Razvoj posttorakotomijskega bolečinskega sindroma pri bolnikih po anterolateralni torakotomiji – primerjava paravertebralne in epiduralne analgezije

Kozar, Sergeja (author), Novak Jankovič, Vesna (mentor)

IZVLEČEK NAMEN Posttorakomijski bolečinski sindrom (PTBS) je posledica torakalnega kirurškega posega, ki se pojavi in vztraja najmanj dva meseca po njem ter pomembno vpliva na kakovost življenja bolnika. Namen raziskave je bila primerjava dveh metod regionalne analgezije pri razvoju PTBS in ugotoviti kakovost življenja pri bolnikih v obeh skupinah. BOLNIKI in METODE V prospektivno randomizirano raziskavo smo vključili 50 bolnikov, pri katerih je bila indicirana anterolateralna torakotomija. Bolnike smo naključno razporedili v dve skupini; prva skupina je prejemala analgetično mešanico po paravertebralnem katetru (skupina TPA; 25 bolnikov), druga pa po epiduralnem katetru (skupina TEA; 25 bolnikov). Pred indukcijo anestezije in kirurškim rezom so bolniki po katetru prejeli 60 mcg/kg morfina in lokalni anestetik (skupina TPA 0.5% bupivakain po modificirani shemi, skupina TEA 0.125% bupivakain po Bromage-jevi shemi). Po opravljenem operativnem posegu so bolniki prejemali analgetično mešanico po katetru; v skupini TPA je bila mešanica sestavljena iz 10 mg morfina, 250 mg bupivakaina in 0.15 mg klonidina/100 ml fiziološke raztopine; v skupini TEA pa iz 10 mg morfina, 250 mg bupivakaina in 0.15 mg klonidina/100 ml fiziološke raztopine. Hitrost infuzije v obeh skupinah je bila enaka – 0.05 ml/kg/h pri obeh skupinah. Po treh mesecih smo ocenili incidenco PTBS in kakovost življenja po operativnem posegu, za kar smo uporabili Kratek vprašalnik o bolečini. REZULTATI PTBS je opisalo 52,25% bolnikov (skupina TPA 47, 37%; skupina TEA 57, 14%). Pri oceni PTBS ni bilo statistično pomembnih razlik v obeh skupinah; ravno tako ni bilo nobenih statistično pomembnih razlik v obeh skupinah glede kakovosti življenja. ZAKLJUČKI Obe preiskovani metodi – aplikacija analgetične mešanice po paravertebralnem in po epiduralnem katetru sta primerljivi pri razvoju posttorakotomijskega bolečinskega sindroma; ravno tako sta primerljivi glede kakovosti življenja po operativnem posegu. KLJUČNE BESEDE: Posttorakotomijski bolečinski sindrom, anterolateralna torakotomija, paravertebralni kateter, epiduralni kateter, kakovost življenja

• Language: Slovenian
• Keywords: Posttorakotomijski bolečinski sindrom, anterolateralna torakotomija, paravertebralni kateter, epiduralni kateter, kakovost življenja
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2022
• PID: 20.500.12556/RUL-137668
• COBISS.SI-ID: 130248451
• Publication date in RUL: 25.06.2022

Secondary language

• Language: English
• Title: Development of postthoracotomy pain syndrome in patients undergoing anterolateral thoracotomy – a comparision of paravertebral and epidural analgesia

Abstract

ABSTRACT OBJECTIVE Post-thoracotomy pain syndrome (PTPS) is one of the major concerns following the thoracic surgery; it is defined as a persistent pain two months after the procedure and affects quality of life. Our study was aimed to compare two methods of regional analgesia in development of this syndrome as well as establish the quality of life in both groups. PATIENTS and METHODS 50 patients undergoing thoracotomy were enrolled in the prospective randomised study. They were randomized to thoracic paravertebral cathether analgesia group (group TPA; 25 patients) and to thoracic epidural analgesia group (group TEA; 25 patients). Before induction of anaesthesia and start of the surgery patients in both groups received 60 mg/kg morphine and local anaesthetic (TEA group: 0.125% bupivacaine, TPA group: 0.5% bupivacaine according to Bromage scheme). After the procedure TEA group received a mixture, composed of morphine 10 mg, bupivacaine 125 mg and clonidine 0.15 mg/100 mL saline; the rate of infusion was 0.05 mL/kg/h. TPA group received another mixture, composed of morphine 10 mg, bupivacaine 250 mg and clonidine 0.15 mg/100 mL saline; the rate of infusion was the same as already noted above. Post-thoracotomy pain was assessed in three-month period after the surgery. The quality of life was evaluated with Brief Pain Inventory.   RESULTS Post-thoracotomy pain was experienced in 52, 25% of all the patients (TPA group 47, 37%, TEA group 57, 14%). No differences in assessment of post-thoracotomy pain were observed in TPA group as compared to TEA group. No differences in the quality of life were observed between two groups. CONCLUSION Both methods – thoracic paravertebral and epidural analgesia - are comparable in development of post-thoracotomy pain syndrome. The quality of life after procedure is comparable in both groups. KEY WORDS post-thoracotomy pain syndrome, anterolateral thoracotomy, paravertebral cathether, epidural cathether, quality of life

• Keywords: post-thoracotomy pain syndrome, anterolateral thoracotomy, paravertebral cathether, epidural cathether, quality of life