Zengin Musa, Alagoz Ali
Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR.
Cureus. 2021 Oct 22;13(10):e18982. doi: 10.7759/cureus.18982. eCollection 2021 Oct.
Background Thoracic epidural analgesia (TEA) and thoracic paravertebral block (TPVB) are commonly used in geriatric patients for pain management after thoracotomy. In this study, we aimed to investigate the effect of TEA and TPVB on postoperative analgesia in geriatric patients who underwent thoracotomy. Methodology Postoperative analgesia follow-up files of patients over 65 years of age who underwent thoracotomy were analyzed retrospectively. Patient's demographic data, diagnosis, type of surgery, postoperative 24-hour mean arterial pressure (MAP), heart rate, respiratory rate, peripheral oxygen saturation, static/dynamic visual analog scale (VAS) scores, need for additional analgesics, global pain assessment, and side effects such as nausea, vomiting, hypotension, bradycardia, and respiratory depression were examined. The patients were divided into two groups: those treated with TEA (Group 1) and those treated with TPVB (Group 2). Results There was no statistically significant difference between the groups in terms of demographic data (p > 0.05). MAP in the TEA group was statistically significantly lower than in the second and sixth-hour TPVB group (p = 0.008, p < 0.001). VAS static scores in the TEA group were statistically significantly lower at 30 minutes (p = 0.001), and at one, two, six, twelve, and twenty-four hours compared to the TPVB group (p < 0.001, except at 30 minutes). VAS dynamic scores were statistically significantly lower in the TEA group at 30 minutes, and at one, two, six, twelve, and twenty-four hours compared to the TPVB group (p < 0.001). There was no statistically significant difference between the groups in terms of nausea, vomiting, hypotension, and bradycardia (p > 0.05). The use of additional analgesics in the TEA group was statistically significantly lower than in the TPVB group (p < 0.001). Conclusions More effective postoperative analgesia results with stable hemodynamic conditions were observed in geriatric patients who underwent TEA for thoracotomy compared to TPVB. Regarding side effects, although there was a lower incidence in TPVB, this was not statistically significant when compared to TEA. TEA, as a component of the multimodal analgesia approach, can be accepted as a safe and effective method in the elderly patient group who underwent thoracotomy.
胸段硬膜外镇痛（TEA）和胸段椎旁阻滞（TPVB）常用于老年患者开胸术后的疼痛管理。在本研究中，我们旨在调查TEA和TPVB对老年开胸患者术后镇痛的影响。
回顾性分析65岁以上开胸患者的术后镇痛随访档案。检查患者的人口统计学数据、诊断、手术类型、术后24小时平均动脉压（MAP）、心率、呼吸频率、外周血氧饱和度、静态/动态视觉模拟量表（VAS）评分、额外镇痛药物的需求、整体疼痛评估以及恶心、呕吐、低血压、心动过缓和呼吸抑制等副作用。患者分为两组：接受TEA治疗的患者（第1组）和接受TPVB治疗的患者（第2组）。
两组在人口统计学数据方面无统计学显著差异（p>0.05）。TEA组的MAP在统计学上显著低于TPVB组在第2小时和第6小时的MAP（p = 0.008，p<0.001）。与TPVB组相比，TEA组的VAS静态评分在30分钟时（p = 0.001）以及在1小时、2小时、6小时、12小时和24小时时均有统计学显著降低（除30分钟外，p<0.001）。与TPVB组相比，TEA组的VAS动态评分在30分钟时以及在1小时、2小时、6小时、12小时和24小时时均有统计学显著降低（p<0.001）。两组在恶心、呕吐、低血压和心动过缓方面无统计学显著差异（p>0.05）。TEA组额外镇痛药物的使用在统计学上显著低于TPVB组（p<0.001）。
与TPVB相比，接受TEA开胸手术的老年患者术后镇痛效果更有效，血流动力学条件更稳定。关于副作用，虽然TPVB的发生率较低，但与TEA相比无统计学显著差异。TEA作为多模式镇痛方法的一部分，可被认为是老年开胸患者组中一种安全有效的方法。
