Ortopedik alt ekstremite cerrahisinde spinal anestezi ile kombine siyatik-femoral sinir bloğunun karşılalaştırılması
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Çalışmamızda, spinal anestezi tekniği ile kombine siyatik-femoral blok tekniklerini karşılaştırmayı amaçladık. Çalışmamız, prospektif ve randomize olarak planlandı. Dicle Üniversitesi Tıp Fakültesi Etik Kurulu onayı alındıktan sonra elektif alt ekstremite operasyonu planlanmış, ASA 1–2 grubu, 18–65 yaşları arasındaki 60 hasta çalışmaya dahil edildi. Her grupta 30 kişi olacak şekilde spinal anestezi grubu (Grup S) ve kombine siyatik femoral sinir bloğu grubu (Grup KSFB) olarak iki gruba ayrıldı. Rejyonal blok odasına alınan hastalar rutin monitörize edildi (Nb, SpO2, NIBP). Spinal anestezi grubunda; Tüm hastalara oturur pozisyonda, 26 G spinal iğne ile L3-L4 veya L4-L5 lomber aralığından, 2 cc % 0.5 levobupivakain uygulandı. Kombine siyiatik-femoral blok grubunda; 20 cc % 0.5’lik levobupivakain, 10 cc % 2’lik prilokain, 10 cc izotonik karıştırılarak, toplam 40 cc olacak şekilde lokal anestezik solüsyonu hazırlandıktan sonra önce siyatik blok, bunu takiben femoral blok uygulandı. Tekniğin uygulanma zamanı, hastayı cerrahi ekibe teslim süresi, tam motor blok oluşma zamanı, hastalardaki hemodinamik değişiklikler, cerrahi sırasında ve postoperatif dönemde oluşan komplikasyonlar, intraoperatif ek analjezik ihtiyacı, motor blok süresi, postoperatif ilk analjezik gereksinim zamanı ve total analjezik tüketimi miktarı, hasta memnuniyeti ve cerrahi memnuniyet parametrelerine bakıldı. Gruplar arasında demografik veriler açısından anlamlı fark saptanmadı. Tekniğin uygulanma süresi kombine siyatik-femoral blok grubunda istatistiksel olarak daha uzun bulundu (p<0.01). Hastayı cerrahi ekibe teslim etme süresi kombine siyatik-femoral blok grubunda istatistiksel olarak daha uzun bulundu (p<0.01). Total motor blok oluşma zamanı ve motor blok süresi kombine siyatik-femoral blok grubunda istatistiksel olarak daha uzun bulundu (p<0.01). Grup içi ve gruplar arası karşılaştırmalarda; hemodinamik veriler açısından istatistiksel olarak anlamlı fark bulunmadı (p>0.05). Peroperatif komplikasyonlar açısından gruplar arasında istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Postoperatif komplikasyonlar arasından, gruplar arası karşılaştırmalarda baş ağrısı ve idrar retansiyonu spinal anestezi grubunda daha sık görüldü (p<0.05). Postoperatif dönem ilk analjezik gereksinim zamanı kombine siyatik-femoral blok grubunda istatistiksel olarak daha uzun bulundu (p<0.01). Postoperatif 24 saatlik dönemdeki anljezik tüketim miktarı kombine siyatik-femoral blok grubunda istatistiksel olarak daha az bulundu (p<0.01). Hasta memnuniyeti ve cerrahi memnuniyet açısından gruplar arasında istatistiksel olarak anlamlı fark saptanmadı (p>0.05) Sonuç olarak; ortopedik alt ekstremite cerrahi girişimlerinde her iki yöntemin de etkili ve güvenli olduğu, fakat periferik sinir bloğu uygulamasının postoperatif dönemde uzun süreli analjezi sağlama ve postoperatif analjezik tüketimini azaltma gibi önemli avantajlarının olabileceği fikrine vardık.
