Total diz artroplastisi olacak hastalarda postoperatif analjezi amaçlı bupivakain, lidokain ve bupivakain+lidokain karışımıyla ultrasonografi eşliğinde yapılan femoral sinir bloğunun analjezik etkilerinin karşılaştırılması
Küçük Resim Yok
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda genel anestezi altında total diz artroplastisi (TDA) yapılacak olgularda erken postoperatif ağrı tedavisi için Ultrasonografi (US) eşliğinde lidokain, bupivakain ve lidokain+bupivakain karışımıyla yapılan femoral sinir bloğunun analjezik etkinliklerini araştırmayı ve karşılaştırılmayı amaçladık. Genel anestezi altında total diz artroplastisi planlanan, 40-80 yaş arası, ASA I-III fiziksel statüsü olan 66 hasta çalışmaya dahil edildi. Hastalar Grup B (Bupivakain Grubu), Grup L (Lidokain Grubu) ve Grup B+L (Bupivakain+ Lidokain Grubu) olarak rastgele 3 gruba (her grupta 22 hasta) ayrıldı. Hastalar monitorizasyonu takiben, standart olarak anestezi indüksiyonu 2 mg/ kg Propofol, 1 mcg/kg Fentanil ve kas gevşemesi 0,6 mg/kg Rokuronyum verilerek yeterli bilinç kaybı ve kas gevşemesi sağlandıktan sonra entübe edilerek end-tidal CO2 değerleri 34 ile 38 mmHg arasında olacak şekilde mekanik ventilatöre bağlandı. Anestezi idamesinde 3 lt/dk taze gaz akımı içinde %50 N2O/O2 karışımı ve % 1.5-2.0 sevofluran kullanıldı. Grup B'deki hastalar için 15 mL %0,5'lik Bupivakain HCI, Grup L'dekiler için 15 mL %2'lik Lidokain HCI ve Grup B+L için ise 7,5 mL %0,5'lik Bupivakain ve 7,5 mL %2'lik Lidokain karışımı hazırlanarak US eşliğinde femoral sinir bloğu yapıldı. Femoral sinir bloğu hasta ekstübe edilmeden önce genel anestezi altında, yüksek çözünürlüklü US cihazının lineer probuyla femoral sinir tespit edilip 22-gauge iğne kullanılarak gerçekleştirildi. Ekstübe edilen hastalar postanestezik bakım ünitesine alınarak 1 saat boyunca takip edildi. Tüm hastalara günde 4 defa 1 gr parasetamol iv verildi. VAS değeri 4 ve üstünde olan hastalara 4 mcg/mL tramadol konsantrasyonuyla hazırlanan HKA cihazı intravenöz yolla başlandı. HKA yöntemine rağmen ağrı kontrol edilemediğinde (VAS 5 cm ve üzerinde ise) Petidin HCl 0.5 mg/kg iv uygulanarak yeterli analjezi sağlandı. Gruplar arası demografik ve klinik özellikler açısından istatistiksel olarak anlamlı fark bulunmadı (p>0,05). Grup B'de, Grup L ve Grup B+L'ye göre 8. ve 12. saatteki VAS istirahat ve hareket medyan değerleri istatistiksel olarak anlamlı derecede daha düşük bulundu (p<0,001). Grup B'de, Grup L ve Grup B+L'ye göre; 0-12. saat, 12-24. saat ve total tramadol tüketim miktarı istatistiksel olarak anlamlı derecede daha düşük bulundu (p<0,05). Grup B'de, Grup L ve Grup B+L'ye göre hasta memnuniyeti istatistiksel olarak anlamlı derecede daha yüksek bulundu (p<0,05). Genel anestezi altında total diz artroplastisi yapılan hastalarda postoperatif analjezi amacıyla ultrasonografi eşliğinde yapılan femoral sinir bloğunun postoperatif erken dönemde etkin analjezi sağladığı, opioid tüketimini azalttığı, genel anestezi sonrasında oluşan cerrahiye bağlı şiddetli ağrıyı önlediği ve hasta memnuniyetini artırdığı ayrıca bupivakainle yapılan femoral sinir bloğunun ise TDA'ya bağlı postoperatif ağrı kontrolünde ve opioid tüketimini azaltmada lidokain ve bupivakain+lidokain'den daha faydalı olacağı kanısındayız.
