Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Timelog-Based Approach to Early Post-Thoracotomy Pain in Lung Cancer Surgery
Akciğer Kanseri Cerrahisinde Torakotomi Sonrası Erken Dönem Ağrıya Zaman Akışı Temelli Yaklaşım
Derya ÖZDEN OMAYGENÇa, Necati ÇITAKb, Özgür İŞGÖRÜCÜb, Zeynep Nilgün ULUKOLc, Gamze BABUR GÜLERd, Yunus AKSOYe, Cem Emrah KALAFATe, Mesut BUZd, Çağrı CEMALLERd, İbrahim Celalettin KOCATÜRKe
aClinic of Anesthesiology and Intensive Care, Kanuni Sultan Süleyman Training and Research Hospital,
bClinic of Thoracic Surgery, University of Health Sciences Bakırköy Sadi Konuk Training and Research Hospital, Clinics of
cAnesthesiology and Intensive Care,
dThoracic Surgery, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital,
eClinic of Cardiology, İstanbul Mehmet Akif Ersoy Chest Cardiovascular Surgery Training and Research Hospital, İstanbul, TURKEY
Turkiye Klinikleri J Anest Reanim. 2019;17(2):39-49
doi: 10.5336/anesthe.2019-65493
Article Language: EN
Full Text
ABSTRACT
 Objective: Postoperative pain is a major concern about thoracotomy and acts a determinant of quality of life and complication occurrence. Here we sought to disctinctively assess the predictors of significant pain in the 1st, 6th, and 12 hours of elective lung cancer surgery. Material and Methods: Seventy American Society of Anesthesiologists (ASA) 1-3 patients who were performed posterolateral thoracotomy by the same surgical team were retrospectively recruited. Perception of pain was quantified by Visual Analogue Scale (VAS) and VAS scores of 1st, 6th and 12th hours were recorded and a score of four or higher was identified as significant pain. Postoperative analgesia was provided either by thoracic epidural analgesia (TEA) with 0.1% bupivacaine or pethidine- based intravenous analgesia (IVA) in our sample population. Results: Regarding demographic characteristics, there were almost no significant differences among groups with and without significant pain (Group Significant Pain, SP, and Group Tolerable Pain, TP; respectively) at the first 12 hours. Exceptions were the presence of higher rates of iatrogenic rib fracture (p=0.02) and operation related complications (p=0.046) in Group SP at 1st and 6th hours respectively. The frequency of patients treated with IVA was significantly higher in SP group at 1st and 6th hours but not at 12th hour. Conclusion: Type of analgesia was solely detected to be a persistent determinant of significant pain after lung cancer surgery. However, this was valid for only the first six hours.

Keywords: Analgesia, epidural; pain measurement; thoracotomy
ÖZET
 Amaç: Postoperatif ağrı torakotomiye ilişkin temel bir sorundur; ve sadece yaşam kalitesinde değil komplikasyon görülme sıklığında da belirleyici rol oynar. Bu çalışmada elektif akciğer kanser cerrahisi sonrası 1,6 ve 12. saatlerde kaydadeğer ağrıyı predikte eden etkenlerin birbirinden ayrı olarak tespit edilmesi hedeflenmiştir. Gereç ve Yöntemler: Aynı cerrahi ekip tarafından posterolateral torakotomi ile opere edilen 70 Amerikan Anesteziyoloji Derneği (ASA) 1-3 hastanın verileri retrospektif olarak incelendi. Vizüel Analog Skalası (VAS) ile sayısallaştırılan ağrı algısına dair skorların 1, 6 ve 12. saatlerdeki değerleri kaydedildi ve dört ve üzeri değerler kaydadeğer ağrı olarak nitelendi. Postoperatif analjezi ya %0,1'lik bupivakainle torasik epidural analjeziyle (TEA); ya da petidin temelli intravenöz analjeziyle (İVA) sağlandı. Bulgular: İlk 12 saatte kaydadeğer ağrısı (Grup KA) olan ve olmayan (Grup Dayanılabilir Ağrı; DA) gruplar arasında demografik özellikler açısından hemen hiç belirgin fark yoktu. İstisnalar ise sırasıyla 1. ve 6. saatlerde iyatrojenik kot kırıklarının (p=0,02) ve operasyonla ilişkili komplikasyonların (p=0,046) Grup KA'da daha fazla olmasıydı. Kaydadeğer ağrı grubunda İVA ile tedavi edilen hastaların oranı 1. ve 6. saatte anlamlı olarak fazlayken 12. saatte anlamlı fark yoktu. Sonuç: Akciğer kanseri cerrahisi sonrası kaydadeğer ağrı varlığını öngördürme konusunda analjezi yönteminin süreğen bir belirteç olduğu ancak bu durumun sadece ilk altı saat için geçerli olduğu sonucuna varıldı.

Anahtar Kelimeler: Analjezi, epidural; ağrı ölçümü; torakotomi
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