Süleyman DENİZ, Mustafa KÜRKLÜ, Tuncer ÇAYCI, Ercan KURT, Abdülkadir ATIM

Comparison of the postoperative analgesic efficacy of an ultrasound-guided fascia iliaca compartment block versus 3 in 1 block in hip prosthesis surgery

Amaç: Bu çalışmada, kalça kırığı sonucu kalça protezi ameliyatı geçirecek hastalarda ultrason rehberliğinde fasiya iliyaka kompart- man bloğu ve 3-1 bloğun ameliyat sonrası anal jezik etkinliğini karşılaştırmayı amaçladık. Gereç ve Yöntem: Elekti f şartlarda kalça protezi ameliyatı olacak, 20 ve 80 yaş arası 70 hasta, yerel etik komite onayını aldıktan sonra bu randomize, ileriye yönelik, kontrollü çalışmaya dahil edildi. PCA ve vizüel analog skala (VAS) hakkında bilgi verildi. Tüm hastalar rastgele üç gruba ayrıldı. Anestezi indüksiyonu tüm gruplar için standardize edildi. Ultrason rehberliğinde fasiya iliyaka kompartman bloğu (FICB) ilk gruba ve 3-1 blok ise ikinci gruba anestezi indüksiyonu öncesi uygulandı. Kontrol grubu için bir blokaj uygulanmadı. Tüm hastalara cerrahi kesi sonrası 20 mg tenoksikam ve 1 mg/kg tramadol intravenöz yoldan enjekte edildi. Ameliyat sonrasında IV tramadol hasta kontrollü anal jezi (PCA) rutin olarak tüm hastalara başlandı. Çalışmamızda Kortizol ve ACTH düzeyleri, hemodinamik parametreler, bulantı ve sedasyon varlığı araştırıldı. Bulgular: Çalışmamızda ultrason rehberliğinde uygulanan FICB ve 3-1 bloğun kontrol grubuna göre, VAS değerleri ve opioid tüketimini azalttığını, bulantı ve sedasyon üzerine hiçbir yan etkisinin olmadığını ve stres hormonlarını baskıladığını tespit ettik. Sonuç: Kalça protez operasyonlarında ultrason eşliğinde uygulanan 3-1 blok ve FICBnin ameliyat sonrası anal jezi sağlamak ama- cıyla multimodal anal jezik tedavinin bir parçası olması ve bu yöntemlerin güvenli bir yol olarak belirtilmesi gerektiğine inanmaktayız.

Kalça protez operasyonlarında ultrasonografi rehberliğinde gerçekleştirilen fasia iliaka kompartman bloğu ile 3-1 bloğun ameliyat sonrası analjezik etkinliğinin karşılaştırılması

Objectives: In this study, we aimed to compare the postoperative analgesic efficiency of an ultrasound-guided fascia iliaca compartment block and a 3 in 1 block in patients who underwent hip prosthesis surgery as a result of hip fracture. Methods: With approval from the local ethics committee, 70 patients, aged 20 to 80, undergoing hip prosthesis surgery under elective conditions were included in this randomized, prospective, controlled study. They were informed of the patient- controlled analgesia (PCA) device and visual analog scale (VAS). All patients were separated randomly into three groups. Anaesthesia induction was standardized for all groups. An ultrasound guidance fascia iliaca compartment block (FICB) was applied to the first group before anaesthesia induction. For the second group, a 3 in 1 block was applied, while for the control group no block was applied. After incision on all patients, 20 mg tenoxicam and 1 mg/kg tramadol were injected intrave- nously. Following surgery, IV tramadol PCA was begun on all patients routinely. In our study, the presence of cortisol and ACTH levels, hemodinamical parameters, nausea and sedation were determined. Results: We observed a decrease in VAS values and opioid consumption, no adverse effects on nausea and sedation, and a suppression of stress hormones in both the ultrasound-guided FICB and 3 in 1 block groups. Conclusion: We believe that the safe and efficient application of the ultrasound-guided 3 in 1 block and the FICB is necessary in multimodal analgesic treatment in order to enable postoperative analgesia in hip prosthesis surgery

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1. Høgh A, Dremstrup L, Jensen SS, Lindholt J. Fascia iliaca com- partment block performed by junior registrars as a supple- ment to pre-operative analgesia for patients with hip frac- ture. Strategies Trauma Limb Reconstr 2008;3(2):65-70. 2. Inan N, Akin Takmaz S, Iltar S, Yazici I, Başar H. The effects of two different multimodal analgesic regimens in total hip re- placement surgery. Agri 2009;21(2):69-74. 3. Godoy Monzon D, Iserson KV, Vazquez JA. Single fascia iliaca compartment block for post-hip fracture pain relief. J Emerg Med 2007;32(3):257-62. 4. Capdevila X, Biboulet P, Bouregba M, Barthelet Y, Rubeno- vitch J, d Athis F. Comparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiograph- ic analysis. Anesth Analg 1998;86:1039-44. 5. Dalens B, Vanneuville G, Tanguy A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesth Analg 1989;69:705-13. 6. Anker-Møller E, Spangsberg N, Dahl JB, Christensen EF, Schultz P, Carlsson P. Continuous blockade of the lumbar plexus after knee surgery: a comparison of the plasma con- centrations and analgesic effect of bupivacaine 0.250% and 0.125%. Acta Anaesthesiol Scand 1990;34(6):468-72. 7. Matheny JM, Hanks GA, Rung GW, Blanda JB, Kalenak A. A comparison of patient-controlled analgesia and continuous lumbar plexus block after anterior cruciate ligament recon- struction. Arthroscopy 1993;9(1):87-90. 8. Serpell MG, Millar FA, Thomson MF. Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement. Anaesthesia 1991;46(4):275-7. 9. Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravas- cular technic of lumbar plexus anesthesia: the 3-in-1 block. Anesth Analg 1973;52(6):989-96. 10. Swenson JD, Bay N, Loose E, Bankhead B, Davis J, Beals TC, et al. Outpatient management of continuous peripheral nerve catheters placed using ultrasound guidance: an experience in 620 patients. Anesth Analg 2006;103(6):1436-43. 11. Swenson JD, Brown NA. Evaluation of a new fenestrated nee- dle for ultrasound-guided fascia iliaca block. J Clin Anesth 2007;19(3):175-9. 12. Dolan J, Williams A, Murney E, Smith M, Kenny GN. Ultrasound guided fascia iliaca block: a comparison with the loss of resis- tance technique. Reg Anesth Pain Med 2008;33(6):526-31. 13. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubeno- vitch J, d Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 1999;91(1):8-15. 14. Kehlet H, Holte K. Effect of postoperative analgesia on surgi- cal outcome. Br J Anaesth 2001;87(1):62-72. 15. Kehlet H, Rung GW, Callesen T. Postoperative opioid analge- sia: time for a reconsideration? J Clin Anesth 1996;8(6):441-5. 16. Hanna MH, Elliott KM, Stuart-Taylor ME, Roberts DR, Buggy D, Arthurs GJ. Comparative study of analgesic efficacy and morphine-sparing effect of intramuscular dexketoprofen trometamol with ketoprofen or placebo after major ortho- paedic surgery. Br J Clin Pharmacol 2003;55(2):126-33. 17. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000;85(1):109-17.