The aim of this study is to investigate the effects of ultrasonography (US) guided femoral nerve block with lidocaine, bupivacaine and mixture of bupivacaine +lidocaine for the early postoperative pain treatment in the patients undergoing total knee arthroplasty (TDA) under general anesthesia. Sixty-six ASA physical status I–III patients, aged 40-80 years, undergoing unilateral total knee arthroplasty were enrolled in this clinical study. Patients were randomly assigned into 3 groups (each group 22 patients); Group B (Bupivacaine Group), Group L (Lidocaine Group) and Group B + L (Bupivacaine + Lidocaine Group). After the monitoring, the induction of anaesthesia was achieved with Propofol 2 mg/kg, 1 mcg/kg Fentanyl and 0.6 mg/kg Rocuronium was used for muscle relaxation. After endotracheal intubation, the patients were mechanically ventilated to maintain their end-tidal CO2 values between 34 and 38?mmHg. In 3 lt/min fresh gas flow with mixture of %50 N2O/O2 and % 1.5-2.0 Sevoflurane was used for maintenance of anesthesia. US guided femoral nerve block performed with 15 mL of 0.5% Bupivacaine HCI to Group B, 15 mL 2% Lidocaine HCI to Group L and 7.5 mL of 0.5% Bupivacaine HCI and 7.5 mL of 2% Lidocaine HCI to Group B + L under general anesthesia. After the femoral nerve block, the patients were extubated. All the patients admitted to the postanaesthesia care unit, were followed for at least 1?h until complete recovery. After arrival in the postanesthesia care unit, the patients were connected to a PCA device and administered with tramadol HCl (50?mg bolus dose, 20?min lockout time) via this device. Pain scores, tramadol consumption and side effects were recorded by one of the authors blinded to the patient group. Pethidine HCl was administered 0.5?mg/kg intravenously as a rescue analgesia if the VAS value was >5. There were no statistically significant differences between the groups in terms of their age, sex, demographics, and clinical characteristics (P > 0.05 for all). The median VAS scores of rest and action at the 8th and the 12th hour was significantly lower in Group B than in Group L and Group B+L (P< 0.001 for both). It was found that tramadol consumption in Group B was statistically significant lower than Group L and Group B+L Group C within the postoperative 0-12 h, 12-24 h and 0–24?h period (P < 0.05 for all). Group B showed statistically significant higher patient satisfaction compared to Group L and Group B+L (p < 0.05). Based on this study, US guided single shot femoral nerve block provides effective analgesia in early postoperative period, reduces opioid consumption and increase the patient satisfaction. Also single shot femoral block with bupivacaine is much more effective than lidocaine and bupivacaine + lidocaine.
The aim of this study is to investigate the effects of ultrasonography (US) guided femoral nerve block with lidocaine, bupivacaine and mixture of bupivacaine +lidocaine for the early postoperative pain treatment in the patients undergoing total knee arthroplasty (TDA) under general anesthesia. Sixty-six ASA physical status I–III patients, aged 40-80 years, undergoing unilateral total knee arthroplasty were enrolled in this clinical study. Patients were randomly assigned into 3 groups (each group 22 patients); Group B (Bupivacaine Group), Group L (Lidocaine Group) and Group B + L (Bupivacaine + Lidocaine Group). After the monitoring, the induction of anaesthesia was achieved with Propofol 2 mg/kg, 1 mcg/kg Fentanyl and 0.6 mg/kg Rocuronium was used for muscle relaxation. After endotracheal intubation, the patients were mechanically ventilated to maintain their end-tidal CO2 values between 34 and 38?mmHg. In 3 lt/min fresh gas flow with mixture of %50 N2O/O2 and % 1.5-2.0 Sevoflurane was used for maintenance of anesthesia. US guided femoral nerve block performed with 15 mL of 0.5% Bupivacaine HCI to Group B, 15 mL 2% Lidocaine HCI to Group L and 7.5 mL of 0.5% Bupivacaine HCI and 7.5 mL of 2% Lidocaine HCI to Group B + L under general anesthesia. After the femoral nerve block, the patients were extubated. All the patients admitted to the postanaesthesia care unit, were followed for at least 1?h until complete recovery. After arrival in the postanesthesia care unit, the patients were connected to a PCA device and administered with tramadol HCl (50?mg bolus dose, 20?min lockout time) via this device. Pain scores, tramadol consumption and side effects were recorded by one of the authors blinded to the patient group. Pethidine HCl was administered 0.5?mg/kg intravenously as a rescue analgesia if the VAS value was >5. There were no statistically significant differences between the groups in terms of their age, sex, demographics, and clinical characteristics (P > 0.05 for all). The median VAS scores of rest and action at the 8th and the 12th hour was significantly lower in Group B than in Group L and Group B+L (P< 0.001 for both). It was found that tramadol consumption in Group B was statistically significant lower than Group L and Group B+L Group C within the postoperative 0-12 h, 12-24 h and 0–24?h period (P < 0.05 for all). Group B showed statistically significant higher patient satisfaction compared to Group L and Group B+L (p < 0.05). Based on this study, US guided single shot femoral nerve block provides effective analgesia in early postoperative period, reduces opioid consumption and increase the patient satisfaction. Also single shot femoral block with bupivacaine is much more effective than lidocaine and bupivacaine + lidocaine.
Açıklama
Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
