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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Comparison between Thoracic Epidural Block and Thoracic Paravertebral Block for Post Thoracotomy Pain Relief
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Comparison between Thoracic Epidural Block and Thoracic Paravertebral Block for Post Thoracotomy Pain Relief

机译：胸膜硬膜外阻滞与胸椎旁脊柱阻滞对开胸术后疼痛缓解的比较

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Introduction: Postoperative pain after thoracotomy is being considered one of the most severe pain and if not treated well, can result in various respiratory and other complications.Aim: Present study was conducted with the aim to compare continuous thoracic epidural infusion with continuous paravertebral infusion for postoperative pain using Visual Analogue Scale (VAS) score and four point observer ranking. The secondary outcomes measured were pulmonary functions and any complication like hypotension, bradycardia, nausea, vomiting, urinary retention and neurological complications if any.Materials and Methods: Sixty patients of age group 18-60 years posted for anterolateral thoracotomy surgery for lung resection were randomised either to epidural or paravertebral group in this randomised prospective double blind study. In Epidural group 7.5ml bolus of 0.125% Bupivacaine with 50μg Fentanyl and in Paravertebral group 15ml bolus of 0.125% Bupivacaine with 50μg Fentanyl was given 30 minutes before the anticipated end of surgery. Bolus dose was followed by infusion of 0.125% Bupivacaine with 2μg/ml Fentanyl at the rate of 5 ml/hr in both groups. Parameters noted were Mean Arterial Pressure (MAP), Heart Rate (HR), Oxygen Saturation (SpO2), Arterial Blood Gas (PaCO2, P/F ratio), Visual Analogue Scale (VAS) and Four Point Observer Ranking Scale (FPORS) for pain, number of sensory segments blocked (by checking for pinprick sensation), requirement of infusion top ups and rescue analgesia (Tramadol), pre and postoperative pulmonary function test {(Forced Expiratory Volume (FEV)1, Forced Vital Capacity (FVC), FEV1/FVC, Peak Expiratory Flow Rate (PEFR)} and complications from start of infusion till 24 hours in the postoperative period.Results: Both the techniques were effective in relieving pain but pain relief was significantly better with epidural. Postoperatively, HR, SpO2, P/F ratio and PaCO2 were comparable between group E and P. There was significant decline in FeV1, FVC, FeV1/FVC and PEFR in postoperative period as compared to preoperative value in both the groups. Hypotension and bradycardia were more in group E.Conclusion: Both the techniques, continuous thoracic epidural block and continuous thoracic paravertebral block were effective for post-thoracotomy pain relief; however, epidural block provides better pain relief. The incidence of sympatholytic complications was more in epidural group. The effect on respiratory mechanics was equivalent. Hence, paravertebral block can be used in post thoracotomy pain relief in those patients where thoracic epidural is contraindicated.
机译：简介：开胸手术后的疼痛被认为是最严重的疼痛之一，如果治疗不当，可能会导致各种呼吸道疾病和其他并发症。目的：进行本研究的目的是比较连续胸腔硬膜外输注与连续椎旁副输注的差异。使用视觉模拟量表（VAS）评分和四点观察者评分对术后疼痛进行评估。测量的次要结局为肺功能以及是否存在低血压，心动过缓，恶心，呕吐，尿retention留和神经系统并发症等并发症。材料与方法：60名年龄在18-60岁的前外侧胸廓切开手术切除肺的患者被随机分配。在这项随机前瞻性双盲研究中，无论是硬膜外还是椎旁。在硬膜外组中，在预期手术结束前30分钟给予7.5ml的0.125％布比卡因与50μg芬太尼大剂量推注;而椎旁组中的15ml的0.125％布比卡因与50μg芬太尼快速推注。两组剂量后，以0.1％的布比卡因和2μg/ ml的芬太尼输注，剂量为5ml / hr。记录的参数是平均动脉压（MAP），心率（HR），血氧饱和度（SpO2），动脉血气（PaCO2，P / F比），视觉模拟量表（VAS）和四点观察者分级量表（FPORS）疼痛，感觉节段数受阻（通过检查针刺感），输液补充量和急救镇痛剂（曲马多），术前和术后肺功能检查{（强制呼气量（FEV）1，强迫肺活量（FVC），结果：两种技术均能有效缓解疼痛，但硬膜外可明显改善疼痛，术后HR，SpO2和FEV1 / FVC，峰值呼气流速（PEFR）}和从输注开始到术后24小时的并发症。 E组与P组相比，术前FeV1，FVC，FeV1 / FVC和PEFR均较术前明显下降; E组低血压和心动过缓更为明显。结论：博连续胸腔硬膜外阻滞和连续胸椎旁脊柱阻滞对缓解开胸术后疼痛有效。但是，硬膜外阻滞可以更好地缓解疼痛。硬膜外组的交感神经并发症发生率更高。对呼吸力学的影响是等效的。因此，在禁忌胸膜硬膜外的患者中，椎旁阻滞可用于开胸术后的疼痛缓解。

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