Perkütan transhepatik bilier drenaj girişimlerinde ultrason eşliğinde yapılan torasik paravertebral bloğun ağrı kontrolündeki etkisi
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Date
2013-01-21
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Uludağ Üniversitesi
Abstract
Bu çalışma perkütan bilier drenaj işleminden önce ultrason eşliğinde uygulanan torakal paravertebral bloğun (UG-PVB) peroperatif ağrı kontrolüne olan etkisi ve güvenirliği analiz etmek amacıyla planlandı. Otuz hasta (ASA I-II), paravertebral blokla standart perkütan bilier drenaj (PBD) prosedürü (çalışma grubu, 15 hasta) ve UG-PVB olmaksızın standart PBD prosedürü (kontrol grubu, 15 hasta) uygulanmak üzere rasgele olarak ikiye ayrıldı. Ağrı skorları işlem sırasındaki 6 aşamada ve sonrasında Vizuel Analog Skala (VAS) ile değerlendirildi. Bütün UG-PVB prosedürlerinde teknik başarı elde edilmiştir. Medyan VAS-skoru sürecin bütün aşamalarında çalışma grubunda kontrol grubuna göre daha düşüktü (p<0.001). Medyan midazolam miktarı çalışma grubunda [medyan(min-maks) = 1 (0,5-2,5) mg] kontrol grubuna [3 (3-5) mg] göre anlamlı olarak daha düşüktü (p<0.001). Çalışma grubunda 1 kişide (%6,7) peroperatif bulantı-kusma görülürken, kontrol grubunda 8 kişide (%53,3) bulantı-kusma görülmüştür. Kontrol grubunda bulantı kusma görülme oranı anlamlı olarak daha fazlaydı (p=0,014). Her iki gruptaki hastaların hiçbirinde solunum depresyonu ya da pnömotorax gözlenmemiştir. Bu çalışma PBD işlemi ile UGPVB işleminin peroperatif ağrı kontrolü ve düşük morbidite açısından etkin bir yöntem olduğunu göstermektedir.
This study was designed to analyze the efficacy and safety of ultrasound guided paravertebral block (UG-PVB) performed before percutane ous biliary drainage (PBD) procedure for peroperative pain management. Thirty (ASA I-II) patients were randomly assigned to receive either standart PBD with PVB (study group, 15 patients) or standard PBD without UG-PVB (control group, 15 patients). Efficacy on pain control were assessed with Visual Analogue Scale (VAS) at 6 stages of the PBD procedure and postprocedural period. Technical success was achieved in all UG-PVB procedures. Median VAS-score was significantly lower in the study group than the controls at all stages of the process (p<0.001). The median amount of midazolam was significantly lower in study group [median (min-max) = 1 (0.5-2.5) mg] than in group control [3 (3-5) mg] (p<0.001). Peroperative nausea- vomiting was observed only in 1 patient (6.7%) in study group and in 8 patients (53.3%) in control group. Nausea and vomiting frequency was significantly greater in the control group (p=0.014). Respiratory depression or pneumothorax was observed in none of the patients in both groups. The present study shows that PBD with UG-PVB is more efficacious in terms of peroperative pain control and lower morbidities in patients undergoing PBD.
This study was designed to analyze the efficacy and safety of ultrasound guided paravertebral block (UG-PVB) performed before percutane ous biliary drainage (PBD) procedure for peroperative pain management. Thirty (ASA I-II) patients were randomly assigned to receive either standart PBD with PVB (study group, 15 patients) or standard PBD without UG-PVB (control group, 15 patients). Efficacy on pain control were assessed with Visual Analogue Scale (VAS) at 6 stages of the PBD procedure and postprocedural period. Technical success was achieved in all UG-PVB procedures. Median VAS-score was significantly lower in the study group than the controls at all stages of the process (p<0.001). The median amount of midazolam was significantly lower in study group [median (min-max) = 1 (0.5-2.5) mg] than in group control [3 (3-5) mg] (p<0.001). Peroperative nausea- vomiting was observed only in 1 patient (6.7%) in study group and in 8 patients (53.3%) in control group. Nausea and vomiting frequency was significantly greater in the control group (p=0.014). Respiratory depression or pneumothorax was observed in none of the patients in both groups. The present study shows that PBD with UG-PVB is more efficacious in terms of peroperative pain control and lower morbidities in patients undergoing PBD.
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Keywords
Analjezi, Paravertebral anestezi, Bilier drenaj, Analgesia, Paravertebral anesthesia, Biliary drainage
Citation
Eygi, E. vd. (2013). "Perkütan transhepatik bilier drenaj girişimlerinde ultrason eşliğinde yapılan torasik paravertebral bloğun ağrı kontrolündeki etkisi". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 39(1), 27-32.