Diz artroplastisinde postoperatif ağrı kontrolü için uygulanan femoral sinir bloğunda % 0,5’lik levobupivakaine tramadol ilavesinin etkiniği

Amaç: Bu çalışmada, spinal anestezi ile gerçekleştirilen total diz artroplastisi girişimlerinde postoperatif analjezi amacıyla tek enjeksiyon femoral 3-1 blok tekniğinde, levobupivakaine tramadol ilavesinin etkisi prospektif olarak araştırıldı. Gereç ve Yöntem: Total diz artroplastisi planlanan 24 hasta, rastgele 2 gruba ayrıldı. Tüm hastalara spinal anestezi öncesi tek enjeksiyon femoral blok; Levobupivakain Grubu’nda (Grup-L) 0,3 mL kg-1 % 0.5’lik levobupivakain, Levobupivakain + Tramadol Grubu’nda (Grup-LT) 0,3 mL kg-1 % 0.5’lik levobupivakain + 1,5 mg kg-1 tramadol ile yapıldı. Femoral blok sonrası tüm hastalara 15 mg hiperbarik bupivakainle selektif spinal anestezi uygulandı. Postoperatif dönemde ağrı değerlendirmesi Görsel Analog Skala (VAS) ve Verbal Ağrı Skalası (VPRS) ile yapıldı. VAS 30’un üstüne çıktığında iv morfin ile hasta kontrollü analjezi (HKA) başlandı. Femoral blok öncesi, spinal anestezi öncesi, operasyon sonu, HKA başlangıcından sonra 2, 4, 6, 12 ve 24. saatlerdeki istirahat ve hareketle VAS ve VPRS değerleri, toplam morfin gereksinimi, ek analjezik ihtiyacı, kan basıncı, kalp hızı ve yan etkiler kaydedildi. Bulgular: Çalışmaya dahil edilen hastalarda istirahatte daha fazla olmak üzere tüm periyotlarda, VAS ve VPRS skorları düşük bulunmuştur. Bu blok tekniğinde levobupivakaine tramadol eklenmesi anlamlı olmasa da blok oluşma süresini kısaltmıştır (Her iki grupta VAS

Knee arthroplasty and femoral block

Objective: In this study, efficacy of single shot femoral block technique by adding tramodol to levobupivacaine in order to provide postoperative analgesia in patients undergoing total knee arthroplasty with spinal anesthesia was investigated, prospectively. Methods: Twenty four patients that were planned to undergo total knee arthroplasty were enrolled to study. Patients were randomly divided into 2 groups. Femoral block was performed with in Levobupivacaine Group (Group-L) 0.3 mL kg-1 0.5% levobupivacaine and Levobupivacaine+Tramadol (Group Group-LT) 0.3 mL kg-1 0.5% levobupivacaine + 1.5 mg kg-1 tramadol before spinal anesthesia performed. After that selective spinal anesthesia was performed with 15 mg hyperbaric bupivacaine. Pain evaluation was made with Visual Analog Scala (VAS) and Verbal Pain Rating scala (VPRS) postoperatively. Intravenous morphine PCA was begun when the VAS over 30. Activity and resting VAS and VPRS values, total morphine need, additional analgesic need, blood pressure, heart rate and side effects were recorded before femoral block, before spinal anesthesia, end of the surgery and 2, 4, 6, 12 and 24 hours following the initiation of the PCA. Results: In the patients enrolled to the study, while more prominent in the resting, VAS and VPRS scores were lower in all periods. However pain scores were detected quite better in favor of tramadol given group. Although it was not meaningful to add tramadol to this block technique, it decreased the time to occurrence of block (VAS <3 and VPRS < 1 in both groups). Although time for initiating PCA and total morphine consumption were the same in both groups, amount of needed morphine and additional analgesic need were significantly lower in tramadol given group. No side effects were detected in both groups originating form the usage of local anesthetic and Tramadol. Conclusion: Single shot femoral 3 in 1 block technique, performed preoperatively in order to provide postoperative analgesia following total knee arthroplasty was observed simple, safe and efficient block. Levobupivacaine, was observed to be used safely in single shot femoral block. Adding tramadol to levobupivacaine in this block technique detected quite better pain control at resting and activity period.

Kaynakça

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