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Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial / Alívio da dor pós-toracotomia com analgesia subpleural ou analgesia epidural torácica: ensaio clínico randomizado
Tezcan, Aysu Hayriye; Karakurt, Özgür; Eryazgan, Mehmet Ali; Baskan, Semih; Örnek, Dilsen Hatice; Baldemir, Ramazan; Koçer, Bülent; Baydar, Mustafa.
  • Tezcan, Aysu Hayriye; Ankara Numune Education and Research Hospital. Anesthesiology and Reanimation Department. Ankara. TR
  • Karakurt, Özgür; Ankara Numune Education and Research Hospital. Anesthesiology and Reanimation Department. Ankara. TR
  • Eryazgan, Mehmet Ali; Ankara Numune Education and Research Hospital. Anesthesiology and Reanimation Department. Ankara. TR
  • Baskan, Semih; Ankara Numune Education and Research Hospital. Anesthesiology and Reanimation Department. Ankara. TR
  • Örnek, Dilsen Hatice; Ankara Numune Education and Research Hospital. Anesthesiology and Reanimation Department. Ankara. TR
  • Baldemir, Ramazan; Ankara Numune Education and Research Hospital. Anesthesiology and Reanimation Department. Ankara. TR
  • Koçer, Bülent; Ankara Numune Education and Research Hospital. Anesthesiology and Reanimation Department. Ankara. TR
  • Baydar, Mustafa; Ankara Numune Education and Research Hospital. Anesthesiology and Reanimation Department. Ankara. TR
São Paulo med. j ; 134(4): 280-284, July-Aug. 2016. tab, graf
Article in English | LILACS | ID: lil-792824
ABSTRACT
ABSTRACT CONTEXT AND

OBJECTIVE:

Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy. DESIGN AND

SETTING:

Randomized study at Ankara Numune Education and Research Hospital, in Turkey.

METHODS:

Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patient-controlled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patient-controlled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively.

RESULTS:

In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression.

CONCLUSION:

Thoracic epidural analgesia is superior to subpleural analgesia for relieving post-thoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary.
RESUMO
RESUMO CONTEXTO E

OBJETIVO:

Dor pós-toracotomia é severa e intensa, causada por trauma de nervos periféricos, músculos e costelas. O objetivo foi comparar analgesia subpleural (SPA) com analgesia epidural torácica (TEA) em pacientes submetidos à toracotomia. TIPO DE ESTUDO E LOCAL Estudo randomizado no Hospital Educação e Pesquisa de Numune, em Ancara, Turquia.

MÉTODOS:

Trinta pacientes com o estado físico I-III da Sociedade Americana de Anestesiologistas foram agendados para toracotomia diagnóstica eletiva e escolhidos aleatoriamente para receber, num período de 24 horas, SPA ou TEA, ambas controladas pelo próprio paciente, para controle da dor pós-toracotomia. Os dois grupos receberam mistura de 3 ug/ml de fentanil com solução de 0,05% de bupivacaína por meio de bomba de analgesia controlada pelo paciente. Foi administrada analgesia de resgate por via intravenosa, com 100 mg de tramadol, nos dois grupos. No pós-operatório, a escala visual analógica foi utilizada para medir presença de dor durante a tosse ou em repouso, ao longo de 24 horas.

RESULTADOS:

No grupo SPA, todos os pacientes necessitaram de analgesia de resgate. Cinco pacientes (33%) necessitaram de analgesia de resgate no grupo TEA (P < 0,05). Os pacientes com SPA exibiram pontuações superiores na escala visual analógica, em repouso e ao tossir, em comparação aos que receberam TEA. Nenhum dos pacientes teve quaisquer efeitos secundários no pós-operatório, como hipotensão ou depressão respiratória.

CONCLUSÃO:

A analgesia peridural torácica é superior à analgesia subpleural no alívio da dor pós-toracotomia. Consideramos que estudos sobre a dosagem de drogas eficazes para proporcionar analgesia subpleural são necessários.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Pain, Postoperative / Thoracotomy / Analgesia, Epidural / Analgesia, Patient-Controlled / Interpleural Analgesia Type of study: Controlled clinical trial Limits: Adult / Aged / Female / Humans / Male Language: English Journal: São Paulo med. j Journal subject: Cirurgia Geral / Ciˆncia / Ginecologia / Medicine / Medicina Interna / Obstetr¡cia / Pediatria / Sa£de Mental / Sa£de P£blica Year: 2016 Type: Article Affiliation country: Turkey Institution/Affiliation country: Ankara Numune Education and Research Hospital/TR

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Full text: Available Index: LILACS (Americas) Main subject: Pain, Postoperative / Thoracotomy / Analgesia, Epidural / Analgesia, Patient-Controlled / Interpleural Analgesia Type of study: Controlled clinical trial Limits: Adult / Aged / Female / Humans / Male Language: English Journal: São Paulo med. j Journal subject: Cirurgia Geral / Ciˆncia / Ginecologia / Medicine / Medicina Interna / Obstetr¡cia / Pediatria / Sa£de Mental / Sa£de P£blica Year: 2016 Type: Article Affiliation country: Turkey Institution/Affiliation country: Ankara Numune Education and Research Hospital/TR