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Öğe Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy(Termedia Publishing House Ltd, 2013) Sagiroglu, Gonul; Baysal, Ayse; Kiraz, Osman Gazi; Meydan, Burhan; Tasci, Ahmet Erdal; Iskender, IlkerAim of the study: We aimed to compare the efficacy of the continuous use of thoracic epidural and intercostal analgesia for post-thoracotomy pain. Material and methods: Sixty patients completed a prospective, randomized, double-blinded study. The patients were randomized to receive thoracic epidural (group 1, n = 30) or intercostal block (group 2, n = 30) for 24 hours. In both groups, 0.25% bupivacaine was infused at a rate of 5 ml/h through an inserted catheter. Visual analog scale at rest (VAS-R) and after coughing (VAS-C) scores were recorded at baseline and at 1, 6 and 24 hours after surgery to evaluate pain. Morphine consumption, complications and side effects were recorded as well. Results: VAS-R and VAS-C scores were similar at baseline; however, 1st, 6th and 24th hour scores of group 1 were significantly lower than the scores of group 2 (for VAS-R; p = 0.017, p = 0.001, p = 0.023, for VAS-C; p = 0.006, p = 0.002, p = 0.032, respectively). 24-hour morphine consumption was lower in group 1 in comparison to group 2 (p = 0.032). In group 1, 5 out of 30 patients (17%) experienced hypotension, compared with none in group 2 (p = 0.02). Conclusions: For post-thoracotomy pain, better control of analgesia is observed with the thoracic epidural technique; however, intercostal block constitutes an alternative method as it is characterized by lower incidence of hypotension.Öğe Comparison of ON-Q elastomeric pump system and thoracic epidural analgesia methods for pain management after thoracotomy(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2017) Sagiroglu, Gonul; Baysal, Ayse; Meydan, Burhan; Kiraz, Osman Gazi; Tasci, Ahmet ErdalBackground: This study aims to compare the results of continuous infusion of local anesthetics through either ON-Q elastomeric pump or thoracic epidural analgesia for management of pain after thoracotomy. Methods: Ninety-seven patients (86 males, 11 females; mean age 56.37 years; range 34 to 86 years) were included in this prospective and randomized study. Patients were randomized into two groups to undergo either ON-Q elastomeric pump system (group 1, n=50) or thoracic epidural analgesia (group 2, n=47) for 24 hours. In both groups, continuous 0.125% bupivacaine infusion was performed from a catheter at a rate of 0.1 mL/kg/hour. Intravenous morphine was provided to all patients through patient controlled analgesia method. Postoperative pain was evaluated with visual analog scale during rest and coughing at baseline and postoperative first, sixth, 12th, and 24th hours. Results: Although visual analog scale rest and coughing scores of group 1 at first, sixth, 12th, and 24th hours were significantly higher than group 2, its baseline values were similar to group 2. Total local anesthetic consumption of group 2 was higher than group 1. Although hypotension was not observed in any patient in group 1, significant hypotension was observed in seven patients (14.9%) in group 2. The incidences of nausea and vomiting were 4% (n=2) in group 1 and 17% (n=8) in group 2. Conclusion: Thoracic epidural analgesia provides superior analgesia compared to ON-Q elastomeric pump system in pain treatment after thoracotomy. Still, having lesser incidence of hypotension and easier technical application, ON-Q elastomeric pump system may be considered as an alternative method to thoracic epidural analgesia.Öğe Torakotomi sonrası ağrı tedavisinde meperidin veya morfin ile intravenöz hasta kontrollü analjezi uygulamalarının karşılaştırılması(2013) Sağıroğlu, Gönül; Çopuroğlu, Elif; Kiraz, Osman Gazi; Baysal, Ayşe; Sağıroğlu, Tamer; Meydan, Burhan; Yüksel, VolkanAmaç: Torakotomi ile yapılan ameliyatlardan sonra intravenöz hasta kontrollü analjezi (İHKA) ile meperidin veya morfin uygulamalarının hemodinamik parametreler ve ağrı kontrolü üzerine etkilerinin postoperatif erken dönemde karşılaştırılması. Yöntemler: Yüz kırk hasta (ASA I-III) prospektif çalışmada randomize olarak meperidin (Grup 1) ve morfin (Grup 2) gruplarına ayrıldı. Postoperatif ilk 24 saatteki İHKA kullanımı; Grup 1de, 50 mg yükleme dozu, 7 mg sa-1 bazal infüzyon, 5 mg bolus dozunda Grup 2de ise, 5 mg yükleme dozu, 0,5 mg sa-1 bazal infüzyon, 0,5 mg bolus dozunda uygulanırken, kilit zamanı 15er dakikaydı. Toplanan veriler; sistolik, diastolik ve ortalama kan basınçları, kalp atım hızı, nabız oksimetresi satürasyonu, vizüel analog skala (VAS) ve Ramsey sedasyon skala değerleri, total ve ek analjezikler ile yan etkilerdi. Bulgular: Grup 1in 2, 4, 16. saat VAS değerleri Grup 2ye göre anlamlı derecede yüksekti (p=0,08; p=0,014; p=0,031). Grup içi karşılaştırmalarda, her iki grupta da postoperatif bazal değere göre diğer tüm saatlerdeki VAS değerleri istatistiksel anlamlı düzeyde düşüktü (p=0,0001). Grup 1in total ve ek doz morfin tüketimi (%25 tam olmayan çapraz toleransa göre hesaplanan morfin eşdeğer doz karşılığı) Grup 2den yüksek bulundu (p=0,001, p=0,0001). Grup 1in postoperatif 2, 4, 8, 16. saatlerdeki sistolik ve ortalama kan basıncı değerleri ile postoperatif 2, 4, 8. saat diastolik kan basıncı değerleri Grup 2den yüksekti (p<0,05). Hipotansiyon insidansı, Grup 1de (%7,1) Grup 2den (%18,6) daha azdı (p=0,043). Sonuç: Torakotomi ağrısında İHKA yöntemiyle verilen morfin tedavisi ile meperidinden daha iyi analjezik etkinlik elde edilebilir. Morfin analjezisinde hipotansiyon oluşması ilacın İHKAda kullanımını sınırlamakta ve dikkatli bir yaklaşımı gerektirmektedir.