In this study, we aimed at comparing the spinal anesthesia technique with the combined sciatic-femoral block technique. The study was planned as prospective and randomized. After approval of the Ethics Committee of the Medical School of the Dicle University, 60 patients of ASA Group 1-2 and aged 18-65 who were to undergo an elective lower extremity surgery were included in the study. They were divided into two groups of 30 people, the spinal anesthesia group (Group S) being one and the combined sciatic-femoral nerve group (Group CSFB) the other. The patients who were taken to the regional block room were monitored (Nb, SpO2, NIBP). In the Spinal Anesthesia Group; All patients were administrated 2 cc 0.5% levobupivacaine in sitting position with a 26 G spinal needle through L3-L4 or L4-L5 lumbar interspace. In the combined sciatic-femoral block group; 20 cc 0.5% levobupivacaine, 10 cc 2% prilocaine and 10 cc isotonic were mixed to prepare a 40 cc local anesthetic solution, and firstly the sciatic block and then the femoral block was applied. The parameters of the time the technique was applied, the duration of patient’s delivery to the surgery team, the time that full motor block is obtained, the hemodynamic changes in the patients, complications emerged during the surgery and the post-operative period, the need for intra-operative supplementary analgesic, the duration of motor block, the need for first post-operative analgesic and the total amount of analgesic consumed, patient satisfaction and surgery satisfaction, all were checked. There was no significant difference between the groups in demographical data. The duration of the technique’s application was found to be statistically longer in the combined sciatic-femoral block group (p<0.01). The duration of the patient’s delivery to the surgery team was found to be statistically longer in the combined sciatic-femoral block group (p<0.01). The time that full motor block is obtained and the duration of motor block duration was found to be longer in the combined sciatic-femoral block group (p<0.01). For the intra-group and inter-group comparisons, there was no statistically significant difference in terms of hemodynamic data (p>0.05). There was no statistically significant difference between groups in terms of peroperative complications p>0.05). For the inter-groups comparisons, the postoperative complications such as headache and urine retention were found to be more frequent in the spinal anesthesia group (p<0.05). The requirement time for first analgesic in the post-operative period was found to be statistically longer in the combined sciatic-femoral block group (p<0.01). The amount of analgesic consumed in the first 24 hours post-operatively was found to be statistically less in the combined sciatic-femoral block group (p<0.01). There was no statistically significant difference between the groups in terms of patient satisfaction and surgery satisfaction. As a conclusion; we arrived at the idea that both methods are effective and safe in surgery attempts for the orthopedic lower extremity, while the peripheral nerve block application could have important advantages like providing long term analgesia in the post-operative period and reducing the post-operative analgesic consumption.
In this study, we aimed at comparing the spinal anesthesia technique with the combined sciatic-femoral block technique. The study was planned as prospective and randomized. After approval of the Ethics Committee of the Medical School of the Dicle University, 60 patients of ASA Group 1-2 and aged 18-65 who were to undergo an elective lower extremity surgery were included in the study. They were divided into two groups of 30 people, the spinal anesthesia group (Group S) being one and the combined sciatic-femoral nerve group (Group CSFB) the other. The patients who were taken to the regional block room were monitored (Nb, SpO2, NIBP). In the Spinal Anesthesia Group; All patients were administrated 2 cc 0.5% levobupivacaine in sitting position with a 26 G spinal needle through L3-L4 or L4-L5 lumbar interspace. In the combined sciatic-femoral block group; 20 cc 0.5% levobupivacaine, 10 cc 2% prilocaine and 10 cc isotonic were mixed to prepare a 40 cc local anesthetic solution, and firstly the sciatic block and then the femoral block was applied. The parameters of the time the technique was applied, the duration of patient’s delivery to the surgery team, the time that full motor block is obtained, the hemodynamic changes in the patients, complications emerged during the surgery and the post-operative period, the need for intra-operative supplementary analgesic, the duration of motor block, the need for first post-operative analgesic and the total amount of analgesic consumed, patient satisfaction and surgery satisfaction, all were checked. There was no significant difference between the groups in demographical data. The duration of the technique’s application was found to be statistically longer in the combined sciatic-femoral block group (p<0.01). The duration of the patient’s delivery to the surgery team was found to be statistically longer in the combined sciatic-femoral block group (p<0.01). The time that full motor block is obtained and the duration of motor block duration was found to be longer in the combined sciatic-femoral block group (p<0.01). For the intra-group and inter-group comparisons, there was no statistically significant difference in terms of hemodynamic data (p>0.05). There was no statistically significant difference between groups in terms of peroperative complications p>0.05). For the inter-groups comparisons, the postoperative complications such as headache and urine retention were found to be more frequent in the spinal anesthesia group (p<0.05). The requirement time for first analgesic in the post-operative period was found to be statistically longer in the combined sciatic-femoral block group (p<0.01). The amount of analgesic consumed in the first 24 hours post-operatively was found to be statistically less in the combined sciatic-femoral block group (p<0.01). There was no statistically significant difference between the groups in terms of patient satisfaction and surgery satisfaction. As a conclusion; we arrived at the idea that both methods are effective and safe in surgery attempts for the orthopedic lower extremity, while the peripheral nerve block application could have important advantages like providing long term analgesia in the post-operative period and reducing the post-operative analgesic consumption.
Açıklama
Anahtar Kelimeler
Anestezi, Anesthesia, Spinal anestezi, Spinal anesthesia, Cerrahi, Surgery, Ekstremiteler, Extremities, Femoral sinir, Femoral nerve, Ortopedik cerrahi, Orthopedic surgery, Siyatik sinir, Sciatic nerve, Sinir bloğu, Nerve block
