Title Učinkovitost analgezije kontinuiranom paravertebralnom blokadom kod korekcije skolioze prednjim pristupom u dječjoj dobi Title (english) Eficacy of continuous paravertebral block on postoperative pain after ventral spondylodesis in scoliosis correction Author Davorka Židak305627428 Mentor Ino Husedžinović (mentor)Committee member Jasminka Peršec (predsjednik povjerenstva)Committee member Vedran Uglešić (član povjerenstva)Committee member Gordana Stipančić (član povjerenstva)Committee member Tomislav Đapić (član povjerenstva)Committee member Slobodan Mihaljević (član povjerenstva)Granter University of Zagreb Defense date and country 2019-02-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616 - Pathology. Clinical medicine Abstract Kirurška korekcija skolioza prednjim pristupom je vrlo ekstenzivni ortopedski zahvat. Bol nakon torakotomije je jedna od najintenzivnijih boli što poslijeoperacijsku analgeziju čini vrlo kompleksnom, naročito u populaciji djece i adolescenata. Terapija akutne poslijeoperacijske boli važan je postupak ne samo zbog osiguravanja bolesnikovog komfora nego i zbog preveniranja komplikacija, ponajprije respiracijskih.
Cilj ove studije je ispitati utjecaj kontinuirane paravertebralne blokade na intenzitet poslijeoperacijske boli kod prednje spondilodeze u kirurškoj korekciji skolioza u dječjoj dobi.
Istraživanje je provedeno kao monocentrična prospektivna studija u razdoblju od svibnja 2015. do prosinca 2016.godine. Uključeno je 80 bolesnika u dobi od 10 do 18 godina ASA I i II statusa. U ispitnu skupinu je svrstano 40 bolesnika kojima je paravertebralno postavljen kateter za kontinuiranu regionalnu analgeziju i apliciran 0,25%-tni levobupivacain, a u kontrolnu skupinu 40 bolesnika koji su za analgeziju intravenski dobivali kombinaciju opioidnog analgetika tramala i metamizola. Intenzitet boli nakon operacije procjenjivan je pomoću VAS skale 1, 4, 8, 12 i 24 sata nakon operativnog zahvata, te svakih 12 sati do petog poslijeoperacijskog dana. Respiracijski parametri FVC, FEV1 i PEF određivani su prije operacije, zatim jednom dnevno do 5. poslijeoperacijskog dana. Bilježena je potrošnja analgetika, trajanje hospitalizacije i zadovoljstvo analgezijom te ukupno zadovoljstvo svim postupcima.
Bolesnici u skupini kontinuirane paravertebralne analgezije zahtijevali su oko 50% manje intravenskih analgetika u odnosu na kontrolnu skupinu. Nije uočena statistički značajna razlika u procjeni boli pomoću vizualno analogne skale niti u vrijednostima respiracijskih parametara osim kod FEV1 2. i 4. poslijeoperacijskog dana. Hospitalizacija je bila kraća i ocjena zadovoljstva veća kod bolesnika ispitne skupine.
Zaključno možemo reći da kontinuirana paravertebralna bokada značajno utječe na smanjenje boli kod korekcije skolioze prednjim pristupom kod djece i adolescenata.
Abstract (english) Aim: Surgical correction of scoliosis by anterior approach is a very extensive orthopaedic procedure. Pain after thoracotomy is one of the most intense types of pain and its treatment is a very complex procedure, especially in children and adolescents. Acute postoperative pain therapy is an important process, not only for the patient's comfort, but also for preventing complications, mainly respiratory. The aim of this study is to research the impact of continuous paravertebral nerve block on the intensity of pain in the early postoperative period, after the surgical correction of scoliosis by anterior approach. Methods: The research was conducted from May 2015 to December 2016 as a monocentric prospective study of 80 patients of ASA I and II status, aged 10-18 years. The test group consistsed of 40 patients with a paravertebral catheter applied with 0.25% levobupivacaine for continuous regional analgesia at a dose of 0,1 ml/kg/h. The 40 patients in the control group were intravenously given a combination of analgesics: metamizole at a dose of 0,5-1 gr and opioid analgesic tramadol at a dose of 2 mg/kg to a maximum of 100 mg. The intensity of pain after the operation was measured using the VAS scale at 1, 4, 8, 12, and 24 hours after the operation, then every 12 hours until the 5th postoperative day. Respiratory parameters FVC, FEV1 and PEF were determined before surgery in a sitting position on the bed and once daily until the 5th postoperative day. Analgesics consumption, the number of days in hospital, satisfaction with analgesia and overall satisfaction with the procedures were recorded. Results: Given the demographic characteristics, height, weight, age, gender and Cobb's angle, there were no statistically significant differences between the groups. The patients in the group with continuous paravertebral analgesia consumed about 50% less intravenous analgesics than the patients in the control group. Statistically significant difference was not found in the VAS scores nor was it found in the values of respiratory parameters, except for FEV1 of the second and the fourth postoperative days. The average grade for postoperative analgesia quality was 8,38 in the test group and 7,05 in the control group. This difference was statistically significant. The average satisfaction rating for all procedures was 7.48 in the test group and 6.60 in the
control group and is also statistically significantly different. In the test group the number of days in hospital was lower.
Conclusion: The results of this study show that continuous thoracic paravertebral blockade with the use of 0.25% of levobupivacaine achieves satisfactory postoperative analgesia with significantly lower consumption of opioid analgesics and fewer side effects. The multimodal approach, linking peripheral nerve blocks and systemic analgesia, was shown to be the most optimal in the treatment of postoperative pain. It is also important to mention that due to the lowered necessity for opioid analgesics decreases the chances of side effects, such as respiratory depression and addiction. The thoracic paravertebral block is an effective method for postoperative analgesia of children and adolescents after ventral spondylodesis in scoliosis correction.
Keywords
kontinuirana paravertebralna blokada
intravenska analgezija
terapija boli
torakotomija
korekcija skolioza
Keywords (english)
continuous paravertebral nerve block
intravenous analgesia
pain therapy
thoracotomy
scoliosis correction
Language croatian URN:NBN urn:nbn:hr:127:577724 Study programme Title: dental medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2020-01-22 13:17:48
