Ulger Gulay, Baldemir Ramazan
Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR.
Cureus. 2021 Dec 28;13(12):e20781. doi: 10.7759/cureus.20781. eCollection 2021 Dec.
Background Although video-assisted thoracoscopic surgery (VATS) is a less invasive technique compared to thoracotomy, patients often experience postoperative pain. Hence, intravenous patient-controlled analgesia (PCA) is frequently used. The geriatric age group constitutes a significant portion of patients undergoing thoracic surgery. However, pain management can often be difficult in elderly patients. In this study, we aimed to examine the pain management techniques applied in geriatric patients who underwent VATS and to compare the efficacy and side effects of PCA with morphine and tramadol. Methodology The following patients were included in this study: aged 65 years and older, those who underwent elective VATS under general anesthesia, and those who underwent thoracic paravertebral block in the operating room for postoperative pain. We recorded diagnoses, demographic data, American Society of Anesthesiologists status, complications developed during the intraoperative or postoperative 24 hours, postoperative rest and cough Visual Analog Scale (VAS), and need for additional analgesics. The patients were divided into the following two groups: those treated with tramadol PCA (tramadol group) and those treated with morphine PCA (morphine group). Results A total of 65 patients were included in this study. Overall, 22 patients were administered tramadol PCA while 43 were administered morphine PCA. There was no statistically significant difference between the groups concerning complications. The 24-hour VAS resting score was statistically significantly lower in patients administered morphine than those administered tramadol (p < 0.05). There was no statistically significant difference between the groups concerning zero-minute, thirty-minute, one-hour, two-hour, six-hour, and twelve-hour VAS resting and cough scores at all times (p > 0.05). Conclusions There was no significant difference in the tramadol and morphine groups concerning analgesic efficacy, patient satisfaction, and side effects among geriatric patients who underwent VATS and were administered intravenous PCA. In our view, both tramadol and morphine can be used safely in geriatric patients requiring intravenous PCA. Moreover, because the 24-hour analgesic efficacy was observed to be better in the morphine group in our study, morphine can be preferred in geriatric patients.
背景 尽管与开胸手术相比，电视辅助胸腔镜手术（VATS）是一种侵入性较小的技术，但患者术后常经历疼痛。因此，静脉自控镇痛（PCA）经常被使用。老年患者群体在接受胸外科手术的患者中占很大比例。然而，老年患者的疼痛管理往往很困难。在本研究中，我们旨在检查应用于接受VATS的老年患者的疼痛管理技术，并比较吗啡和曲马多PCA的疗效和副作用。
方法 本研究纳入以下患者：年龄65岁及以上、在全身麻醉下接受择期VATS的患者，以及在手术室接受胸椎旁神经阻滞用于术后疼痛的患者。我们记录了诊断、人口统计学数据、美国麻醉医师协会状态、术中或术后24小时出现的并发症、术后静息和咳嗽视觉模拟量表（VAS）评分，以及额外镇痛药物的需求。患者被分为以下两组：接受曲马多PCA治疗的患者（曲马多组）和接受吗啡PCA治疗的患者（吗啡组）。
结果 本研究共纳入65例患者。总体而言，22例患者接受曲马多PCA，43例患者接受吗啡PCA。两组在并发症方面无统计学显著差异。接受吗啡治疗的患者24小时VAS静息评分在统计学上显著低于接受曲马多治疗的患者（p < 0.05）。在所有时间点，两组在零分钟、三十分钟、一小时、两小时、六小时和十二小时的VAS静息和咳嗽评分方面均无统计学显著差异（p > 0.05）。
结论 在接受VATS并接受静脉PCA的老年患者中，曲马多组和吗啡组在镇痛效果、患者满意度和副作用方面无显著差异。我们认为，曲马多和吗啡均可安全用于需要静脉PCA的老年患者。此外，由于在我们的研究中观察到吗啡组24小时镇痛效果更好，因此吗啡可作为老年患者的首选。
