Effects of the prolonged thoracic epidural analgesia on ventilation function and complication rate after the lung cancer surgery
| Autor: | Māris Mihelsons, Nataļja Jakušenko, Sanita Udre, Immanuels Taivans, Uldis Kopeika, Gunta Strazda |
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| Rok vydání: | 2007 |
| Předmět: |
Plaučiai--Komp¬likacijos
Vital capacity medicine.medical_specialty Lung Neoplasms Time Factors medicine.medical_treatment Vital Capacity Anesthesia General Lungs--Surgery Pneumonectomy Postoperative Complications thoracic epidural analgesia Carcinoma Non-Small-Cell Lung Forced Expiratory Volume medicine Humans Prospective Studies Prospective cohort study Lungs--Complications Pain Measurement Lung cancer surgery Pain Postoperative business.industry Mortality rate Incidence Postoperative complication lung function General Medicine Surgery lung surgery postoperative complications Analgesia Epidural Anesthesia Data Interpretation Statistical Anesthetic Breathing Plaučiai--Chirurgija business Pulmonary Ventilation medicine.drug |
| Zdroj: | Medicina Volume 43 Issue 3 Medicina, ISSN 1010-660X, 2007, T. 43, Nr. 3, p. 199-207 Scopus-Elsevier Medicina; Volume 43; Issue 3; Pages: 199 |
| ISSN: | 1648-9144 |
| Popis: | Thoracic epidural analgesia has been considered to have a good anesthetic efficacy and to decrease the postoperative complication rate, while its effect upon the ventilation function is still the topic of many clinical studies. The aim of this study was to evaluate the course of early postoperative period using thoracic epidural analgesia. Material and methods. A total of 453 patients undergoing the operation due to the non–small cell carcinoma were selected and examined. Their postoperative complications and mortality rate were evaluated. In 79 patients, arterial oxygen saturation (SaO2), forced vital capacity, forced expiratory volume in the first second, and the efficacy of analgesia were analyzed within the first 7 days after the operation. These patients were divided into subgroups according to the type of the operation – lobectomy or pneumonectomy – and the type of analgesia – thoracic epidural analgesia or opiates administered intramuscularly (control group). Results. A better statistically significant efficacy of analgesia was observed in thoracic epidural analgesia group than in the control group (visual analog pain scale score 2.5 versus 5.3, P< 0.01). There was also a statistically significant lower incidence of postoperative complications (20.5% versus 38.8%, respectively). Thoracic epidural analgesia is a factor decreasing the relative risk of complications (RR=0.53, 95% CI 0.28–0.99, P=0.0233). In the lobectomy group, 24 hours after the surgery, forced vital capacity was 61±12% in the group receiving thoracic epidural analgesia and 45±13% in the control group (P=0.0152) forced expiratory volume in the first second was 56±17% and 41±11%, respectively (P=0.0308). In the pneumonectomy group, 24 hours after the surgery, forced vital capacity was 47±16% in the group receiving thoracic epidural analgesia, 35±8% in the control group (P=0.080). Forced expiratory volume in the first second was 47±15% and 36±7%, respectively (P=0.0449). Conclusion. We conclude that analgesia with intramuscularly administered opioids provides unsatisfactory analgesia, especially in the first days after the operation. Thoracic epidural analgesia is a safe method, which provides a better quality of life for the patient, decreases the postoperative complication rate, and improves the ventilation function after the lung operations. |
| Databáze: | OpenAIRE |
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