Clinical Research Ethic Committee of Gaziantep University

This study is a retrospective study conducted after obtaining approval from the Clinical Research Ethics Committee (decision no: 2021/241, dated 07/07/2021). It was carried out by reviewing the recorded data of patients who underwent thoracotomy surgery in the Department of Anesthesiology and Reanimation at Gaziantep University Faculty of Medicine Şahinbey Research and Application Hospital between October 1, 2020, and May 31, 2021. The study was conducted in accordance with the "Ethical Principles for Medical Research Involving Human Subjects" outlined in the Declaration of Helsinki published by the World Medical Association in 2013.

This study included a total of 130 patients, aged 18-75 years, with ASA physical status scores of I, II, or III, who underwent thoracotomy surgery and received ultrasound-guided ESPB or TPVB for postoperative analgesia. Written informed consent was obtained from all participants. Patients were excluded from the study if they were emergency cases, had an ASA class IV or V status, had peripheral vascular disease, were pregnant, had heart failure, were allergic to local anesthetics, or if their medical records were inaccessible.

The patients were divided into two groups of 65 individuals each, based on the type of regional analgesia administered for thoracotomy. The groups were designated as Group 1 (patients who received ESPB) and Group 2 (patients who received TPVB). Data on patients' age, gender, ASA classification, height, body weight, BMI, comorbidities, smoking status, indication for thoracotomy, thoracotomy side, duration of operation, postoperative 0th, 3rd, 6th, 12th, 24th. VAS scores, average tramadol and morphine consumption, and the presence of postoperative nausea, pruritus, and shoulder pain were collected retrospectively from medical records.

A 20-gauge peripheral venous access was provided in the operating room, and a balanced electrolyte solution was initiated at 3-5 ml/kg/hour. After completing monitoring with electrocardiography (ECG), pulse oximetry (SpO2), and non-invasive arterial pressure (mmHg), 0.03 mg/kg midazolam (Zolamid 15 mg/3 ml, VEM İlaç, Ankara/Turkey) was administered to provide sedation. Intravenous induction was performed with 2 mg/kg propofol (Propofol Lipuro 1% 200 mg/20 ml, B. Braun Medikal Dış Ticaret A.Ş., Esenler/Istanbul), 1 μg/kg fentanyl (Talinat ampoule 0.5 mg/10 ml, VEM İlaç San. ve Tic A.Ş, Çankaya/Ankara), and 6 mg/kg rocuronium (Esmeron® vial 50 mg/5 ml, Merck Sharp Dohme İlaçları Ltd. Şti., Levent/Istanbul). Female patients were intubated with 35Fr and male patients with 37Fr double-lumen endotracheal tubes (Teleflex Medical, Sheridan® Sher-i-Bronch® Endobronchial Tube). Fiberoptic bronchoscopy was used to confirm the correct placement of the endobronchial tube. After the intubation procedure, all patients underwent radial artery catheterization and subclavian central venous catheterization using a 3-lumen, 8.5F central venous catheter (Gemed Sağlık Ürünleri San. Tic. Ltd. Şti., Kartal/Istanbul).

During the perioperative period, a lung-protective mechanical ventilation strategy was employed during both double-lung ventilation and single-lung ventilation. Anesthesia maintenance was initiated with sevoflurane (Sevorane® Liquid 100%, Baxter Turkey Renal Services Inc., Ostim/Ankara) at a rate of 2 L/min in a mixture of 55% air and 45% oxygen, maintaining a minimum alveolar concentration (MAC) between 1.0 and 1.5. For intraoperative analgesia, remifentanil (Rentanil® vial containing 5 mg lyophilized powder, VEM İlaç San. ve Tic A.Ş, Çankaya/Ankara) was started at a dose of 0.15 mcg/kg/min. Throughout the operation, EtCO2 levels were maintained between 30-35 mmHg.