Suzan ADALI, Kerem ERKALP, Mevlüt ÇÖMLEKÇİ, Tezer Betül KILIÇÇIOĞLU, Veysel ERDEN, Tayfun ALDEMİR

Alt ekstremite cerrahisinde ropivakainle uygulanan kombine siyatik-femoral blok ile unilateral spinal blo⁄un komplikasyonlar açısından karşıtırılması

Amaç: Alt ekstremite cerrahisinde, spinal anestezi ile kombine siyatik-femoral blok (KSFB) tekniklerinin; uygulama zamanı, hastayı cerrahi ekibe teslim süresi, hemodinamik değişiklikler, cerrahi sırasında ve postoperatif dönemde oluşan komplikasyonlar açısından farklılıkları karşılaştırılması amaçlanmıştır. Yöntem: Alt ekstremite patolojileri nedeniyle, rejyonal anestezi ile operasyonu planlanan, ASA II-III grubu, yaşları 50–90 arasında, 50 hasta çalışmaya dâhil edildi. Hastalar spinal anestezi grubu (SAG, n=25) ve kombine siyatik-femoral blok grubu (KSFBG, n=25) olmak üzere iki gruba ayrıldı. Hemodinamik parametreler, peroperatif ve postoperatif 48 saatlik dönemde gelişen tüm komplikasyonlar ve yan etkiler kaydedildi. Bulgular: Gruplar arasında ameliyat süreleri bakımından anlamlı fark saptanmazken, teknik uygulama süresi KSFBG’nda daha uzundu. Hastayı cerrahi ekibe teslim süreleri her iki grupta birbirine benzer olarak bulundu. Motor blok süresi açısından KSFBG’nda bulunan değerler istatistiksel olarak anlamlı uzun bulunurken, sensoriyel blok süreleri açısından anlamlı bulunmadı. Hemodinamik parametrelerin SAG’nda daha fazla değiştiği görüldü. Fakat bu değerler, vital bulguları önemli ölçüde etkileyecek düzeyde olmadı ve istatistiksel olarak anlamlı bulunmadı. Postoperatif dönemde, SAG’nda sırt ağrısı ve baş dönmesi sıklığı ile postoperatif miksiyon süresi istatistiksel olarak anlamlı derecede uzun bulundu. Sonuç: Ropivakain kullanılarak yapılan alt ekstremite ortopedik cerrahi girişimlerinde her iki yöntemin de birbirine alternatif olarak güvenle kullanılabileceği kanısındayız.

Comparison of the complications unilateral spinal anesthesia with combined sciaticfemoral nerve block techniques with ropivacaine in lower extremity surgery

Objective: Spinal anesthesia and combined sciatic- femoral block techniques for lower extremity surgery were compared for differences in; time required to perform anesthesia and readiness for surgery, hemodynamic changes and complications during surgery and postoperative period. Method: Fifty ASA II-III patients aged between 50 and 90, scheduled for lower extremity pathologies with regional anesthesia were enrolled. The patients allocated into two groups as spinal anesthesia group (SAG, n=25 ) and combined sciatic-femoral nerve block group (CSFNBG, n=25). Hemodynamic parameters, all complications and adverse effects during peroperative and postoperative period for 48 hours were recorded. Results: No significant difference was found between two groups for operation times but time required to perform anesthesia was longer in CSFNB group. Time required to readiness for surgery was found similar between the groups. The time for motor block in CSFNB was found significantly longer while sensorial block was not. The hemodynamic parameters were more impaired in SAG. But those results were not at a level of effecting the vital signs and was not found statistically significant. Backache and dizziness incidence and postoperative micturation time was found significantly higher in SAG. Conclusion: In our opinion using ropivacaine for both techniques can safely be used alternative to each other in lower extremity orthopedic surgery.

