Torakotomi sonrası ağrı tedavisinde hasta kontrollü analjezi yöntemi ile intravenöz morfin, epidural morfin, epidural morfin+bupivakain ve epidural morfin+ropivakainin etki ve yan etkilerinin karşılaştırılması
Özet
A Comparison The Effects and Side Effects of Intravenous Morphine, Epidural Morphine, Epidural Morphine+Bupivacaine, Epidural Morphine+Ropivacaine in Postthoracotomy Pain Management With Patient Controlled Analgesia Technique Acute postthoracotomy pain is one of the most painful procedure and a variety of analgesic techniques are used for controlling it. The aim of this randomised, double- blind, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on postthoracotomy pain. 60 patients undergoing thoracotomy were randomly allocated into 4 groups by sealed envelop technique. Group IVM (n=15), EM (n=15), Group EMB and Group EMR (n=15) received patient controlled intravenous morphine, epidural morphine, epidural morphine-bupivacaine and epidural morphine-ropivacaine respectively. Peroperatif haemodynarnic variables, postoperative pain while at rest and coughing, side effects and rescue analgesic requirements were noted at 30 and 60 minutes and 2, 4, 6, 12, 24, 36, 48, and 72l hours. Diclophenac sodium 75 mg im was administered when VAS>50. ANOVA, Kruskall Wallis One-Way ANOVA and Chi- Square tests were used and p<0.05 was considered as significant. Values are expressed as median and interquartile range. Patients' characteristics and demographic data were similar among groups. Diclophenac sodium requirement during the study was lower in Group EM 75mg (0- 150) compared with Group rVM 225mg (75-225) (p=0.039), Group EMB 225mg (75-300) (p=0.006) and Group EMR 225 mg (150-375) (p=0.02). Area under VAS- time curve was lower in Group EM 335 cm2 (305-375) compared to Group F/M 445 cm2 (355-462) (p= 0.028) but similar with Group EMB 447 cm2 (290-520) and Group EMR cm2 395(270-512). Pain scores at rest were higher at the 12, 24, 36, and 48th hours in Group rVM compared to Group EM (p<0.05). Pain scores at rest were higher at the 30th and 60 minutes in Group EM and Group IVM compared to Group EMB (p<0.05). Pain scores while coughing at the 30th minute was higher in Group EM compared to Group EMB (p<0.05). In postoperative pain management there was no difference between Group IVM and Group EMR. As a result morphine used at the epidural route was found more effective than the intravenous route. Rescue analgesic requirement was the least at the epidural morphine group among the other groups. While Group EM was more effective at the late period of postoperative, when added bupivacain to epidural morphine the effectiveness move to the early period of time. All side effects between four groups were similar so all techniques can be used safely. We concluded that epidural morphine was the most effective and prefered between four groups.Key words: bupivacaine, patient controlled analgesia, morphine, ropivacaine, postthoracotomy pain