AHMET KEMALETTİN KOLTKA, Yılmaz YENİGÜN, Semra KÜÇÜKGÖNCÜ, TÜLAY ÖZKAN SEYHAN, NÜZHET MERT ŞENTÜRK

Ön kol cerrahisinde infraklaviküler ve korakoid yaklaşımların karşılaştırılması

Amaç: Çeşitli risklerine rağmen, brakiyal pleksusa infraklaviküler yaklaşımlar popülerlik kazanmıştır. Bu çalışmada, önkol cerrahisi uygulanan hastalarda vertikal infraklavikular (VİB) ve korakoid blokların (KB) başarı oranları, blok başlama zaman- ları, blok yapma zamanları ve olumsuz etkilerinin sıklığı karşılaştırıldı. Gereç ve Yöntem: Etik komite ve hasta onamı alındıktan sonra ön kol cerrahisi ameliyatı uygulanacak 40 hasta çalışmaya alındı. Brakiyal pleksus sinir stimulatörü ve kalem uçlu yalıtılmış iğne kullanılarak lokalize edildi. Blok için 30 ml %0.5 bupi- vakain kullanıldı. Bloklar ilk beş dakika boyunca dakikada bir, 15. dakikaya kadar beş dakikada bir ve sonrasında 15 dakikada bir ve ameliyatın sonunda değerlendirildi. Bulgular: Blok başlama zamanları gruplar arasında benzer değerlerde idi. 5, 10 ve 15. dakikalarda yapılan değerlendirmelerde Grup KBde duysal blok daha derin idi. Ayrıca 5, 10, 15 ve 30. dakikalarda yapılan değerlendirmelerde Grup KBde motor blok daha fazla idi. VİB yapılan hastalarda blok yapma zamanı daha kısa idi. Korakoid blok yapılan bir hastada genel aneste- ziye geçmek gerekti. Korakoid blok yapılan iki hastada damar ponksiyonu dışında başka yan etki saptanmadı. Sonuç: Korakoid blok ile daha yüksek oranlarda duysal ve motor blok benzer bir blok başlangıç zamanı ve ciddi bir kompli- kasyon olmaksızın sağlandı. KB, önkol cerrahisi için VİBye emin ve etkin bir alternatif olarak kabul edilebilir.

A comparison of vertical infraclavicular and coracoid approaches in forearm surgery

Objectives: Despite several risks, infraclavicular approaches to the brachial plexus gained popularity. Te present study compared success rates, block onset times, block performance times, and frequency of adverse efects of vertical infraclavicular (VIB) and coracoid blocks (CB) in patients undergoing forearm surgery. Methods: After ethical committee approval and informed consent 40 patients undergoing forearm surgery were included. Te bra- chial plexus was located using a nerve stimulator and an insulated pencil point needle. Tirty ml bupivacaine 0.5% was used for the block. Te blocks were assessed every minute for the frst 5 min, then every 5 min for 15 min and then every 15 min and at the end of the operation. Results: Block onset times of both groups were similar. Higher rates of sensory block were found in group CB at the 5th, 10th, and 15th minutes of assessment. Also higher rates of motor block were found in group CB at the 5th, 10th, 15th and 30th minutes of assessment. Time to perform block was shorter in group VIB. One patient in CB group required general anaesthesia. Except two vascular punctures in group CB no other side-efects were observed. Conclusion: Coracapid block provided higher rates of sensorial and motor blocks in a similar onset time without serious complica- tions. CB can be accepted as a safe and reliable alternative to VIB for forearm surgery.

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