مقایسه بوپیواکایین اینتراپلورال با کرایوآنالژزی بر روی درد

Aim and Background:Thoracotomy is one of the most painful operations and many attempts have been done to provide analgesia after surgery to make convenience for the patient and prevent from major complications too. Intercostal cryoanalgesia, local anesthetic drugs administration through intrapleural catheter, intravenous or epidural opioid administration are some applied methods. In this study there is a comparison in level of analgesia after thoracotomy between intrapleural bupivacaine and cryoanalgesia, and also the influence of these 2 methods on prevention of FEV1 and FVC reduction is investigated. Methods and Materials: This clinical trial study was performed on 50 patients in ASA Class I, II which were among 20 to 70 years old and candidate for elective thoracotomy and divided into 2 groups randomly(each groups were consisted of 25 patients). In the first group, 40ml 0.25 percent bupivacaine was administered per each 6h through intrapleural at the end of surgery. In the second group, at the end of operation cryoanalgesia was performed to intercostals nerves, at the level of incision, 2 cranial and 2 caudal. Pain score of the patients was recorded during 24 hours post operation on the base of visual analogue score(VAS). If the patient is needed more analgesia, 30mg intravenous meperidine was administrated and it was recorded. Every patient underwent spirometery before surgery and also 48h and one week post operation. The data was analyzed by spss software and T-test and Mann-whitney test at the end. The difference between data on every point with p<0.05 considered significant. Findings: There was a significant difference between the two groups in meperidine requirements(P=0/033). But there was no significant difference in post operation pain score and rate of improvement in FEV1 and FVC between 2 groups. Also there was no significant difference between two groups in rate of FVC and FEV1 depended on the type of operation. Conclusions: Our study showed that rate of meperidine requirements for supplementary analgesia in intrapleural bupivacaine group is less than cryoanalgesia group. But there is no significant difference between groups in pain score and of FEV1 and FVC, and it is not possible to make an assessment because of sample insufficiency and it is needed to be more investigated.