Torakotomi sonrası ağrı kontrolünde torakotomi kapama tekniklerinden sinir disseksiyonu sonrası intra-interkostal bağlama ile periost yaklaştırma tekniklerinin karşılaştırılması
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Date
2011
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Uludağ Üniversitesi
Abstract
Postoperatif akut ağrı toraks cerrahisi sonrasında önemli bir sorun olarak kabul edilmektedir. Bu klinik çalışmada torakotomi kapama tekniklerinden periost yaklaştırma ve sinir disseksiyonu sonrası intra-interkostal bağlama yapılan hastaların ağrı düzeylerini karşılaştırmayı amaçladık.Etik kurul onayını takiben, Kasım 2008-Temmuz 2011 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Hastanesi Göğüs Cerrahisi Ana Bilim Dalı'nda bu torakotomi kapama yöntemlerinden biri uygulanan 60 hasta çalışmaya dahil edildi. İntra-interkostal bağlama yapılan 30 hasta ve periost yaklaştırma tekniği ile kapama yapılan 30 hasta prospektif-randomize olarak incelendi.Hastaların hepsine torakal epidural kateterden bupivakain ve fentanil karışımı hasta kontrollü analjezi (PCA) sistemiyle verildi. Hastaların ağrı düzeyinin değerlendirilmesinde 2, 4, 8, 16, 24 ve 48'inci saatlerde PCA tüketim düzeyi, gözlemci sözel değerlendirme skalası (OVRS), istirahat ve öksürme sırasındaki görsel analog skorları (VASİ ve VASÖ) ve Ramsey sedasyon skoru kaydedildi.Periost yaklaştırma yapılan hastaların 2. saat PCA tüketimi, 2, 24 ve 48'inci saatlerdeki VASİ ve VASÖ skorları, 24'üncü saat OVRS skorları intra-interkostal bağlama yapılan hastalara oranla istatistiksel olarak anlamlı düşük bulundu.Sonuç olarak, torakotomi sonrası hastaların ağrı kontrolünde periost yaklaştırmanın sinir disseksiyonu sonrası intra-interkostal kapamaya göre daha yararlı bir teknik olduğunu gösterdik. Bu yöntemin kullanılması torakotomi hastalarının daha konforlu bir postoperatif dönem geçirmelerini sağlayabilir.
Early postoperative pain after thoracotomy is one of the important paramenters that results in increased of morbidity. The aim of this prospective randomized clinical study was to compare pain control of patients undergoing one of thoracotomy closure techniques; either periostal closure or intra-intercostal sutures with nerve dissection. Between November 2008 and July 2011, following the Ethical Committee approval of Uludağ University, Medical Faculty Hospital, sixty patients undergoing one of these thoracotomy closure techniques were prospectively randomized into two groups. Thirty patients were included in intra-intercostal sutures with nerve dissection group and thirty patients in periostal closure group. Epidural analgesia with patient controlled analgesia system (PCA), combination of bupivacain and fentanyl, was routinely used in all patients. Consumption doses of PCA, observer verbal ranking scale for pain (OVRS) score, visual analogue score at rest (VASR) / at caugh (VASC) and Ramsey sedation score were recorded in all patients at 2, 4, 8, 16, 24 and 48 hours after surgey. Two hours PCA consumption, VASR/VASC scores at 2, 24 and 48 hours and OVRS scores at 24 hours in patients undergoing periostal closure technique were significantly lower than patients with intra-intercostal sutures with nerve dissection. In conclusion, we have proven that the periostal closure is superior to intra-intercostal suture technique with nerve dissection in the postoperative pain control. This technique may increase patients comphort and reduce related morbidity in the early as well as late postoperative period.
Early postoperative pain after thoracotomy is one of the important paramenters that results in increased of morbidity. The aim of this prospective randomized clinical study was to compare pain control of patients undergoing one of thoracotomy closure techniques; either periostal closure or intra-intercostal sutures with nerve dissection. Between November 2008 and July 2011, following the Ethical Committee approval of Uludağ University, Medical Faculty Hospital, sixty patients undergoing one of these thoracotomy closure techniques were prospectively randomized into two groups. Thirty patients were included in intra-intercostal sutures with nerve dissection group and thirty patients in periostal closure group. Epidural analgesia with patient controlled analgesia system (PCA), combination of bupivacain and fentanyl, was routinely used in all patients. Consumption doses of PCA, observer verbal ranking scale for pain (OVRS) score, visual analogue score at rest (VASR) / at caugh (VASC) and Ramsey sedation score were recorded in all patients at 2, 4, 8, 16, 24 and 48 hours after surgey. Two hours PCA consumption, VASR/VASC scores at 2, 24 and 48 hours and OVRS scores at 24 hours in patients undergoing periostal closure technique were significantly lower than patients with intra-intercostal sutures with nerve dissection. In conclusion, we have proven that the periostal closure is superior to intra-intercostal suture technique with nerve dissection in the postoperative pain control. This technique may increase patients comphort and reduce related morbidity in the early as well as late postoperative period.
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Keywords
Torakotomi, Postoperatif ağrı, İntra-interkostal sütür, Periost yaklaştırma, Thoracotomy, Postoperative pain, Intra-intercostal sutures, Periostal closure
Citation
Aygün, M. (2011). Torakotomi sonrası ağrı kontrolünde torakotomi kapama tekniklerinden sinir disseksiyonu sonrası intra-interkostal bağlama ile periost yaklaştırma tekniklerinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.