hrvatski

Učinkovitost interkostalne blokade na poslijeoperacijsku bol i potrošnju analgetika nakon prednje spondilodeze kod korekcije skolioze

Aim: Surgical correction of scoliosis by anterior approach is a very extensive orthopedic procedure. Pain after thoracotomy is one of the most intense types of pain, and its treatment is a very complex procedure. In scoliosis surgery, the majority of patients are children and adolescents, and good analgesia is of even greater importance. The aim of this study was to examine the impact of intercostal nerve block on analgesic consumption and patient satisfaction in the early postoperative period after surgical correction of scoliosis by anterior approach. Methods: The study included 80 patients diagnosed with thoracic and thoracolumbar scoliosis having undergone anterior spondylodesis. The study group (group I) consisted of 40 patients administered intercostal block in the dermatome of incision and two adjacent dermatomes, with 10 mL 0.5% levobupivacain (Chirocaine, Abbott, Latina, Italy) ; control group (group NI) of 40 patients received intravenous analgesia for pain intensity of 6 or more on the visual analog scale, with a single dose of opioid analgesics (Tramal 2 mg/kg, max 100 mg), and for pain intensity of 4-6 a single dose of a nonsteroidal antirheumatic drug (metamizole 1 g). We observed differences in the consumption of opioid analgesics and nonsteroidal anti-infl ammatory drugs (NSAIDs) during the fi rst fi ve postoperative days, patient general satisfaction and satisfaction with analgesia. Results: Postoperative consumption of opioid analgesics did not differ on the fi rst postoperative day (group I 2.2 vs. group NI 2.4 doses), but did differ on the third, fourth and fi fth postoperative days. A statistically signifi cant reduction in opioid consumption was observed on the second postoperative day (group I 1.6 vs. control group 2.1 doses ; p<0.03). There was no difference between group I and group NI in the consumption of NSAIDs during the fi rst fi ve postoperative days. The mean score for the postoperative analgesia quality was 8.6 in group I and 6.8 in control group (p<0.03). Respiratory complications such as atelectasis and pneumonia were not reported in any of the patients. Conclusion: In conclusion, we can say that infi ltration techniques reduce consumption of intravenous analgesics in the early postoperative period in young patients and increase satisfaction with the overall course of treatment. There is the need for continuous infi ltration analgesic techniques and their clinical validity should be confi rmed by prospective studies.

interkostalni blok ; intravenska analgezija ; terapija boli ; torakotomija ; korekcija skolioze

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