EMİNE AYSU ŞALVIZ, Yavuz GÜRKAN, Murat TEKİN, Levent BULUÇ

Ultrasound-guided psoas compartment block and general anesthesia for arthroscopic knee surgery: a case report

Psoas kompartman bloğu, lumbar pleksusun kökler hizasında bloke edilmesi sebebiyle periferik yaklaşımlara göre daha tam bir blok- tur. Genellikle yüzeyel anatomik işaret noktaları kullanılarak blok lokalizasyonu belirlenir ve lokal anestezik enjeksiyonu periferik sinir stimülatörü ile kuadriseps kasının kontraksiyonu görülerek uygulanır. Ultrason sinir bloklarında tek başına veya sinir stimülatö- rü yardımı ile rehberlik sağlayabilir. Biz, bu yazıda spinal anestezi girişimini reddeden, genel anestezi ve ultrason rehberliğinde psoas kompartman bloğu altında diz artroskopi cerrahisi geçiren, 48 yaşında, ASA II, erkek hasta ile ilgili deneyimimizi sunduk. Hastaya standart monitorizasyon uygulandı ve lateral dekübit pozisyon verilmesi sonrasında vertebra, psoas, erektor spina and kuadratus lumborum kasları L4-5 seviyesinde konveks prob ile gözlendi. İğne ultrason rehberliğinde ilerletildi ve iğne ucunun lokalizasyonu kuadriseps kas kontraksiyonu ile doğrulandı. Otuz mL lokal anestezik karışımının (10 mL %2lik lidokain ve 20 mL %5lik le- vobupivakain) lumbar pleksus etrafına enjekte edilmesinin ardından hastaya genel anestezi uygulandı. Anestezi ve cerrahi işlem ek anestezik/analjezik ihtiyacı veya komplikasyon olmaksızın başarıyla tamamlandı. Hastanın ameliyat sonrası dönemde istirahatte ya da mobilizasyonda ilk 24 saatte ağrı şikayeti olmadı. Bu olgu sunumu, ultrason rehberliğinde psoas kompartman bloğunun diz artroskopi cerrahisinde ameliyat esnası ve sonrası analjezi için uygun ve etkin bir yöntem olduğunu göstermektedir.

Artroskopik diz cerrahisi için genel anestezi ve ultrason rehberliğinde psoas kompartman blok uygulaması: Olgu sunumu

Anesthetizing the lumbar plexus at its origin facilitates a more complete psoas compartment block compared to peripheral approaches. It is usually performed using surface anatomical landmarks, and the site for local anesthetic injection is confirmed by observing quadriceps muscle contraction to peripheral nerve stimulation. Ultrasound may provide guidance alone or to- gether with the aid of nerve stimulation during nerve blocks. We present a 48-year-old male patient, American Society of Anesthesiologists (ASA) physical status II, who refused spinal anesthesia, and underwent knee arthroscopy with ultrasound- guided psoas compartment block and general anesthesia. Following the standard monitoring and lateral decubitus position- ing, the vertebral body, psoas, erector spinae, and quadratus lumborum muscles and hyperechoic nerve roots of the patient were visualized at the level of L4-5 with curvilinear ultrasound probe. The needle was inserted with ultrasound guidance, and correct tip position was confirmed with quadriceps contraction. Then, the mixture of 30 mL local anesthetic (10 mL 2% lidocaine and 20 ml 5% levobupivacaine) was injected at the estimated position of the lumbar plexus (junction of the posterior third and anterior two-thirds of the psoas muscle). He also received general anesthesia for the surgery. Anesthesia and surgi- cal procedures were completed successfully without any additional anesthetic/analgesic requirement or complication. The postoperative period was pain-free both at rest and during mobilization for 24 hours. This case report shows that ultrasound- guided psoas compartment block is feasible and efficient for peri- and postoperative analgesia during knee arthroscopy.

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