Abstract
BackgroundTEA (thoracic epidural analgesia) is considered a basic method of analgesia used in thoracic surgeries. PVB (paravertebral block) is an alternative method. The thesis compares effectiveness of both methods in postoperative analgesia with particular focus on assessment of the postoperative pain management quality.MethodsThe study involved 2 groups of patients, each consisting of 30 patients undergoing posterolateral thoracotomy. The study group involved patients anesthetized applying PVB method, while the control group involved patients anesthetized with TEA. Hemodynamic and respiratory parameters as well as severity of pain assessed using NRS (numeric rating scale) during the first 3 days after the surgery, number of days of hospitalization, and the need to use additional pain relievers were taken into account in both groups. Evaluation of postoperative pain management quality was performed applying Clinical Quality Indicators in Postoperative Pain Management.ResultsNo statistical significance was demonstrated between the groups in respect of hemodynamic and respiratory parameters values, the need to use additional pain relievers and the number of days of hospitalization. There was no statistically significant difference between the groups in respect of general assessment of pain management quality, except for the assessment of the lowest level of pain within the last 24 h of measurement. This result in TEA group was statistically significantly lower than the one in PVB group (p = 0.019).ConclusionsIn the assessment of postoperative pain management quality both analyzed methods are statistically significantly different only in the category of “lowest level of pain within the last 24 hours of measurement”, to the benefit of TEA group. No statistically significant difference has been observed between the two study groups with respect to the remaining parameters.Trial registrationKB-0012/71/15. Date of registration 22 June 2015.
Highlights
Thoracic epidural analgesia (TEA) is considered a basic method of analgesia used in thoracic surgeries
Thoracotomy is a type of a surgery that involves one of the most perceptible pains during the postoperative period [1]
Pulling of visceral or vagus nerves as well as the presence of drain in the pleural cavity after the operative procedure cause the sensation of pain [4]
Summary
TEA (thoracic epidural analgesia) is considered a basic method of analgesia used in thoracic surgeries. Due to the fact that during posterolateral thoracotomy numerous layers of the chest wall are being cut and dissected, and the dissection takes place within the lung itself and its components (bronchial tubes, vessels, nerves), there are many sources and mechanisms of the post-thoracotomy pain. This results from nociceptive mechanisms, and involves neuropathic component resulting from minor or larger damage to intercostal nerves or other nerves during the surgery. Methods involving regional analgesia are often used in treatment of pain post thoracotomy and post thoracoscopic surgeries
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