Berit Gökçe CEYLAN, Sarı Sinem AK, Özlem ÖZORAK, Lütfi YAVUZ, Füsun EROĞLU

Gastrointestinal ve kardiyak tutulumu mevcut progresif sistemik sklerozisli kaşektik olguda kombine femoral siyatik sinir bloğu uygulaması

Progresif sistemik sklerozis etyolojisi belli olmayan multisistemik bir hastalıktır. Sistemlere ait fonksiyonel bozukluklar anestezi uygulamasında güçlüklere sebep olmaktadır. Ayak amputasyonu planlanan gastrointestinal ve kardiyak tutulumu mevcut progresif sistemik sklerozisli ağır kaşektik olguda kombine femoral siyatik sinir bloğu uygulayarak stabil bir hemodinami ile operasyon sağlamayı amaçladık. Yaygın dolaşım bozukluğu sebebiyle sol ayak amputasyonu için operasyon planlanan 63 yaşındaki kadın olgunun, gastrointestinal tutulumu nedeniyle ileri derecede kaşektik (22 kg), kardiyak tutulumu nedeniyle atriyoventriküler tam bloğu ve pulmoner ek hastalıkları vardı. Ağız açıklığı kısıtlı olan olguda olası havayolu güçlüğü, aspirasyon ve hipotansiyon riskleri nedeni ile genel veya santral blok uygulanamadı ve kombine siyatik femoral blok planlandı. Gerekli preoperatif değerlendirme yapıldıktan sonra altında önce Labat tekniği ile 3 mL %7.5’luk levobupivakain, 1 mL %2’lik lidokain ve 11 mL %0.09’luk NaCl eklenerek toplam 15 mL volüm ile siyatik sinir bloğu, aynı dozlarda femoral sinir bloğu gerçekleştirildi. Operasyonda ek analjezik desteği gerekmedi, hemodinami stabil seyretti. Postoperatif 8. saatte ağrısı başlayan hastaya hasta kontrollü analjezi aygıtı ile tramadol infüzyonu uygulandı. Hasta 10 gün sonra taburcu edildi. Genel anestezi veya santral blok uygulamalarının kontrendike olduğu, olgumuzda olduğu gibi gastrointestinal ve kardiyak tutulumu mevcut, ileri derecede kaşektik yüksek riskli sistemik sklerozisli olgularda kombine femoral siyatik sinir bloğun alternatif bir anestezi tekniği olabileceğini düşünüyoruz.

Combined femoral and sciatic nerve block in a cachectic progressive systemic sclerosis case with gastrointestinal and cardiac involvement

Scleroderma is a multisystemic disease of unknown etiology. The systemic disturbances cause difficulties in anesthesia practice. We present a successfully combined sciatic femoral block performed in a multisystemic scleroderma case who was planned for foot amputation. Combined sciatic-femoral block was planned for the patient, for whom left foot amputation was decided by the Orthopedics Department, with related physical weakness, probable difficult airway, and accompanying cardiac and pulmonary diseases. Following the required preoperative evaluation, sciatic and femoral block was performed with a total 15 ml volume consisting of 3 ml levobupivacaine 7.5% and 1 ml lidocaine 2% added to 11 ml NaCl 0.09% subsequently. Additional analgesic treatment was not required perioperatively, and the patient was hemodynamically stable. Tramadol infusion was applied with Patient Controlled Analgesia device at the 8th hour. The patient was discharged on the postoperative 10th day. We think that in high-risk severe cachectic systemic scleroderma cases, general anesthesia and central blocks are contraindicated. If gastrointestinal and cardiac involvements are present, as in our case, combined femoral-sciatic block may be considered as an alternative anesthetic technique.

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