Çocuklarda üst ekstremite Tendon transfer cerrahisinde uygulanan interskalen bloğun postoperatif analjezik etkinliği

Amaç: İnterskalen blok, cerrahi girişimlerden sonra analjezi sağlamak amacıyla çocuklarda kullanılan tekniklerden birisidir. Çalışmamızda, üst ekstremitede tendon transfer cerrahisi uygulanacak olan hastaların postoperatif dönemdeki ağrılarının tedavisinde interskalen blok uygulanmasının etkinliğini araştırdık. Yöntem: Tendon transfer cerrahisi uygulanacak, ASA I-III, 2-13 yaş arası, 40 hasta çalışmaya dahil edildi. Tüm çocuklar genel anestezi aldıktan sonra; Grup I (n=20)’de operasyon sonunda ultrasonografi (USG) yardımıyla interskalen blok uygulandı. Grup II (n=20)’deki hastalara lokal anestezik yerine, eş değer miktarda serum fizyolojik verildi. Her iki gruptaki hastalara operasyon bitiminden 30 dakika önce hasta kontrollü analjezi (HKA) başlandı. Hastaların; 1., 6., 12., 24., 36. ve 48. saatlerdeki Visual Analog Score (VAS) değerleri, Children’s and Infant’s Postoperative Pain Score (CHIPPS) değerleri, istenilen-verilen HKA analjezik miktarları, yan etkiler, ek analjezik ilaç kullanımları ve aile memnuniyetleri kaydedildi. Bulgular: VAS değerleri grup II’ de, 1., 6., 12., 24., 36. ve 48. saatlerde anlamlı şekilde yüksekti (p< 0,05). CHIPPS skorları grup I ‘de, 1., 6., 12. ve 24. saatlerde daha düşük bulundu (p< 0,05). Grup I’ deki hastaların analjezik ihtiyaçları daha azdı (p< 0,05) ve aile memnuniyetinin daha fazla olduğu görüldü (p< 0,05). Grup I’ deki hastalarda hiç ek analjezik ihtiyacı olmadı. Bulantı oranı grup I ‘de daha düşüktü (p< 0,05). Sonuç: İnterskalen blok uygulanan hastalarda; postoperatif dönemde analjezik gereksiniminin azaldığı ve aile memnuniyetinin daha fazla olduğu sonucuna varıldı.

The postoperative analgesic effect of interscalene block for children undergoing tendon transfer operation in upper extremity

Objective: Interscalene block is new techniques which is used for postoperative analgesia in children. We investigated the efficacy of interscalene block in treatment of postoperative pain of children in tendon transfer cases in upper extremity. Method: Fourty patients between 2-13 ages in ASA I-III who would undergo tendon transfer surgery were enrolled in our study. After all the children in study have taken general anesthesia, in group I (n=20); interscalene block was performed by the help of ultrasonography after the operation. This block was not applied in group II by local anesthetics; instead of serum physiologic was given. In both groups, 30 minutes before the end of the operation, patient controlled analgesia (PCA) was started. Visual analogue scores (VAS), children&#8217;s and infant&#8217;s postoperative pain scores (CHIPPS), desired and given PCA analgesic amounts, side effects, family satisfaction and additional analgesic drug usages in postoperative 1., 6., 12., 24., 36., 48., hours were recorded. Results: VAS scores were higher at 1., 6., 12., 24., 36. and 48. hours in group II (p<0.05). CHIPPS scores were lower in group I at 1., 6., 12., 24. hours (p< 0.05). The required analgesic amount was lower in group I. Family satisfaction was higher in group I (p< 0.05). No other analgesic drug was given in group I. The rate of nausea was lower in group I (p< 0.05). Conclusion: In patients in which interscalene block was performed required analgesic amount was lower in postoperative period and family satisfaction was higher.

