ISSN : 1300-0012   E-ISSN 2458-9446 Home      |      Contact      |      TR
 
 
Volume: 32  Issue: 3  Year: 2020
 

Attention: These articles have been accepted for publication; however, this list does not indicate the order in which articles will be published. As new articles are accepted, the order displayed here will change.

Effects of Paravertebral Block and Intravenous Analgesic Methods on Postoperative Pain Management and Opioid Consumption in Laparoscopic Cholecystectomies [Ağrı]
Ağrı. Ahead of Print: AGRI-60487 | DOI: 10.14744/agri.2020.60487  

Effects of Paravertebral Block and Intravenous Analgesic Methods on Postoperative Pain Management and Opioid Consumption in Laparoscopic Cholecystectomies

Levent Gündost1, Kemalettin Koltka2, Nükhet Sivrikoz2, Özlem Turhan2, Dilek Hündür2, Hacer Ayşen Yavru2, Emre Çamcı2
1Dr. Burhan Nalbantoğlu State Hospital, Department of Anesthesiology And Reanimation, Nicosia, Turkish Republic Of Northern Cyprus
2Istanbul University Istanbul Medical Faculty, Department of Anaesthesiology And Reanimation, Istanbul, Turkey

OBJECTIVE: The aim of this study was to evaluate the efficiency of thoracic paravertebral block (TPVB) on postoperative analgesia in laparoscopic cholecystectomies under general anesthesia.
MATERIALS METHODS: After university ethics committee approval and informed consents; 78 patients aging between 18-70 years, with ASA I-III for elective laparoscopic cholecystectomy were enrolled. Patients were randomly seperated into two groups: Group 1(38 patients); TPVB performed unilaterally at T6 before surgery and Group 2(40 patients); only general anesthesia. Postoperatively, patients in both groups received Patient-Controlled Analgesia with CADD-Legacy® PCA. Visuel analog scale (VAS) scores at rest and on movement were recorded during postoperative first 24 hours. Tramadol consumption during first 24 hours, nause and vomiting rate, time to first passing bowel gas and defecation, nutrition, mobilization and disharge hours were also noted.
RESULTS: Patients received ultrasonography guided TPVB had significantly lower postoperative VAS scores at rest and on movement at 4th, 6th, 12th,18th, and 24th hours and significantly lower tramadol consumption postoperatively. It was observed that 77,5% of the patients in Group 2 needed at least one dose of additional fentanyl intraoperatively. Group 2 had a significantly higher vomiting rate. It was observed that the first bowel gas and defecation time, nutrition and mobilization hours were later. There was no significant difference between the discharge hours of both groups.
CONCLUSION: Preoperatively performed TPVB resulted in an efficient analgesia after laparoscopic cholecystectomy. We observed TPVB can also reduce perioperative, and postoperative opioid requirements.

Keywords: Laparoscopic cholecystectomy, paravertebral block, visual analog scale, fentanyl, tramadol


Laparoskopik Kolesistektomilerde Paravertebral Blok ve İntravenöz Analjezik Yöntemlerin Postoperatif Ağrı Yönetimi ile Opioid Tüketimine Etkileri

Levent Gündost1, Kemalettin Koltka2, Nükhet Sivrikoz2, Özlem Turhan2, Dilek Hündür2, Hacer Ayşen Yavru2, Emre Çamcı2
1Dr. Burhan Nalbantoğlu Devlet Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Lefkoşa, Kuzey Kıbrıs Türk Cumhuriyeti
2İstanbul Üniversitesi İstanbul Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Ana Bilim Dalı, İstanbul, Türkiye

AMAÇ: Primer olarak genel anestezi altında yapılan elektif laparoskopik kolesistektomilerde (LK) preoperatif torakal paravertebral blok (TPVB) uygulamasının postoperatif analjezi üzerindeki etkisini görmektir.
MATERYAL VE METOT: Üniversite etik kurul onayı ve hasta onamları alındıktan sonra, elektif laparoskopik kolesistektomi planlanan, 18-70 yaş aralığında ve ASA I-III olan 78 hasta çalışmaya dahil edildi. Hastalar; preoperatif ultrasonografi(USG) eşliğinde TPVB uygulanan (Grup 1) 38 hasta ve uygulanmayan (Grup 2) 40 hasta olarak randomize edildi. Her iki gruba postoperatif dönemde HKA (CADD-Legacy®) uygulandı. Hastalara Grup 1’de USG eşliğinde preoperatif unilateral T6 seviyesinden TPVB uygulandı. Postoperatif ilk 24 saatte her iki grubun istirahat ve hareket visüel analog skala (VAS) skorları, postoperatif kullanılan tramadol miktarı, bulantı kusma insidansları, gaz-gayta çıkışı, mobilizasyon, beslenme ve taburculuk saatleri kaydedildi.
BULGULAR: Postoperatif istirahat ve hareket sırasında 4., 6., 12., 18. ve 24. saatte bakılan VAS skorları ve postoperatif tramadol tüketimi Grup 1’de anlamlı derecede düşük saptandı. Grup 2’deki hastaların %77,5’inin intraoperatif en az bir doz ek fentanil ihtiyacı olduğu, bu grupta hastaların kusma oranının anlamlı derecede daha fazla olduğu, gaz-gayta çıkışı, beslenme ve mobilizasyon saatlerinin daha geç saatlerde olduğu gözlemlendi. Her iki grubun taburculuk saatleri arasında anlamlı fark olmadığı saptandı.
SONUÇ: Bu çalışmada LK’lerde TPVB uygulamasının, postoperatif analjezik etkinlik sağladığı, intraoperatif ve postoperatif opioid ihtiyacını azalttığı gözlemlendi

Anahtar Kelimeler: Laparoskopik kolesistektomi, paravertebral blok, vizüel analog skala, fentanil, tramadol




Corresponding Author: Nükhet Sivrikoz, Türkiye


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