primerjava paravertebralne in epiduralne analgezije
Povzetek
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
Ključne besede
anesteziologija;Kirurgija;Disertacije;Torakotomija;Zapleti;Bolečine;Zdravljenje bolečin;Analgezija;
Podatki
Jezik: |
Slovenski jezik |
Leto izida: |
2022 |
Tipologija: |
2.08 - Doktorska disertacija |
Organizacija: |
UL MF - Medicinska fakulteta |
Založnik: |
[S. Kozar] |
UDK: |
616-089:615.212(043.3) |
COBISS: |
130248451
|
Št. ogledov: |
170 |
Št. prenosov: |
25 |
Ocena: |
0 (0 glasov) |
Metapodatki: |
|
Ostali podatki
Sekundarni jezik: |
Angleški jezik |
Sekundarni naslov: |
Development of post-thoracotomy syndrome in patients after anterolateral thoracotomy |
Sekundarni povzetek: |
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 |
Sekundarne ključne besede: |
Kirurgija;Bolečina;Analgezija;Thoracotomy;Thoracic surgical procedures;Pain;Analgesia;Methods;Analgesia, epidural;Analgetics;Administration and dosage;Patients;Postoperative period;Quality of life;Surveys and questionnaires;Prospective studies;Data analysis;Statistics and numerical data;Torakotomija;Torakalni kirurški postopki;Metode;Epiduralna analgezija;Analgetiki;Dajanje in doziranje;Bolniki;Pooperativno obdobje;Kvaliteta življenja;Ankete in vprašalniki;Prospektivne študije;Analiza podatkov;Statistika;Univerzitetna in visokošolska dela; |
Vrsta dela (COBISS): |
Doktorska disertacija |
Študijski program: |
0 |
Konec prepovedi (OpenAIRE): |
1970-01-01 |
Komentar na gradivo: |
Univ. v Ljubljani, Medicinska fak. |
Strani: |
[6], 49 f. |
ID: |
15738838 |