Rejyonel intravenöz anestezi tekniği ile kübital tünel sendromu cerrahisinde tek merkez deneyimi

Amaç: Ulnar sinirin dirsek bölgesinde sıkışması sonucu oluşan kübital tünel sendromunun (KTS) cerrahi tedavisinde rejyonel intravenöz anestezi (RIVA) uygulamasında tek merkezin 7 yıllık deneyimini paylaşmak. Gereç ve yöntem: 2012-2019 yılları arasında tek merkezde RIVA tekniği ile opere edilen KTS'li toplam 100 hasta retrospektif olarak incelendi. RIVA tekniğinde ameliyatlı kolda venöz drenaj sağlandıktan sonra üst kolda çift manşonlu turnike şişirilerek %2'lik lidokain (3 mg/kg) solüsyonunda seyreltilmiş 30-40 mL'lik solüsyon verilerek anestezi sağlandı. İntravenöz kateter yoluyla %1 salin. Uygulanan cerrahi yöntemler (transpozisyon veya eksternal dekompresyon ile internal nöroliz), demografik veriler, preoperatif ve postoperatif ağrı için görsel analog skala (VAS) skorları karşılaştırıldı. Bulgular: 100 hastanın 30'una cerrahi transpozisyon (grup 1), 70 hastaya (grup 2) eksternal dekompresyon ile internal nöroliz uygulandı. Grup 1 ve 2'deki hastaların yaş ortalaması sırasıyla 66,3±12,1 ve 60,6±11,7 idi. Grup 1'deki hastaların %73,3'ünü, grup 2'deki hastaların %87,1'ini kadınlar oluşturuyordu. Grup 1'de 18 (%60), grup 2'de 42 (%60) hastada sağ taraf etkilenmişti. Grup 1'de ortalama postoperatif 3. hafta VAS skoru (1,96±0,76), preoperatif ortalama VAS skorundan (7,46±0,93; p<0,001) anlamlı derecede düşüktü. Benzer şekilde grup 2'de ameliyat sonrası 3. hafta ortalama VAS skoru (1,84±0,62), ameliyat öncesi ortalama VAS skorundan (7,45±0,87; p<0,001) anlamlı derecede düşüktü. Ameliyat öncesi ve sonrası 3. hafta VAS skorları açısından gruplar arasında anlamlı fark yoktu. Sonuç: KTS'nin cerrahi tedavisinde teknik alt yapı varlığında RIVA yöntemi tercih edilebilir.

Anahtar Kelimeler:

Ulnar sinir, dekompresyon, RİVA, VAS.

Single-center experience of cubital tunnel syndrome surgery using regional intravenous anesthesia technique

Aims: To share the 7-year experience of a single center in the application of regional intravenous anesthesia (RIVA) for surgical treatment of cubital tunnel syndrome (CTS) caused by compression of the ulnar nerve in the elbow region. Methods: A total of 100 patients with CTS who were operated with the RIVA technique at a single center between 2012 and 2019 were retrospectively analyzed. In the RIVA technique, after providing venous drainage in the operated side arm, the double cuff tourniquet was inflated in the upper arm, and anesthesia was provided by administering a 30–40 mL solution of 2% lidocaine (3 mg/kg) diluted in 1% saline through the intravenous catheter. The surgical methods applied (transposition or internal neurolysis with external decompression), demographic data, preoperative and postoperative visual analog scale (VAS) scores for pain were compared. Results: Out of 100 patients, 30 patients underwent surgical transposition (group 1) while internal neurolysis with external decompression was performed in 70 patients (group 2). The mean age of patients in groups 1 and 2 was 66.3±12.1 and 60.6±11.7 years, respectively. Women accounted for 73.3% of patients in group 1 and 87.1% of patients in group 2. The right side was affected in 18 (60%) patients in group 1 and 42 (60%) patients in group 2. In group 1, the mean postoperative 3rd-week VAS score (1.96±0.76) was significantly lower than the mean preoperative VAS score (7.46±0.93; p<0.001). Similarly, in group 2, the mean postoperative 3rd-week VAS score (1.84±0.62) was significantly lower than the mean preoperative VAS score (7.45±0.87; p<0.001). There was no significant between-group difference with respect to preoperative or postoperative 3rd-week VAS scores. Conclusion: In the presence of technical infrastructure, the RIVA method can be preferred in the surgical treatment of CTS.

