Cumhuriyet Üniversitesi Tıp Fakültesi Göğüs Cerrahisi AD, Sivas

Objective: Postthoracotomy pain has long been recognized as a cause of postoperative morbidity, resulting in inadequate ventilation, coughing, atelectasis, hypoxia and pulmonary infection. Effective analgesia provides early mobilization after surgery and reduces morbidity. In this prospective clinical study we compared the effects of the three different analgesic agents on postthoracotomy pain. Method: Forty-five patients, ASA I-III, undergoing elective thoracotomy were randomized into four groups for intraoperative intercostal nerve blockade using 20% prilocaine (Group I, n=12), 0.5% bupivacaine (Group II, n=12), 0.75% ropivacaine (Group III, n=11) and none (Control Group, n=10). Postoperative pain was assessed by a visual analogue scale (VAS) at rest and cough and by Prince Henry Pain Scale (PHPS) at recovery room, 2., 4., 8., 12., 24., 48. hours. Mean arterial pressure, heart rate, respiratory rate and peripheral oxygen saturation were recorded. Food intake and analgesic consumption were investigated. Results: Demographic data, operation type and time were similar in all groups. There were no significant differences in all groups with respect to mean arterial pressure, heart rate, respiratory rate and peripheral oxygen saturation values. The VAS scores at rest and cough were lower in group III patients, particulary during the first 12 hours postoperatively. Food intake and analgesic consumption were not significantly different between groups. Conclusion: After thoracotomy, elimination of pain with an effective analgesic may accelerate recovery and reduce complication rates. Intercostal nerve blockade is an effective, safe and easy method in the treatment of postthoracotomy pain.