Is intravenous morphine alone effective for postoperative analgesia in bilateral, single-port video-assisted thoracoscopic sympathectomy performed in the supine position?

Abstract

Introduction The method of operation carried out by clip application that utilizes the supine position and single port for thoracoscopic sympathectomy has been defined in recent years. This method leads to less pain as less tissue damage occurs. There is no any recommendation about postoperative analgesia management. The aim of this study is to investigate whether intravenous morphine alone effective for postoperative analgesia in bilateral, single-port video-assisted thoracoscopic sympathectomy performed in the supine position. Methods After obtaining ethical committee approval, postoperative analgesia management of 28 patients who underwent bilateral, single-port video-assisted thoracoscopic sympathectomy was retrospectively investigated. The patients were divided into two groups; After induction of anaesthesia, intrathecal morphine was administered to a group at a dose of 0.6 mg/3 mL, and postoperative patient-controlled analgesia(PCA) was administered intravenously (IV) with a locked time of 1 mg bolus for 30 minutes(Group ITM,n=14). In the other group, IV morphine was applied in the same doses only by the PCA method(Group PCA,n=14). Visual analogue scale (VAS) values and IV total morphine consumption were recorded at the time of extubation and at the 6th, 24th and 48th hours postoperatively. For statistical significance p value was determined as 0.05. Results In terms of demographic and surgical data (mean age, gender, ASA scores, duration of operation), there was no statistically difference between the groups. At the time of extubation and at the postoperative 6th hour, VAS scores were statistically significantly lower in Group ITM than in the Group PCA (Comparison of the recorded VAS score after extubation: 0.71±1.20 in Group ITM, 2.43±1.74 in Group PCA, p=0.012. Postoperative 6th hour VAS score comparison: 0.21±0.57 in Group ITM, 1.57±1.60 in Group HKA, p=0.011). There was no significant difference between the groups in terms of VAS values at the postoperative 24th and 48th hours. In Group PCA, total IV morphine (mg) consumption at the postoperative 24th and 48th hours was statistically significantly higher than the Group ITM (total morphine consumption at the postoperative 24th hour: 14.57±20.18 vs. 4.14±5.62, p Discussion The results of this study show that in the management of pain after thoracoscopic sympathectomy operations performed with this method, we believe that even though an adequate analgesia is provided through ITM, IV PCA morphine provided clinically acceptable analgesic efficacy, and a regional administration may not be required in patients who will be operated with this method.