الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 221 |  |  |
| | | from | 221 | | |
Abstract
Thoracotomy, which is used for the exploration of the thoracic cavity and for the management of pulmonary, mediastinal, diaphragmatic and esophageal pathologies, can be performed posterolaterally, anterolaterally or anteriorly. Pain following thoracotomy may result in hypoxemia, depending on the altered mechanical functions of the lungs and ventilation–perfusion mismatch. The main causes of postoperative pain during the early period include intercostal muscle, soft tissue damages and rib fractures. Intravenous (IV) drugs such as opioids, non-steroidal anti-infammatory drugs (NSAIDs), local anesthetic injections to the wound site and regional anesthetic techniques are used to relieve thoracotomy pain. Among different regional anesthetics, thoracic epidural block, paravertebral block, intercostal block and intra/extrapleural block are frequently used. The midpoint transverse process to pleura (MTP) block has been described as an alternative end-point for thoracic paravertebral blockade. Our prospective randomized study aimed to evaluate the analgesic efficacy of pre-emptive of ultrasound-guided midpoint transverse process to pleura block in patients undergoing posterolateral thoracotomy. This study was carried out in Tanta University Hospitals from June2021 After approval of ethical committee, The study included 70 patients scheduled for posterolateral thoracotomy, Patients were randomly allocated into two equal groups: group I: underwent ultrasound-guided midpoint transverse process to pleura block after induction of general anesthesia and before surgical incision. group II: received general anesthesia and the same block intervention technique but instead of local anesthetic a placebo (2 ml normal saline) was injected. After induction of general anesthesia and before surgical anesthesia the patients underwent ultrasound-guided midpoint transverse process to pleura block (MTP) and Sham block. Measurements: 1. Heart rate and main arterial blood pressure were measured before block (base line value), after induction of general anesthesia, at end of surgery, at 0,4 , 8 ,12 ,18 hours postoperatively and time of rescue analgesia . 2. Postoperative NRS score was measured on scale from (0-10, where 0 =no pain and 10= the worst pain) at 0, 4 ,8 , 12 ,18 hours during rest and cough . 3. Time till administration of first rescue analgesia. 4. Total morphine consumption at 24 hours after surgery. 5. O2 saturation and SPO2/FIO2 ratio at 6, 8, 12 and 24 h postoperatively. 6. Development of chronic pain 3 months after surgery were measured. 7. Undesirable side effects as (nausea, vomiting, respiratory depression) was measured. The results of our study showed: 1. There was no statistically significant difference between the two groups as regard patients’ demographic data (age, sex and ASA physical status). 2. As regard HR the two groups showed no statistically significant difference at base line, after general anesthesia and at time of rescue analgesia but showed significant increase in mean HR values in (Sham) group as compared to (MTP) group after surgical incision, at end of surgery, 0, 4, 8, 12 and 18 hours. 3. As regard MAP there was statistically significant increase in (Sham) group as compared to (MTP) group at base line, after general anesthesia, after surgical incision, at end of surgery, 0, 4 ,8 ,12, 18 hours and time of rescue analgesia . 4. As regard NRS score there was statistically significant increase in (Sham) group as compared to (MTP) group at 0, 4, 8, 12 and 18 hours at rest and at cough. 5. There was significant delay in the onset of first rescue analgesia in (MTP) group as compared to (Sham) group. 6. The total 24 hours morphine consumption was significantly decreased in As (MTP) group as compared to (Sham) group. 7. As regard arterial oxygen saturation there was statistically significant decrease in (Sham) group as compared to (MTP) group at 6, 8 , 12 and 24 hours. 8. As regard SPO2/FIO2 there was statistically significant decrease in (Sham) group as compared to (MTP) group at 6, 8 , 12 and 24 hours. 9. As regard 3 months chronic postoperative pain there was statistically significant increase in (Sham) group as compared to (MTP) group. 10. As regard incidence of undesirable side effects there was statistically significant increase in (Sham) group as compared to (MTP) group.