.: ORİJİNAL ARAŞTIRMA
Ortopedik Alt Ekstremite Cerrahisinde Spinal Anestezi ile Kombine Femoral ve Siyatik Bloğun; Hemodinamik Etkileri ve Anestezik-Analjezik Etkinliğinin Karşılaştırılması: Prospektif Randomize Kontrollü Bir Çalışma
Combined Femoral Sciatic Block with Spinal Anesthesia in Orthopedic Lower Extremity Surgery; Hemodynamic Effects and Comparison of Anesthesic-Analgesic Effectiveness: Prostective Randomized Controlled Study
Turkiye Klinikleri J Anest Reanim. 2024;22(1):15-22
doi: 10.5336/anesthe.2024-102370
Makale Dili: TR
Tam Metin
Ücretsiz Erişim
ÖZET
Amaç: Bu çalışmada; tek başına spinal anestezi (SA) veya kombine femoral siyatik blok (KFSB) altında alt ekstremite cerrahisi geçirecek hastalarda; motor ve duyu blok başlama süreleri, perioperatif ve postoperatif hemodinamik parametreleri, motor blok ortadan kalkma süreleri ve analjezik etkinliklerini karşılaştırmak amaçlanmıştır. Gereç ve Yöntemler: Ortopedik alt ekstremite cerrahisi planlanan Amerikan Anestezistler Derneği I-III, 18-65 yaş aralığında, total 40 hasta, prospektif, randomize, kontrollü olarak çalışmaya dâhil edildi. Hastalar, randomize olarak SA grubu (n=20) (15 mg Heavy Bupivakain), KFSB grubu [%0,5 bupivakain hidroklorür+ %2 lidokain+serum fizyolojik (30, 15, 15 mL) solüsyonu] olacak şekilde 2 gruba ayrıldı. İşlem öncesinde her hastaya 0,03 mg/kg midazolam uygulandı. Perioperatif 5 dk'lık aralıklarla kalp tepe atımı (KTA), sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), ortalama arter basıncı (OAB) ve periferik oksijen saturasyonu monitörize edilip takip altına alındı. Perioperatif, 5, 15, 30, 60. dk değerleri ile postoperatif 1, 3, 6 ve 12. saatlerdeki değerler kaydedildi. Hastaların motor ve duyusal blok seviyeleri modifiye edilmiş Bromage skalası ve pinprick testi ile değerlendirildi, görsel analog skala [visual analogue scale (VAS)] değerleri ve ilk analjezik yapılma saatleri kaydedildi. Bulgular: KFSB grubunda VAS skorları anlamlı olarak daha düşük (p=<0,01), ilk kurtarma analjezik ihtiyaç zamanı ise anlamlı olarak daha uzun süreydi (p=<0,01). SA grubunda; tüm zaman noktalarında SKB, DKB, OAB ve KTA değerlerinde anlamlı düşme gözlemlendi (p=<0,05). Hastaların motor blok başlama zamanı KFSB anlamlı yüksek bulundu (p=<0,01). Sonuç: Femoral-siyatik bloklar, SA ve diğer santral bloklara göre hemodinamiyi daha az etkilemesi, daha uzun süreli postoperatif analjezi sağlaması nedeniyle özellikle deneyimli anestezistler tarafından uygulandığında ortopedik alt ekstremite cerrahilerinde daha uygun bir yaklaşım olduğu görüşündeyiz.
Anahtar Kelimeler: Spinal anestezi; kombine femoral-siyatik blok; hemodinamikler; ortopedik alt ekstremite cerrahisi
Amaç: Bu çalışmada; tek başına spinal anestezi (SA) veya kombine femoral siyatik blok (KFSB) altında alt ekstremite cerrahisi geçirecek hastalarda; motor ve duyu blok başlama süreleri, perioperatif ve postoperatif hemodinamik parametreleri, motor blok ortadan kalkma süreleri ve analjezik etkinliklerini karşılaştırmak amaçlanmıştır. Gereç ve Yöntemler: Ortopedik alt ekstremite cerrahisi planlanan Amerikan Anestezistler Derneği I-III, 18-65 yaş aralığında, total 40 hasta, prospektif, randomize, kontrollü olarak çalışmaya dâhil edildi. Hastalar, randomize olarak SA grubu (n=20) (15 mg Heavy Bupivakain), KFSB grubu [%0,5 bupivakain hidroklorür+ %2 lidokain+serum fizyolojik (30, 15, 15 mL) solüsyonu] olacak şekilde 2 gruba ayrıldı. İşlem öncesinde her hastaya 0,03 mg/kg midazolam uygulandı. Perioperatif 5 dk'lık aralıklarla kalp tepe atımı (KTA), sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), ortalama arter basıncı (OAB) ve periferik oksijen saturasyonu monitörize edilip takip altına alındı. Perioperatif, 5, 15, 30, 60. dk değerleri ile postoperatif 1, 3, 6 ve 12. saatlerdeki değerler kaydedildi. Hastaların motor ve duyusal blok seviyeleri modifiye edilmiş Bromage skalası ve pinprick testi ile değerlendirildi, görsel analog skala [visual analogue scale (VAS)] değerleri ve ilk analjezik yapılma saatleri kaydedildi. Bulgular: KFSB grubunda VAS skorları anlamlı olarak daha düşük (p=<0,01), ilk kurtarma analjezik ihtiyaç zamanı ise anlamlı olarak daha uzun süreydi (p=<0,01). SA grubunda; tüm zaman noktalarında SKB, DKB, OAB ve KTA değerlerinde anlamlı düşme gözlemlendi (p=<0,05). Hastaların motor blok başlama zamanı KFSB anlamlı yüksek bulundu (p=<0,01). Sonuç: Femoral-siyatik bloklar, SA ve diğer santral bloklara göre hemodinamiyi daha az etkilemesi, daha uzun süreli postoperatif analjezi sağlaması nedeniyle özellikle deneyimli anestezistler tarafından uygulandığında ortopedik alt ekstremite cerrahilerinde daha uygun bir yaklaşım olduğu görüşündeyiz.
