GKD Anest Yoð Bak Dern Derg. 2013; 19(1): 10-15 | DOI: 10.5222/GKDAD.2013.010

Torakotomi Analjezisinde Epidural veya Ýntravenöz Hasta Kontrollü Analjezi Yöntemlerinin Karþýlaþtýrýlmasý

Gönül Saðýroðlu¹, Elif Çopuroðlu¹, Burhan Meydan², Serpil Ertürk², Mine Demir³, Mustafa Küpeli^3
1Trakya Üniversitesi Týp Fakültesi, Anesteziyoloji Ana Bilim Dalý, Edirne
²Süreyyapaþa Göðüs Hastalýklarý Ve Göðüs Cerrahisi Eðitim Araþtýrma Hastanesi, Anestezi Kliniði, Ýstanbul
³Süreyyapaþa Göðüs Hastalýklarý Ve Göðüs Cerrahisi Eðitim Araþtýrma Hastanesi Göðüs Cerrahisi Kliniði, Ýstanbul

AMAÇ: Bu çalýþmada torakotomi sonrasý aðrý tedavisinde, hasta kontrollü analjezide morfinin intravenöz ve epidural uygulamalarýnýn etkinlik ve yan etki profili yönünden karþýlaþtýrýlmasý amaçlandý.
YÖNTEMLER: Prospektif ve randomize olarak oluþturulan çalýþmaya 40 olgu dahil edildi. Olgular torakal epidural morfin (TEM) veya intravenöz morfin (ÝM) grubu olarak 20 kiþilik iki gruba ayrýldý. TEM grubuna anestezi indüksiyonu öncesi 0.5 mg morfin epidural kateterden preemptif olarak uygulandý. Postoperatif torakotomi aðrýsý için hasta kontrollü analjezi (HKA) yöntemi uygulandý. Postoperatif yoðun bakým ünitesinde 0., 4., 16. ve 24. saatlerdeki Vizüel Aðrý Skalasý (VAS) sorgulandý. Yan etkiler kaydedildi.
BULGULAR: Gruplar arasý karþýlaþtýrmalarda TEM grubunda baþlangýçta (p<0.025) ve 4. saatteki (p<0.009) VAS deðerlerindeki düþme istatistiksel açýdan anlamlý bulundu. Grup içi karþýlaþtýrmalarda her iki grupta 4. saatten itibaren tüm zamanlardaki VAS skorlarýnda anlamlý düþme saptandý. HKA istem sayýsý, toplam analjezik miktarý ve ilave analjezik miktarý açýsýndan gruplar arasý anlamlý fark bulunamadý. Komplikasyonlar açýsýndan gruplar arasýnda anlamlý fark bulunmadý.
SONUÇ: Posttorakotomi aðrýsýnda torakal epidural veya intravenöz analjezi yöntemleri uygulanabilir; ancak epidural yöntem ile postoperatif ilk saatlerde daha etkin analjezi saðlanabilir.

Anahtar Kelimeler: torakotomi, hasta kontrollü analjezi, epidural analjezi, intravenöz morfin

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Comparison of Epidural or Intravenous Patient-Controlled Analgesia at Thoracotomy

Gönül Saðýroðlu¹, Elif Çopuroðlu¹, Burhan Meydan², Serpil Ertürk², Mine Demir³, Mustafa Küpeli^3
1Department Of Anesthesiology, Faculty Of Medicine, Trakya University, Edirne, Turkey
²Department Of Anesthesiology, Süreyyapaþa Chest Disease And Thoracic Surgery Hospital, Istanbul, Turkey
³Department Of Thorac Surgery, Süreyyapaþa Chest Disease And Thoracic Surgery Hospital, Istanbul, Turkey

OBJECTIVE: In this study, we aimed to compare the efficacy and side- effect profiles of morfine in terms of epidural or intravenous patient-controlled analgesia in the pain treatment after thoracotomy.
METHODS: Fourty patients were included in our study created as prospective and randomized. Cases were divided into two groups thoracic epidural morphine (TEM) or intravenous morphine (IM), of 20 patient, each. 0.5 mg morfin was given through epidural catheter as preemptive dose before anesthesia induction in TEM group. Patient-controlled analgesia (PCA) was performed for postoperative thoracotomy pain treatment. Visual Analogue Scale (VAS) were questioned at 0.,4.,16. and 24. hours in postoperative intensive care unit. Side effects were also recorded.
RESULTS: Between group-comparisons of TEM group at baseline (p<0.025) and 4th hour (p<0.009) found a statistically significant decrease in VAS scores. Intra-group comparisons in both groups, VAS scores showed a significant decrease at all times after 4th hour. There was no significantly differences between the groups on demand of PCA, total amount of analgesic and the amount of additional analgesics. Decrease in heart rate in both groups after 4th hour,compared with baseline values considered to be significant. No difference were found between groups in terms of complications.
CONCLUSION: aaaa

Keywords: thoracotomy, patient-controlled analgesia, epidural analgesia, intravenous morphine

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