Serkan , YILDIRMAZ, Mediha TÜRKTAN, Ersel GÜLEÇ, Zehra HATİPOĞLU, Dilek ÖZCENGİZ

Çocuklarda ultrasonografi eşliğinde yapılan rektus kılıf bloğunda lokal anestezik volümünün anestezik ve analjezik ajan tüketimi üzerine etkisi

Amaç: Bu çalışmada, çocuklarda yapılacak major abdominal cerrahilerde, ultrasonografi eşliğinde iki farklı volümle uygulanan rektus kılıf bloğunun peroperatif sevofluran ve postoperatif morfin tüketimi üzerine etkilerinin araştırılması amaçlanmıştır.Gereç ve Yöntem: Amerikan Anestezistler Derneği (ASA) I-II grubu, 1-16 yaş arası, major batın cerrahisi yapılacak 40 olgu çalışmaya dahil edildi. Genel anestezi uygulandıktan sonra rastgele iki gruba ayrılan olgulardan Grup I’e (n=20) 0.1 ml/kg % 0.25 levobupivakain (toplam volüm 0.1 ml/kg olacak şekilde serum fizyolojik ile seyreltilerek) ile Grup II’ye (n=20) 0.1 ml/kg % 0.25 levobupivakain (toplam volüm 0.4 ml/kg olacak şekilde serum fizyolojik ile seyreltilerek) ile ultrasonografi eşliğinde rektus kılıf bloğu uygulandı. Operasyon boyunca hemodinamik veriler ve sevofluran tüketimi, operasyon sonunda ağrı düzeyleri, ek analjezik ihtiyacı ve sedasyon düzeyleri kaydedildi.Bulgular: İntraoperatif dönemde inspire edilen ve tüketilen sevofluran miktarları her iki grupta da benzer olup, toplam sevofluran tüketimi Grup I’de 106.85±28.6 ml, Grup II’de 91.50±36.6 ml olarak bulundu (p>0.05). Olguların postoperatif ağrı ve sedasyon skorları ve ek analjezik ihtiyaçları arasında fark saptanmadı.Sonuç: Major abdominal cerrahi uygulanacak çocuklarda ultrasonografi eşliğinde yapılan rektus kılıf bloğunun etkin ve güvenilir bir analjezi sağladığı, uygulanan lokal anestezik volümünü arttırmanın intraoperatif sevofluran tüketimini ve postoperatif ek analjezik ihtiyacını azaltmadığı kanısına varıldı.

Anahtar Kelimeler:

Çocuklar, rektus kılıf bloğu, postoperatif analjezi, sevofluran

Effect of local anesthetic volumes in ultrasound-guided rectus sheath block on anesthetic and analgesic agent consumption in children

Purpose: This study aimed to evaluate the effect of ultrasound-guided rectus sheath block by using two different volume on consumption of peroperative anesthetic and postoperative analgesic agents undergoing major abdominal surgery in children.Material and Methods: American Society of Anesthesiologists (ASA) I-II, 40 patients between 1-16 years and scheduled for major abdominal surgery were included in this study. After induction of general anesthesia, patients were randomly divided into two groups. Ultrasound-guided rectus sheath block was performed with 0.1 ml/kg 0.25% levobupivacaine (total volume of 0.1 ml/kg to be diluted with saline) in Group I (n=20) and 0.1 ml/kg 0.25% levobupivakain (total volume of 0.4 ml/kg to be diluted with saline) in Group II (n=20). Hemodynamic data and sevoflurane consumption during the surgery, pain scores, the sedation levels and additional analgesia requirement after the surgery were recorded.Results: Inspired sevoflurane concentration and consumed sevoflurane amount were similar in both groups. The total sevoflurane consumption was 106.85±28.6 ml in Group I and 91.50±36.6 ml in Group II. There were no statistically significant differences between postoperative pain levels, sedation scores and additional analgesic consumption of the groups. Conclusion: Ultrasound-guided rectus sheath block provide an effective and safe analgesia in children undergoing major abdominal surgery but increased local anesthetic volume does not reduce intraoperative sevoflurane consumption and additional analgesic requirements

Keywords:

Children, rectus sheath block, postoperative analgesia, sevoflurane,

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