Can AKSU, Yavuz GÜRKAN, Alparslan KUŞ, Kamil TOKER, Mine SOLAK

Kocaeli Üniversitesi Hastanesi'nde son bir yılda uygulanan ultrason rehberliğinde obturator blok deneyimlerimiz

Amaç: Obturator sinir bloğu, transüretral rezeksiyon sırasında obturator refleksin gelişmesini önlemek için tanımlanmıştır. Tanımlanmasından bu zamana kadar birçok farklı yaklaşım geliştirilmiştir. Bu çalışmada, interadduktor yaklaşımının sonuçlarının görülmesi hedeflenmiştir.Gereç ve Yöntem: Etik kurul onayı alındıktan sonra; Ekim 2013-Ekim 2014 tarihleri arasında transüretral rezeksiyon cerrahisi geçirmiş olan hastaların dosyaları geriye dönük olarak tarandı.Bulgular: Transüretral rezeksiyon geçiren 137 hasta olduğu bulundu. Cerrahi anestezi amacıyla spinal anestezi ve obturator sinir bloğu kombinasyonu uygulanan hasta sayısı 69'du (2'si kadın, 67'si erkek). Bütün obturator sinir blokları interadduktor yaklaşımla, ultrason eşliğinde yapıldı. Obturator refleksin görülmesinden dolayı iki hastada bloğun başarısız olduğu saptandı. Bütün hastaların operasyonları herhangi bir komplikasyona rastlanmadan tamamlandı.Sonuç: Obturator sinir bloğu obturator refleksin önlenmesi için etkili bir bloktur. Obturator sinir bloğunun spinal anestezi ile kombine edilmesi transüretral cerrahilerin anestezisinde güvenli bir yöntem olarak görülmektedir. Obturator sinir bloğunda ultrason rehberliği blok başarı oranının artmasına yardım etmekte ve hasta güvenliği açısından ek avantajlar sağlamaktadır.

Ultrasound-guided obturator block experience from past year at Kocaeli University Hospital

Objectives: Obturator nerve block is recommended to prevent obturator nerve reflex during transurethral resection. However, alternate techniques have been developed. The aim of the present study was to examine outcomes of interadductor approach.Methods: After obtaining approval from the ethics committee, files of patients who underwent transurethral resection surgery between October 2013 and October 2014 were reviewed.Results: A total of 137 transurethral resection patients were identified, in 69 ( 2 women, 67 men) of whom a combination of spinal anesthesia and obturator nerve block was used. Obturator nerve blocks were ultrasound-guided with interadductor approach. Nerve block was unsuccessful in 2 cases due to obturator nerve reflex. Surgeries were performed without complication.Conclusion: Obturator nerve block is an effective method of preventing obturator nerve reflex. Combination of obturator nerve block and spinal anesthesia seems to be a safe method of anesthesia in transurethral surgery. Ultrasound guidance improves success rates and provides additional advantages for patient safety.

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