Çoklu kosta kırıklarında ağrı tedavisi için erektör spinae plan kateteri: Künt göğüs travması olan olguların anekdot kayıtları

Yüksek enerjili göğüs duvarı travmaları sıklıkla yüksek morbidite ve mortalite ile ilişkili olan çoklu kosta kırıklarına yol açar. Çoklu kosta kırığı olan hastalardaki akciğer komplikasyonları, pulmoner kontüzyon alanlarında yetersiz gaz değişimi ve şid- detli ağrı nedeniyle solunum mekaniğinin bozulması sonucu ortaya çıkar. Bu nedenle analjezi, kosta kırıklarının tedavisinde bir anahtar rol oynar. Erektör spina plan bloku yeni tanımlanan bir tekniktir ve posterior kosta kırıklarında acil servislerde de kullanılmaya başlanmıştır. Erektör spina plan blokları, ilgili bölgenin nispeten yüzeysel olması ve majör vasküler yapılardan uzak olması nedeniyle yoğun bakım ünitesinde antikoagülan tedavi alan hastalarda da uygulanabilir. Bu yazıda, erektör spina plan bloklarından anlamlı olarak fayda gören çoklu kosta kırığı olan üç olgunun anekdot kayıtları sunulmuştur. Bu raporda, tek taraflı enjeksiyon sonrasında duysal blokun bilateral yayılımı, erektör spina plan blokunun mekanik ventilatörden ayrılma üzerine etkisi ve erektör spina plan kateteri takıldıktan sonra arteryel kan gazı analizindeki belirgin düzelme vurgulanmaktadır.

Erector spinae plane catheter for pain management of multiple rib fractures: Anecdotal records of cases with blunt chest trauma

High-energy chest wall traumas usually lead to multiple rib fractures associated with high morbidity and mortality. Pulmonary morbidity in patients with multiple rib fractures results from the impaired gas exchange from the pulmonary contusion areas and compromised breathing mechanics as a result of severe pain. Thus, analgesia plays a key role in the management of rib fractures. Erector spinae plane (ESP) block is a newly described technique and it has come into use in emergency departments for posterior rib fractures. ESP blocks can be administered in patients under anticoagulant therapy in the intensive care unit because the relevant area is located relatively superficial and far from the major vascular structures. In this report, anecdotal records of three patients with multiple rib fractures who had real benefits from ESP blocks are presented. This report highlights the bilateral extent of the sensory block after unilateral injection, the effect of ESP blocks on weaning from mechanical ventila- tion, and dramatic improvement in arterial blood gases analysis following ESP catheter insertion.

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