Anahtar Kelimeler: Spinal anestezi; kombine femoral-siyatik blok; hemodinamikler; ortopedik alt ekstremite cerrahisi
ABSTRACT
Objective: In this study; in patients who will undergo lower extremity surgery under spinal anesthesia (SA) alone or combined femoral sciatic block; it was aimed to compare motor and sensory block onset times, peroperative and postoperative hemodynamic parameters, motor block disappearance times and analgesic effectiveness. Material and Methods: A total of 40 patients, American Society of Anesthesiologists I-III, aged between 18-65, who were planned to undergo orthopedic lower extremity surgery, were included in this prospective, randomized, controlled study. The patients were randomly divided into two groups as Group 1: SA group (n=20) (15 mg Heavy Bupivacaine) and Group 2: Combined femoral-sciatic block (CFSB) group (0.5% bupivacaine hydrochloride + 2% lidocaine + Serum Physiological solution (respectively, 30, 15, 15 mL). Before the procedure, 0.03 mg/kg intravenous midazolam was administered to each patient. Preoperatively, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral oxygen saturation (SpO2) were monitored and recorded at 5-minute intervals. Values were recorded at preoperative 5, 15, 30, and 60 minutes, and postoperatively at 1, 3, 6, and 12 hours. Motor and sensory block levels were assessed using the modified Bromage scale and pinprick test. Pain intensity was measured using a visual analog scale (VAS), and the time to first analgesic administration was recorded. Results: Group 2: In the combined femoral sciatica block group, VAS scores were significantly lower (p=<0.01), and the time to first rescue analgesic requirement was significantly longer (p=<0.01). Group 1: In the SA group; A significant decrease was observed in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate values at all time points (p=<0.05). The onset time of the patients' motor block was significantly higher in the combined femoral sciatic block (p=<0.01). Conclusion: Compared to CFSB, SA and other central blocks; we believe that it is a more suitable and more effective anesthesia method in orthopedic lower extremity surgeries, as it affects hemodynamics less and provides longer-term postoperative analgesia, especially when applied by experienced anesthesiologists.
Keywords: Spinal anesthesia; combined femoral-sciatic block; hemodynamics; orthopedic lower extremity surgery
Objective: In this study; in patients who will undergo lower extremity surgery under spinal anesthesia (SA) alone or combined femoral sciatic block; it was aimed to compare motor and sensory block onset times, peroperative and postoperative hemodynamic parameters, motor block disappearance times and analgesic effectiveness. Material and Methods: A total of 40 patients, American Society of Anesthesiologists I-III, aged between 18-65, who were planned to undergo orthopedic lower extremity surgery, were included in this prospective, randomized, controlled study. The patients were randomly divided into two groups as Group 1: SA group (n=20) (15 mg Heavy Bupivacaine) and Group 2: Combined femoral-sciatic block (CFSB) group (0.5% bupivacaine hydrochloride + 2% lidocaine + Serum Physiological solution (respectively, 30, 15, 15 mL). Before the procedure, 0.03 mg/kg intravenous midazolam was administered to each patient. Preoperatively, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral oxygen saturation (SpO2) were monitored and recorded at 5-minute intervals. Values were recorded at preoperative 5, 15, 30, and 60 minutes, and postoperatively at 1, 3, 6, and 12 hours. Motor and sensory block levels were assessed using the modified Bromage scale and pinprick test. Pain intensity was measured using a visual analog scale (VAS), and the time to first analgesic administration was recorded. Results: Group 2: In the combined femoral sciatica block group, VAS scores were significantly lower (p=<0.01), and the time to first rescue analgesic requirement was significantly longer (p=<0.01). Group 1: In the SA group; A significant decrease was observed in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate values at all time points (p=<0.05). The onset time of the patients' motor block was significantly higher in the combined femoral sciatic block (p=<0.01). Conclusion: Compared to CFSB, SA and other central blocks; we believe that it is a more suitable and more effective anesthesia method in orthopedic lower extremity surgeries, as it affects hemodynamics less and provides longer-term postoperative analgesia, especially when applied by experienced anesthesiologists.
Keywords: Spinal anesthesia; combined femoral-sciatic block; hemodynamics; orthopedic lower extremity surgery
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