ZÜLEYHA KAZAK BENGİSUN, Perihan EKMEKÇİ, Ahmet Hakan HALİLOĞLU

Levobupivacaine for postoperative pain management in circumcision: Caudal blocks or dorsal penile nerve block

Amaç: Bu çalışmada sünnet sonrası pediatrik hastalarda kaudal ve dorsal penil sinir bloğunda (DPSB) levobupivakainin analjezik etkinliği ve yan etki profili değerlendirildi. Gereç ve Yöntem: 2-10 yaşları arasında sünnet planlanan 60 çocuk çalışmaya alındı. Hastalar iki gruba ayrıldı; Grup Kdaki (n=30) hastalara kaudal blok, Grup Pdeki (n=30) hastalara ise DPSB uygulandı. Bloklar cerrahi öncesi, genel anesteziye destek olarak 1mL kg-1 %0.25 levobupivakain ile yapıldı. Postoperatif ağrı ve sedasyon skorları 10 ve 30. dakikalarda, 1, 2, 3, 4, 5 ve 6. saatlerde değerlendirildi. OPS veya MPOPS skorları 4 veya daha fazla olduğunda postoperatif ek analjezik yapıldı. İlk 6 saat boyunca ağrısı olmayan hasta sayısı, analjezi süresi, ilk analjezik zamanı, yürüme, idrara çıkma süreleri, toplam parasetamol ihtiyacı ve hastanede kalış süreleri kaydedildi. Motor blok, ajitasyon, bulantı ve kusma gelişen hastalar kaydedildi. Bulgular: Gruplar arası demografik veriler benzerdi. İlk 6 saati ağrısız geçiren hasta sayısı Grup Kda Grup Pye göre daha fazlaydı (p=0.0001). Grup Kda ilk analjezik zamanı (p=0.000033) ve yürüme zamanı (p=0.004) daha uzundu. Grup Kda 14 hastada motor blok gelişti (p=0.00007). Grup Kda FPRS, OPS ve MPOPS açısından eğri altında kalan alan postoperatif ilk 6 saatte anlamlı olarak daha iyiydi (p

Sünnetlerde postoperatif ağrı kontrolünde levobupivakain; kaudal blok veya dorsal penil sinir bloğu

Objectives: In this study, we evaluated the analgesic efficacy and adverse effect profile of levobupivacaine in caudal and DPNB in postcircumcision pediatric patients. Methods: Sixty boys between 2-10 years of age undergoing circumcision were enrolled. The patients were divided into two groups: Group C (n=30) and Group P (n=30) were applied caudal block or dorsal penile nerve block (DPNB), respectively. Blocks were performed before surgery as a supplement to general anesthesia with 1 mL kg-1 0.25% levobupivacaine. Postoperative pain and sedation scores were assessed on the 10th and 30th minutes, and hours 1-6. The number of pain free patients in the first 6 hours, the duration of analgesia, time to first analgesic administration, walking, micturition, and total paracetamol demands, and length of stay were recorded. Results: Demographic data were similar between groups. The number of children who spent the first 6 hours pain-free was larger in Group C than Group P (p=0.0001). The time to first analgesic (p=0.000033) and walking (p=0.004) were longer in Group C. There were 14 patients with motor block in Group C (p=0.00007). In view of AUC, FPRS, OPS and MPOPS were significantly better in Group C on the first postoperative 6 hours. Conclusion: Caudal block done using levobupivacaine for postoperative pain management in circumcision is more successful than penile block, however there is a significant delay in time to first walking and as might be expected there is an increased risk of motor block.

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