PDF

___

1. Breen P, Park KW. General anesthesia versus regional anesthesia. Int Anesthesiol Clin. 2002; 40(1): 61-71.
2. Tsui BC, Wagner A, Finucane B. Regional anaesthesia in the elderly: a clinical guide. Drugs Aging. 2004; 21(14): 895-910.
3. Valentin N, Lomholt B, Jensen JS, et al. Spinal or general anaesthesia for surgery of the fractured hip. Br J Anaesth 1986; 58: 284-91.
4. Dahl V, Gierloff C, Omland E. et a Spinal, epidural or propofol anaesthesia for outpatient knee arhroscopy? Acta Anaesthesiol Scand 1997; 41: 1341-5.
5. Fanelli G, Casati A, Aldegheri G et al. Cardiovascular effects of two different regional anaesthetic trechniques for unilateral leg surgery. Acta Anaesthesiol Scand 1998; 42: 80-4
6. Kaygusuz K, Gürsoy S, Kol İÖ ve ark. Yüksek Riskli Hastada Kombine Siyatik - Femoral Sinir Bloğu (Olgu Sunumu). C. Ü. Tıp Fakültesi Dergisi 2006; 28(1): 37-40.
7. Auroy Y, Benhamou D, Bargues L. et al. Major complications of regional anesthesia in France: The SOS regional anesthesia hotline service. Anesthesiology 2002; 97: 1274–8.
8. Casati A, Cappelleri G, Aldegheri G. et al. Total intravenous anesthesia, spinal anesthesia or combined sciatic-femoral nerve block for outpatient knee arthroscopy. Minerva Anestesiol. 2004; 70(6): 493-502
9. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2001; (4): CD000521.
10. Enneking FK, Chan V, Greger J. et al. Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg Anesth Pain Med 2005; 30: 24–35.
11. Captevila X, Mavaire P, Dadure C, et al. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: New landmarks, technical guidelines and clinical evaluation. Anesth Analg 2002; 94: 1606–13. 12. Mc Clure JH. Ropivacaine. Br. J. Anaesth 1996; 70: 300–7.
13. Turner G, Blake D, Buckland M, et al. Continuous extradural infusion of ropivacaine for prevention of postoperative pain after major orthopaedic surgery. Br. J. Anaesth 1996; 76: 606–610.
14. Van Kleef JW, Veering BT, Burm AGL. Spinal anesthesia with ropivacaine: a double-blind study of efficacy and safety of 0.5% and 0.75% solutions undergoing minor lower limb surgery. Anesth Analg 1994; 78: 1125–30.
15. Reiz S, Höggmark S, Johansson G, et al. Cardiotoxicity of ropivacain-a new amide local anasthetic agent. Acta Anaesthesiol Scand. 1989; 33: 93–8
16. McDonald SB, Liu SS, Kopacz DJ, et al. Hyperbaric spinal ropivacaine. A comparison to bupivacaine in volunteers. Anesthesiology 1999; 90: 971–7.
17. Rooke GA, Freund PR, Jacobson AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg, 1997; 85: 99–105.
18. Tran D, Clemente A, Finlayson RJ. A review of approaches and techniques for lower extremity nerve blocks. Can J Anaesth. 2007; 54(11): 922-34.
19. Hadzic A, Vloka JD, Kuroda MM, et al. The practice of peripheral nerve blocks in the United States: a national survey. Reg Anaesth and Pain Med 1998; 23(3): 241–6.
20. McNamee DA, Parks L, McClelland AM, et al. Intrathecal ropivacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg mL1 and 10 mg mL1 solutions. Br J Anaesth 2001; 87(5): 743–7.
21. Maxwell MJ, Moran CG, Moppett IK. Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery. Br J Anaesth. 2008; 101(4): 511-7.
22. Rodgers A, Walker N, Schug S, et al. Reduction of post-operative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Br Med J 2000; 321: 1493–733.
23. Naja Z, Hassan MJ, Khatib H, et al. Combined sciatic-paravertebral nerve block vs general anesthesia for fractured hip of the elderly. Middle East J.Anesthesiol 2000 Jun; 15: 559–68.
24. Casati A, Capelleri G, Fanelli G, et al. Regional anaesthesia for outpatient knee arthroscopy: a randomized clinical comparison of two different anaesthetic techniques. Acta Anaesthesiol Scand 2000;44(5):543–7.
25. Capelleri G, Casati A, Fanelli G, et al. A unilateral spinal anesthesia for combined sciatic-femoral nerve block for day-case knee arhtroscopy. A prospective, randomized comparison. Minerva Anesthesiol 2000; 66: 131–6.
26. Fanelli G, Borghi B, Casati A, et al. Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Italian Study Group on Unilateral Spinal Anesthesia. Can J Anaesth 2000; 47: 746–751.
27. Patel NJ, Flashburg MH, Paskin S, et al. A regional anesthetic technique compared to general anesthesia for outpatient knee arthroscopy. Anesth Analg 1986; 65: 185–7.
28. Sansone V, De Ponti A, Fanelli G, et al. Combined sciatic and femoral nerve block for knee arthroscopy: 4 years’ experience. Arch Orthop Trauma Surg 1999; 119: 163–7.