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Abstract：
Background Thoracotomy is associated with severe postoperative pain. Pain developing after thoracotomy causes lung infections, inability to expel secretions, and atelectasis as a result of deep breathing. Effective management of acute pain after thoracotomy may prevent these complications. A multimodal approach to analgesia is widely employed by thoracic anesthetists using a combination of regional anesthetic blockade and systemic analgesia, with both non-opioid and opioid medications and local anesthesia blockade. Nowadays, regional anesthesia techniques such as thoracic epidural paravertebral block (PVB), erector spinae plane block (ESPB), and serratus plane block are frequently used to prevent pain after thoracotomy. In this study, we compared paravertebral block with erector spinae block for pain relief after thoracotomy. Our primary aim was to determine whether there was a difference between postoperative opioid consumption and pain scores. We also compared the two regional anesthesia techniques in terms of intraoperative hemodynamic data and postoperative complications. Methodology Patients aged between 18 and 75 years with an American Society of Anesthesiology (ASA) physical status I-III and scheduled for elective thoracotomy were included in the study. Using www.randomizer.org, patients were divided into two different groups, namely, ESPB and PVB. All patients were provided with a patient-controlled analgesia device preloaded with morphine. Postoperative 24-hour morphine consumptions were recorded. Results Data from 45 patients were used in the final analyses. Morphine consumption was higher in the ESPB group than in the PVB group at 24 hours postoperatively (19.2 ± 4.26 mg and 16.2 ± 2.64 mg, respectively; p < 0.05). There was no significant difference in numerical rating scale scores both at rest and with coughing (p > 0.05). Intraoperative heart rates were similar between groups. However, mean intraoperative blood pressure was significantly lower in the PVB group at 30 minutes (p < 0.05). Nausea and vomiting were observed in two patients in the ESPB group and one patient in the PVB group. The complication of nausea and vomiting was not statistically significant between the two groups (p > 0.05). Catastrophic complications such as hematoma, pneumothorax, and local anesthetic systemic toxicity were not observed in either group. Conclusions We found that patients who underwent PVB consumed less morphine postoperatively than patients who underwent ESPB. However, we did not observe any difference in pain scores between both groups. We think that ESPB can be considered a reliable method in thoracotomy surgery due to its ease of application and the fact that the place where the block is technically performed is farther from the central structures compared to PVB. In light of the results of our study, ESPB can be used as an alternative to PVB, which has been proven as postoperative analgesia in thoracic surgery.
摘要：
背景开胸手术与严重的术后疼痛有关。开胸手术后出现的疼痛会导致肺部感染，无法排出分泌物,深呼吸导致的肺不张。有效管理开胸手术后的急性疼痛可以预防这些并发症。胸麻醉师广泛采用多模式镇痛方法，将局部麻醉阻滞和全身镇痛相结合，同时使用非阿片类药物和阿片类药物和局部麻醉阻滞。如今,区域麻醉技术，如胸段硬膜外椎旁阻滞（PVB），竖脊肌平面块（ESPB），和锯齿肌平面阻滞经常用于预防开胸手术后的疼痛。在这项研究中,我们比较了椎旁阻滞与竖脊阻滞在开胸术后疼痛缓解方面的作用。我们的主要目的是确定术后阿片类药物消耗和疼痛评分之间是否存在差异。我们还在术中血流动力学数据和术后并发症方面比较了两种区域麻醉技术。方法研究包括年龄在18至75岁之间，具有美国麻醉学协会（ASA）身体状况I-III并计划进行选择性开胸手术的患者。使用www。randomizer.org,患者被分为两个不同的组，即,ESPB和PVB。为所有患者提供了预装吗啡的患者自控镇痛装置。记录术后24小时吗啡消耗量。结果45例患者的数据用于最终分析。术后24小时，ESPB组的吗啡消耗量高于PVB组（19.2±4.26mg和16.2±2.64mg，分别为；p<0.05)。在休息和咳嗽时，数字评分量表评分均无显著差异（p>0.05）。术中心率相似。然而,PVB组术中平均血压在30分钟时显著降低(p<0.05).在ESPB组2例患者和PVB组1例患者中观察到恶心和呕吐。两组间恶心呕吐并发症比较差异无统计学意义(p>0.05)。血肿等灾难性并发症，气胸,两组均未观察到局部麻醉药的全身毒性。结论我们发现，接受PVB的患者术后消耗的吗啡少于接受ESPB的患者。然而,我们没有观察到两组之间疼痛评分的任何差异.我们认为ESPB可以被认为是开胸手术中的可靠方法，因为它易于应用，并且与PVB相比，技术上进行阻滞的地方离中心结构更远。根据我们的研究结果,ESPB可以用作PVB的替代品，这已被证明是胸外科手术的术后镇痛。
