Serdar YEŞILTAŞ, Hayrettin DAŞKAYA, Kazım KARAASLAN, Ayda TÜRKÖZ

Önkolda malign melanom nedeniyle opere edilen yüksek riskli hastada supraklavikular, interkostobrakiyal ve lateral femoral kutanöz blok uygulaması

Birden çok ekstremitede cerrahi işlem gereken olgularla anestezi pratiğinde karşılaşılabilmektedir. Bu olgularda uygulanan rejyonal girişimlerde lokal anestezik ilaç doz aşımı olabileceğinden sıklıkla genel anestezi tercih edilmektedir. Ultrasonografininrejyonal anestezi pratiğine girmesinin en önemli faydalarından bir tanesi başarılı blok oluşturmak için gereken lokal anestezikilaç dozunun düşürülmesine olanak sağlamasıdır. Özellikle yüksek riskli hastalarda genel anestezi yerine ultrasonografi eşliğinde çoklu ekstremite bloğu uygulaması mantıklı bir yaklaşım olabilir. Sol önkol lateralinde malign melanom saptanan olguyacerrahi olarak yaranın rezeksiyonu, aksiller sentinel lenf nodu diseksiyonu ve lateral uyluktan greftleme planlanmıştır. Cerrahiişlem farklı ekstremiteleri kapsadığından kombine blok uygulanmıştır. Bu olgu ile;ultrasonografi eşliğinde supraklavikular, interkostobrakiyal ve lateral femoral kutanöz blok uygulamalarımızı sunmayı amaçlıyoruz.

Our performance of supraclavicular, intercostobrachial and lateral femoral cutaneous block in a patient with high risk undergoing malign melanoma surgery on the forearm

The practice of anesthesia can include the need to accommodate surgical interventions on multiple extremities in a single procedure. General anesthesia is usually preferred in such cases in order to prevent an overdose of local anesthetics. One of the major benefits of using ultrasonography to provide regional anesthesia is that it facilitates reducing the local anesthetic drug dose required to obtain a successful block. The use of multiple, ultrasound-guided extremity blocks can be a reasonable alternative approach to general anesthesia, especially in high-risk patients. This report describes the case of a patient with malignant melanoma of the left lateral forearm. Surgical resection of the lesion, dissection of the axillary sentinel lymph node, and grafting from the lateral left thigh were planned. As the surgical procedure involved more than one extremity, a combination of anesthetic blocks was applied using ultrasound guidance. The use of supraclavicular, intercostobrachial, and lateral femoral cutaneous blocks is explained in the context of the literature.

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