___

  • 1. White PF, Rawal S, Latham P, Chi L. Use of continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology 2003;99:918-23.
  • 2. Keskin A. The role of pain in operative strategy. Agri 2004; 16(2):41-3.
  • 3. Erdine S: Postoperatif analjezi. A¤r› sendromlar› ve tedavisi. 2. Bask›. ‹stanbul 2003;33–43.
  • 4. Gurney MA. Pharmacological options for intra-operative and early postoperative analgesia: an update. J Small Anim Pract 2012; 53(7):377-86.
  • 5. Pirim A, Karaman S, Uyar M, Certu¤ A. Addition of ketamine infusion to patient controlled analgesia with intravenous morphine after abdominal hysterectomy. Agri 2006;18(1):52-8.
  • 6. Adriaenssens G, Vermeyen KM, Hoffmann VL, Mertens E, Adriaensen HF. Postoperative analgesia with i.v. patient-controlled morphine: effect of adding ketamine. Br J Anaesth 1999; 83(3):393-6.
  • 7. Moharari R, Sadeghi J, Khajavi M, Davari M, Mojtahedzadeh M. Fentanyl supplement expedites the onset time of sensory and motor blocking in interscalene lidocaine anesthesia. Daru 2010;18(4): 298-302.
  • 8. Casati A, Borghi B, Fanelli G, Montone N, Rotini R, Fraschini G, Vinciguerra F, Torri G, Chelly J. Interscalene brachial plexus anesthesia and analgesia for open shoulder surgery: a randomized, double-blinded comparison between levobupivacaine and ropivacaine. Anesth Analg 2003;96(1):253-9.
  • 9. Tobias JD. Brachial plexus anaesthesia in children. Paediatr Anaesth 2001;11(3):265-75.
  • 10. Suraseranivongse S, Kaosaard R, Intakong P, Pornsiriprasert S, Karnchana Y, Kaopinpruck J, Sangjeen K. A comparison of postoperative pain scales in neonates. Br J Anaesth 2006;97(4): 540-4.
  • 11. Aouad MT, Yazbeck-Karam VG, Nasr VG, El-Khatib MF, Kanazi GE, Bleik JH. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology 2007;107(5):733-8.
  • 12. Fetherston CM, Ward S. Relationships between post operative pain management and short term functional mobility in total knee arthroplasty patients with a femoral nerve catheter: a preliminary study. J Orthop Surg Res 2011;7;6:7.
  • 13. White PF, Rawal S, Latham P, Chi L: Use of continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology 2003;99:918-23
  • 14. Bonnet F, Marret E. Influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth 2005;95(1):52-8.
  • 15. Ivani G, Mossetti V. Pediatric regional anesthesia. Minerva Anestesiol 2009;75:577-83.
  • 16. Ivani G, Mossetti V. Regional anesthesia for postoperative pain control in children: focus on continuous central and perineural infusions. Paediatr Drugs 2008;10(2):107-14.
  • 17. Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-language society of pediatric anesthesiologists. Anesth Analg 1996;83:904-12.
  • 18. Leshkevich AI, Razhev SV, Lukin GI, Sidorov VA. Prolonged blocking of the brachial plexus by axillary approach in children. Anesteziol Reanimatol 1999;(4):41-4.
  • 19. McNeely JK, Hoffman GM, Eckert JE. Postoperative pain relief in children from the parascalene injection technique. Reg Anes 1999;16(1):20-2.
  • 20. Dadure C, Raux O, Gaudard P, Sagintaah M, Troncin R, Rochette A, Capdevila X. Continuous psoas compartment blocks after major orthopedic surgery in children: a prospective computed tomographic scan and clinical studies. Anesth Analg 2004;98(3): 623-8.
  • 21. Dadure C, Raux O, Troncin R, Rochette A, Capdevila X. Continuous infraclavicular brachial plexus block for acute pain management in children. Anesth Analg 2003;97(3):691-3.
  • 22. Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P; Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF). Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth 2010;20(12):1061-9.
  • 23. Small GA. Brachial plexus block anesthesia in children. J Am Med Assoc 1951;147(17):1648-51.
  • 24. Clayton ML, Turner DA. Upper arm block anesthesia in children with fracture. J Am Med Assoc 1959;24:169(4):327-9.
  • 25. Tissot M, Lassauge F, Arbez-Gindre F, Barale F. Brachial plexus block by infraclavicular approach in children. Value of a nerve stimulator? Apropos of 20 cases Agressologie 1991;32(1):86-7.
  • 26. Serlo W, Haapanemi L. Regional anaesthesia in paediatric surgery. Acta Anaesthesiol Scand 1985;29(3):283-6.
  • 27. Bogdanov A, Loveland R. Is there a place for interscalene block performed after induction of general anaesthesia? Eur J Anaesthesiol 2005;22(2):107-10.
  • 28. Sreevastava D, Trikha A, Sehgal L, Arora MK. Interscalene brachial plexus block for shoulder surgery in a patient with arthrogryposis multiplex congenita. Anaesth Intensive Care 2002;30(4):495-8.
  • 29. Ganesh A, Wells L, Ganley T, Maxwell L G, Cucchiaro G. Interscalene brachial plexus block for postoperative analgesia following shoulder arthroscopy in children and adolescents. Acta Anaesthesiol Scand 2008;52(1):162-3.
  • 30. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth 2005;94(1):7-17.
  • 31. Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia 2004;59(7):642-6.
  • 32. Rapp HJ, Folger A, Grau T. Ultrasound-guided epidural catheter insertion in children. Anesth Analg 2005;101(2):333-9.
  • 33. Roberts SA, Guruswamy V, Galvez I. Caudal injectate can be reliably imaged using portable ultrasound--a preliminary study. Paediatr Anaesth 2005;15(11):948-52.
  • 34. Marhofer P, Bösenberg A, Sitzwohl C, Willschke H, Wanzel O, Kapral S. Pilot study of neuraxial imaging by ultrasound in infants and children. Paediatr Anaesth 2005;15(8):671-6.
  • 35. Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg 2007;104(5): 1265-9.
  • 36. De José María B, Banús E, Navarro Egea M, Serrano S, Perelló M, Mabrok M. Ultrasound-guided supraclavicular vs infraclavicular brachial plexus blocks in children. Paediatr Anaesth 2008;18(9): 838-44.
  • 37. Willschke H, Bösenberg A, Marhofer P, Johnston S, Kettner S, Eichenberger U, Wanzel O, Kapral S. Ultrasonographic-guided ilioinguinal/iliohypogastric nerve block in pediatric anesthesia: what is the optimal volume? Anesth Analg 2006;102(6):1680-4.
  • 38. Weintraud M, Marhofer P, Bösenberg A, Kapral S, Willschke H, Felfernig M, Kettner S. Ilioinguinal/iliohypogastric blocks in children: where do we administer the local anesthetic without direct visualization? Anesth Analg 2008;106(1):89-93.
  • 39. Lee JH, Kim YR, Yu HK, Cho SH, Kim SH, Chae WS. Ultrasound - guided interscalene brachial plexus block in a pediatric patient with acute hepatitis. Korean J Anesthesiol 2012; 62(6):568-70.
Anestezi Dergisi-Cover
  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Betül Kartal
Sayıdaki Diğer Makaleler