Keywords:

Ulnar nerve, decompression, RIVA, VAS.,

PDF

___

Elhassan B, Steinmann SP. Entrapment neuropathy of the unlar nerve. J Am Acad Orthop Surg. 2007;15(11):672-681.
Filippou G, Mondelli M, Greco G, et al. Ulnar neuropathy at the elbow: how frequent is the idiopathic form? an ultrasonographic study in a cohort of patients. Clin Exp Rheumatol. 2010;28(1):63-67.
Calışaneller T, Özdemir O, Caner H, Altınörs N. Simple decompression of the ulnar nerve at the elbow via proximal and distal mini skin incisions. Turk Neurosurg. 2011;21(2):167-171.
Alp NB, Akdağ G. Epineural ganglion causing cubital tunnel syndrome: a case report. Jt Dis Relat Surg. 2020;31(1):154-158.
An TW, Evanoff BA, Boyer MI, Osei DA. The prevalence of cubital tunnel syndrome: a cross-sectional study in a U.S. Metropolitan cohort. J Bone Joint Surg Am. 2017;99(5):408-416.
Grandizio LC, Maschke S, Evans PJ. The management of persistent and recurrent cubital tunnel syndrome. J Hand Surg Am. 2018;43(10):933-940.
Chang KV, Wu WT, Han DS, Özçakar L. Ulnar nerve cross-sectional area for the diagnosis of cubital tunnel syndrome: a meta-analysis of ultrasonographic measurements. Arch Phys Med Rehabil. 2018;99(4):743-757.
Cutts S. Cubital tunnel syndrome. Postgrad Med J. 2007;83(975): 28-31.
Wojewnik B, Bindra R. Cubital tunnel syndrome - Review of current literature on causes, diagnosis and treatment. J Hand Microsurg. 2009;1(2):76-81.
Keiner D, Gaab MR, Schroeder HW, Oertel J. Comparison of the longterm results of anterior transposition of the ulnar nerve or simple decompression in the treatment of cubital tunnel syndrome-a prospective study. Acta Neurochir, Wien. 2009;151(4):311-315.
Bartels RH. History of the surgical treatment of ulnar nerve compression at the elbow. Neurosurgery. 2001;49(2):391-399.
Assmus H, Antoniadis G, Bischoff C. Carpal and cubital tunnel and other, rarer nerve compression syndromes. Dtsch Ärztebl Int. 2015;112(1-2):14-25.
Bartels RH, Verhagen WI, van der Wilt GJ, Meulstee J, van Rossum LG, Grotenhuis JA. Perspective randomized control study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: part 1. Neurosurgery. 2005;56(3):522-530.
Huq NS, Ahmed N, Razeghi M. Cubital tunnel release using local anesthesia. Clin Plast Surg. 2013;40(4):557-565.
Bier A. Über einen neuen Weg, Lokalanästhesie an den Gliedmans sen zu erzeugen. Arch Klin Chir. 1908;86:1007-1016.
Holmes CM. Intraveneus regional analgesia. A useful method of producing analgesia of thelimbs. Lancet. 1963;1(7275):245-247.
Omejec G, Podnar S. What causes ulnar neuropathy at the elbow?. Clin Neurophysiol. 2016;127(1):919-924.
Volkmar AJ, Day MA, Fleury IG, Lawler EA, Seering M, Caldwell LS. “Safety and efficacy of forearm tourniquet compared to upper arm tourniquet for local intravenous regional anesthesia in hand surgery: a randomized clinical trial”. Iowa Orthop J. 2021;41(1):177-181.
Yahya A, Malarkey AR, Eschbaugh RL, Bamberger HB. Trends in the surgical treatment for cubital tunnel syndrome: a survey of members of the American Society for Surgery of the Hand. Hand (NY). 2018;13(5):516-521.
Assmus H, Antoniadis G, Bischoff C, et al. Cubital tunnel syndrome - A review and management guidelines. Cent Eur Neurosurg. 2011;72(2):90-98.
Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2007;89(12):2591-2598.
Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2016;11(11):1-41.
