Retrospektif Olarak İncelenmesi
Özet
Thoracotomy is one of the most painful surgical procedures. Surgical incision, pulmonary parenchymal, costal and pleural injury, intercostal neural damage, inflammation of thoracic wall structures in incision neighborhood or placement of chest tube may contribute to this pain. Post thoracotomy pain affects pulmonary functions and leads to morbidities unless treated effectively. Opioid and non-opioid analgesics, epidural infusion, patient-controlled analgesia (PCA), intercostal nerve blockade and local anesthetic wound infusions could be used in postoperative pain management after thoracotomy. The purpose of the study is to compare the pain scores, opioid consumptions and opioid side effects, additional analgesic requirements, duration of ICU and hospital stay, arterial blood gas analysis of patients in postoperative 48 hours after thoracotomy. A total of 60 patients, of whom 28 received i.v. morphine PCA and 32 received morphine PCA and local anesthetic wound infusion, were included in the study. Majority of the patients were male (%65) and average age is 57. Numerical rating scale (NRS) is used to evaluate the pain of the patients. The NRS score at rest and during coughing was significantly lower in the group receiving local anesthetic wound infusion (p<0,05). Additional analgesic requirements (pethidine) and number of morphine boluses were also lower in this group. Opioid side effects, duration of ICU stay, arterial blood gas analysis of patients were similar among groups. Although the duration of hospital stay of patients in group LA was not statistically different there was this 1,5 day of difference between groups which we assume to be clinically meaningful. As a result we can conclude that, local anesthetic wound infusion could be effectively used in postthoracotomy pain management.