Plesenta previa ve ablasyo plesenta olan iki gebede sezaryen için spinal anestezi

Özden DAŞ, Berrin GÜNAYDIN, NURAY BOZKURT, DEMET COŞKUN, Hakan DAYANIR

Ameliyathane ve servis çalışanlarında hepatit B, hepatit C ve HIV seroprevlalansının karşılaştırılması

Ümit Yaşar TEKELİOĞLU, MÜCAHİDE ESRA KOÇOĞLU, Akcan AKKAYA, Abdullah DEMİRHAN, İSMAİL NECATİ HAKYEMEZ, Tekin TAŞ, Hakan BAYIR, HASAN KOÇOĞLU

Plesenta akreta vakalarında perioperatif anestezi yaklaşımı (Retrospektif analiz)

TÜLAY ÖZKAN SEYHAN, Mukadder ORHAN SUNGUR, Fatma DEMİRCAN, İbrahim KALELİOĞLU, Ahmet Cem İYİBOZKURT, Mert ŞENTÜRK

Çocuklarda üst ekstremite Tendon transfer cerrahisinde uygulanan interskalen bloğun postoperatif analjezik etkinliği

Yücel YÜCE, Banu AYHAN, Fatma SARICAOĞLU, Seda B. AKINCI, Gürsel LEBLEBİCİOĞLU, Ülkü AYPAR

Posttorakotomi ağrı yönetimi

Tarık PURTULOĞLU, Ali SIZLAN, Abdülkadir ATIM

İkiz gebede posterior reversible ensefalopati sendromu ve anestezi yönetimi

Mesut ERBAİ, Burhan DOST, Ömür ÖZTÜRK, Abdulkadir İSKENDER, YAVUZ DEMİRARAN

Farklı sevofluran ürünleri ne kadar farklıdır?

Zekeriya ALANOĞLU, ÇİĞDEM YILDIRIM GÜÇLÜ, AHMET ONAT BERMEDE, NESLİHAN ALKIŞ

Sistemik lupus eritematozus hastalığına bağlı dördüncü dereceden nefropatisi olan bir gebede sezaryen anestezi yönetimi

AYÇA TAŞ TUNA, Berrin GÜNAYDIN, NURAY BOZKURT, Hakan DAYANIR, DEMET COŞKUN

Dandy Walker sendromlu hastada genel anestezi uygulaması

Rüveyda İrem DEMİRCİOĞLU, Azra ÖZANBARCI, Safinaz KARABAYIRLI, Burhanettin USTA, Fatih ANDIRAN

İnguinal herni operasyonlarında spinal anestezi ile paravertebral bvlok uygulamalarının Karşılaştırılması

Can BAHAR, Gülten ÜTEBEY, Onur ÖZLÜ