Video yardımcılı torakal cerrahi sonrası postoperatif analjezi yönetimi için ultrasonografi rehberliğinde yapılan erektor spina plan bloğu ve torakal paravertebral blok etkinliği: Prospektif, randomize, kontrollü çalışma

Objective: Evaluation of the effectiveness of ultrasound (US)-guided erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) compared to no intervention control group for postoperative pain management in video assisted thoracic surgery (VATS) patients. Method: Three groups - Group ESPB, Group TPVB and the control group (n=30 per group) were included in this prospective, randomized, controlled study. The US-guided blocks were performed preoperatively in the ESPB and TPVB groups. Intravenous patient-controlled postoperative analgesia via fentanyl was administered in all of the patients. The patients were evaluated using visual analogue scale (VAS) scores, opioid consumption, and adverse events. Results: At all time intervals fentanyl consumption and VAS scores were significantly lower both in ESPB and TPVB groups compared to the control group (p<0.001). Block procedure time was significantly lower and success of one time puncture was higher in Group ESPB as compared with that in Group TPVB (p<0.001). Conclusion: ESPB and TPVB provide more effective analgesia compared to control group in patients who underwent video-assisted thoracic surgery. ESPB had a shorter procedural time and higher success of single-shot technique compared to TPVB.Amaç: Video yardımcılı torakal cerrahi yapılan hastalarda postoperatif analjezi yönetimi içinultrasonografi (US) eşliğinde yapılan erektor spina plan bloğu (ESPB) ve torakal paravertebralbloğun (TPVB) kontrol grubuna göre etkinliğinin değerlendirilmesi amaçlanmıştır.Yöntem: Bu çalışmaya her grup için 30 hasta olmak üzere toplam 90 hasta dahil edilmiştir.Çalışma 3 gruptan oluşmaktadır; Grup ESPB, Grup TPVB ve Kontrol Grubu. ESPB ve TPVB gruplarındaki hastalara preoperatif olarak US eşliğinde blok yapıldı. Tüm gruplardaki hastalara fentaniliçeren hasta kontrollü analjezi (HKA) uygulandı. Hastalar vizuel analog skala (VAS), opioid tüketimi ve yan etkiler kaydedilerek değerlendirildi.Bulgular: Tüm zaman aralıklarında fentanil tüketimi ve VAS Grup ESPB ve Grup TPVB de kontrolgrubuna göre anlamlı olarak daha düşüktü (p<0.001). Blok işlem süresi ESPB grubunda anlamlıolarak daha kısaydı ve iğne ile tek giriş başarısı ESPB grubunda TPVB grubuna göre anlamlı olarakdaha yüksekti (p<0.001).Sonuç: ESPB ve TPVB, video yardımcılı torakal cerrahi yapılan hastalarda kontrol grubuna göreetkili analjezi oluşturmaktadır. ESPB, TPVB’ye göre daha kısa işlem süresi ve tek iğne girişi ile dahayüksek başarı oranına sahiptir

Long-term Outcome of patients with undiagnosed pleural effusion

Introducción: En algunos pacientes no es posible establecer la causa del derrame pleural exudativo. Se han analizado los resultados del seguimiento a largo plazo de pacientes con derrame pleural no diagnosticado. Métodos: Se evaluó retrospectivamente a pacientes con derrame pleural exudativo a los que se les había realizado una biopsia pleural mediante cirugía toracoscópica videoasistida (VATS) entre 2008 y 2012 como parte de los procedimientos diagnósticos. En el estudio se incluyó a 53 pacientes con diagnóstico de pleuritis inespecífica y con datos de seguimiento disponibles. Resultados: Se incluyó a 40 varones y 13 mujeres (promedio de edad, 53,9 ± 13,9 anos). ˜ La mediana de tiempo de seguimiento fue de 24 meses. Durante el seguimiento no se llegó a un diagnóstico en 27 pacientes (51%) y se alcanzó diagnóstico clínico en los 26 pacientes restantes (49%). A 2 pacientes (3,7%) se les diagnosticó neoplasia maligna (mesotelioma maligno). Otras enfermedades diagnosticadas fueron derrame paraneumónico en 12 casos, insuficiencia cardíaca congestiva en 8 casos y otras afecciones en 4 pacientes. El volumen del derrame en la exploración inicial y la reacumulación de fluido tras VATS se asociaron a neoplasia maligna (p=0,004 y 0,0001, respectivamente). Conclusión: Aunque la probabilidad es baja, los pacientes con derrame pleural exudativo y sin diagnóstico tras una biopsia pleural mediante VATS pueden tener neoplasia maligna. Es necesario controlar cuidadosamente a los pacientes con un volumen de derrame inicial alto que reaparece tras la exploración.Introduction: The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed. Methods: Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study. Results: Forty men and 13 women (mean age 53.9 ± 13.9 years) were included. Median follow-up time was 24 months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P = .004 and .0001, respectively). Conclusion: Although the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored