Suzan ADALI, Kerem ERKALP, Veysel ERDEN, Mevlüt ÇÖMLEKÇİ, AHMET MURAT BÜLBÜL, Tayfun ALDEMİR

Ortopedik alt ekstremite cerrahisinde spinal anestezi ile kombine siyatik-femoral blok teknikleri

Amaç: Özellikle eşlik eden hastalıkları bulunan yaşlılarda, alt ekstremitenin ortopedik cerrahilerinde genel anestezi ile birlikte merkezi ve periferik rejyonal anestezi teknikleri kullanılabilir. Bu çalışma, alt ekstremitenin ortopedik cerrahilerinde uygulanan spinal anestezi ile kombine siyatik/femoral blok tekniklerinin hasta-cerrah memnuniyeti açısından etkinliğini incelemektedir. Çalışma planı: ASA skoru 2 veya 3 olan ve yaşları 50 ila 90 arasında değişen 50 ardışık hasta alt ekstremitelerine ortopedik cerrahi girişimde bulunulmak üzere çalışmaya dahil edildi. Hastalar anestezi türüne göre rastgele iki gruba ayrıldı. Spinal anestezi (SA) uygulanan 25 hasta ile kombine siy atik-femoral blok (KSFB) uygulanan 25 hasta, sırasıyla, Grup 1 ve Grup 2 olarak sınıflandırıldı. Spinal anestezi 3 ml 0.75% ropivakain, kombine siyatik-femoral blok uygulaması 10 ml 0.75% ropivakain ve 10 ml serum fizyolojik (toplamda 20 ml) enjekte edilerek gerçekleştirildi. Anestezinin uygulanması ile etki göstermesi arasındaki zaman aralığı ölçüldü. Sonuçlar hasta-cerrah memnuniyeti açısından değerlendirildi. Bulgular: Rejyonal anestezi süresi KSFB grubunda anlamlı şekilde daha uzun idi (p0.05). Çıkarımlar: SA ve KSFB tekniklerinin her ikisinin de alt ekstremitenin ortopedik cerrahilerinde başarılı oldukları görüldü. KSFB grubunda cerrahiye hazırlık süresi daha uzun olmasına rağmen, hasta-cerrah memnuniyeti her iki grupta benzerdi.

Anahtar Kelimeler:

Lumbosakral pleksus, Siyatik sinir, Sinir bloğu, Anesteziden uyanma dönemi, Amides, Anestezi, spinal, Anestezikler, lokal, Alt ekstremite, Kas-iskelet hastalıkları, Hasta memnuniyeti, Tedavi sonucu

Spinal anesthesia and combined sciatic nerve/lumbar plexus block techniques in lower extremity orthopedic surgery

Objective: In lower extremity orthopedic surgeries, central and peripheral regional anesthesia techniques can be used along with general anesthesia, mainly in elderly patients with accompa nying maladies. This study investigates the efficiency of spinal anesthesia and combined sciatic nerve/lumbar plexus block techniques in lower extremity orthopedic surgery in terms of patient surgeon satisfaction. Methods: Fifty consecutive patients (age range: 50-90 years), with an ASA score of 2-3 were scheduled for lower extremity orthopedic surgery. The patients were randomly divided into two groups according to anesthesia type. Group 1 (25 patients) received spinal anesthesia (SA) and Group 2 (25 patients) a combined sciatic/lumbar plexus nerve block (CSLPB). Spinal anesthesia was performed with 3 ml of 0.75% ropivacaine, and the combined sciatic/lumbar plexus nerve block was obtained with 10 ml 0.75% of ropivacaine and 10 ml of normal saline (20 ml in total). We recorded the time elapsed during the administration of the anesthesia and the initiation of its effect. Evaluation was made on patient-surgeon satisfaction. Results: Regional anesthesia duration was significantly longer in the CSLPB group (p<0.0001). The time required to prepare the patients for surgery was statistically and significantly shorter in the SA group (p<0.001). Values of patient and surgeon satisfaction did not significantly corre late (p>0.05). Conclusion: Both standard anesthesia and combined sciatic/lumbar plexus nerve block were effective in lower extremity orthopedic surgeries. Although surgery preparation time was longer in the CSLPB group, patient-surgeon satisfaction was similar in both groups.

Keywords:

Lumbosacral Plexus, Sciatic Nerve, Nerve Block, Anesthesia Recovery Period, Amides, Anesthesia, Spinal, Anesthetics, Local, Lower Extremity, Musculoskeletal Diseases, Patient Satisfaction, Treatment Outcome,

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