Gülten ÜTEBEY, Taylan AKKAYA, Alp ALPTEKİN, Murat SAYIN, Haluk GÜMÜŞ, Yalım ATEŞ

Total kalça protez operasyonlarında lomber pleksus bloğu ve epidural bloğun total kan kaybı ile postoperatif analjeziye etkileri

Amaç: Çalışmamızda, genel anesteziyle total kalça protez (TKP) operasyonu geçiren hastalarda lomber pleksus blokajı ve epidural blokajın total kan kaybı ve postoperatif analjeziye olan etkileri araştırıldı. Gereç ve Yöntem: Çalışmaya genel anestezi ile TKP operasyonu geçiren 45 hasta alındı. Grup GA’da (n=15) genel anestezi, Grup GA+E’de (n=15) genel anestezi+epidural kateter ve Grup GA+LPB’de (n=15) genel anestezi+lomber pleksus kateterizasyonu gerçekleştirildi. Olguların intraoperatif kan transfüzyonu (İOKT) ve intraoperatif kanama (İOK) miktarları kayıt edildi. Ameliyat sonrası dönemde hastaların hemoglobin, hematokrit değerleriyle drende biriken miktarları da kayıt edildi. Ameliyat sonrası dönemde hasta kontrollü analjezi (HKA) cihazıyla intravenöz (İV) analjezi uygulandı. Ayrıca ilk analjezik ihtiyaç zamanı (İAİZ), 24 saatte kullanılan toplam İV morfin miktarı (MORF 24) ve 24 saatlik ağrı değerleri vizüel ağrı skalası (VAS) ile değerlendirildi. Bulgular: İAİZ GA grubunda en düşük (8,7±4 dak.), GA+LPB grubunda en yüksek (42,7±14,4 dak.) ve GA+E grubunda ise GA+LPB grubundan daha az bulundu (32,3±16 dak.). İOKT, İOK, MORF 24 ortalama değerleri GA+LPB grubunda en düşük, GA’de en yüksek ve GA+E’de ise her iki grubun arasında olduğu saptandı (p

The effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in total hip arthroplasty

Objectives: In this study, the effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in patients undergoing total hip arthroplasty (THA) under general anesthesia was documented. Methods: The study included 45 patients undergoing THA under general anesthesia. Group GA (n=15) received general anesthesia, Group GA+E (n=15) received general anesthesia + epidural catheter and Group GA+LPB (n=15) received general anesthesia + lumbar plexus catheterization. Intraoperative blood transfusion (IOBT) requirements and intraoperative bleeding (IOB) were documented. Postoperative hemoglobin, hematocrit and total blood loss through the drains were also documented. All patients received patient-controlled analgesia through the IV route. Time to first analgesic requirement (TFAR), total IV morphine consumption (MORPH 24) and 24-hour visual analogue scale (VAS) values were evaluated. Results: TFAR was the lowest (8.7±4.0 min.) in the GA group and highest (42.7±14.4 min) in the GA+LPB group, and the GA+E group had lower values than the GA+LPB (32.3±16.0 min) group (p<0.05). IOBT, IOB, and MORPH 24 average values were the lowest in the GA+LPB group and highest in the GA group, with GA+E in between (p<0.05). Postoperative first VAS values were significantly different between the GA group and the others (p<0.001). There was also a significant difference between the GA group and the others regarding postoperative average Hb values (p<0.02). Conclusion: THA using either regional technique provides less blood loss and better analgesia. We will consider LPB in our future cases in view of the lower intraoperative blood loss and better analgesia.

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