Buchanan PJ, Chieng LO, Hubbard ZS, Law TY, Chim H. Endoscopic versus open in situ cubital tunnel release: a systematic review of the literature and meta-analysis of 655 patients. Plast Reconstr Surg. 2018;141(3):679-684.
Tosti R, Rekant MS. Wide awake local anesthesia no tourniquet endoscopic cubital tunnel release. J Hand Surg Am. 2022;47(10):1022.1-5.
Okten F, Cakar T, Leblebici KS. (2013). “Lokal anestezikler. In: Guldogus F, Gurkan Y, (editors). Rejyonal Anestezi. 1st ed. İstanbul/Turkey. Nobel Tıp Kitabevi, 79-89.
Caputo AE, Watson HK. Subcutaneous anterior transposition of the ulnar nerve for failed decompression of cubital tunnel syndrome. J Hand Surg Am. 2000;25(3):544-551.
Yoshida A, Okutsu I, Hamanaka I. Endoscopic anatomical nerve observation and minimally invasive management of cubital tunnel syndrome. J Hand Surg Eur Vol. 2009;34(1):115-120.
Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia. 2020;75(1): 101-110.
Uppal V, Sondekoppam RV, Landau R, El-Boghdadly K, Narouze S, Kalagara HKP. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia. 2020;75(10):1350-1363.
Balevi M, Ozturk S. Modified simple decompression of ulnar nerve in the treatment of cubital tunnel syndrome: Report of a series of cases. Niger J Clin Pract. 2018;21(8):974-978.
Ergen E, Ertem K, Karakaplan M, Kavak H, Aslantürk O. Review of anterior submuscular transposition of ulnar nerve for cubital tunnel syndrome. Niger J Clin Pract. 2021;24(8):1170-1173.
Lancigu R, Saint Cast Y, Raimbeau G, Rabarin F. Dellon’s anterior submuscular transposition of the ulnar nerve: Retrospective study of 82 operated patients with 11.5 years. Chir Main. 2015;34(5):234-239.
Zimmerman RM, Jupiter JB, González del Pino J. Minimum 6-year follow-up after ulnar nerve decompression and submuscular transposition for primary entrapment. J Hand Surg Am. 2013;38(12):2398-2404.
Staples R, London DA, Dardas AZ, Goldfarb CA, Calfee RP. Comparative morbidity of cubital tunnel surgeries: a prospective cohort study. J Hand Surg Am. 2018;43(3):207-213.
Hurvitz AP, Fitzgerald BT, Kroonen LT. Wide decompression may render the ulnar nerve unstable: a cadaveric study. J Surg Orthop Adv Fall. 2016;25(3):176-179.
Butler B, Peelman J, Zhang LQ, Kwasny M, Nagle D. The effect of in-situ decompression on ulnar nerve stability: a cadaveric study. J Hand Surg Eur Vol. 2017;42(7):715-719.
Matzon JL, Lutsky KF, Hoffler CE, Kim N, Maltenfort M, Beredjiklian PK. Risk factors for ulnar nerve instability resulting in transposition in patients with cubital tunnel syndrome. J Hand Surg Am. 2016;41(2):180-183.
Tang P. The blocking flap for ulnar nerve instability after in situ release: Technique and a grading system of ulnar nerve instability to guide treatment. Tech Hand Up Extrem Surg. 2017;21(4):137-142.
Kanat A, Balik MS, Kirbas S, Ozdemir B, et al. Paradox in the cubital tunnel syndrome—Frequent involvement of left elbow: First report: First report. Acta Neurochir, Wien. 2014;156(1):165-168.
Saeed A, Zafardar U, Awais M, Akram M. Outcome of neurolysis combined with anterior submuscular transfer of ulnar nerve in McGowan Grade II and III tardy ulnar nerve palsy. J Pak Med Assoc. 2014;64(12 Suppl 2):167-72.
van Gent JA, Datema M, Groen JL, Pondaag W, Eekhof JL, Malessy MJ. Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis. Neurosurg Focus. 2017;42(3):1-7.