Mustafa Caner Okkaoğlu, Adem Selvi, Gökhan Yıldız, Erbil Türksal, Rıdvan Özbek, Esra Özayar

Femoral Blokta Farklı İki Doz Bupivakain Protokolünün Postoperatif Analjezi Üzerine Etkisi: Tek Merkez Verilerinin Retrospektif Analizi

Amaç: Çalışmamızda, total diz protezi (TDP) ameliyatı sonrasında aynı volümde (20 mL) farklı konsantrasyonlarda (%0.5 bupivakain ile %0.25 bupivakain) lokal anestezik ajan ile uygulanan femoral sinir bloğunun analjezik etkinliğini, opioid tüketimine etkisi ve yan etki profilini karşılaştırmayı amaçladık. Yöntem: 2018 Ağustos-2019 Haziran tarihleri arasında spinal anestezi altında tek taraflı TDP ameliyatı olan hastaların dosyaları retrospektif tarandı. Femoral blok için %0.25 bupivakain uygulanan Grup 1’de 81, %0.50 bupivakain uygulanan Grup 2’de 82 toplam 163 hasta çalışmaya dahil edildi. Postoperatif 24 saatteki en yüksek vizuel analog ağrı skalası (VAS) skorları, intravenöz hasta kontrollü analjezi (HKA) cihazlarıyla talep edilen ve tüketilen tramadol miktarı ve yan etki (bulantı, kusma, motor ve duyu defisiti) açısından anlamlı fark olup olmadığına bakıldı. Bulgular: Grup 1’de en yüksek VAS ortalama 2.95±1.31, Grup 2’de ortalama 2.84±1.06 idi ve aralarında anlamlı fark yoktu. Tüketilen tramadol Grup 1’de ortalama 197.04±92.03 mg, Grup 2’de 208.05±85.06 mg idi. Tramadol talep ve tüketimi ile yan etki açısından fark saptanmadı. Sonuç: Femoral blokta 20 mL %0.25 bupivakain, aynı hacimde %0.50 bupivakainle eş analjezik etkinliği sağlamıştır. Bu nedenle sistemik yan etkileri, motor blok riskini ve komplikasyonları azaltmak için %0.25 bupivakain kullanımının daha güvenilir bir seçenek olduğunu düşünüyoruz.

The Effect of Two Different Doses Protocol of Bupivacaine for Femoral Block on Postoperative Analgesia: A Retrospective Analysis of Single Center Data

Objective: In our study, we aimed to compare the analgesic efficacy, side effect profile and its effect on opioid consumption of the femoral nerve block applied with different concentrations of local anesthetic agents (0.5% bupivacaine and 0.25% bupivacaine) in the same volume (20 mL) after total knee replacement (TKR) operation. Methods: The files of patients who underwent unilateral TKR surgery under spinal anesthesia between August 2018 and June 2019 were retrospectively reviewed. A total of 163 patients were included in the study, 81 patients in group 1 who received 0.25% bupivacaine, and 82 patients in group 2 who received 0.50% bupivacaine for femoral block. The highest visual analogue pain scale (VAS) scores in the postoperative 24 hours, the amount of tramadol requested and consumed with intravenous patient-controlled analgesia (PCA) devices, and whether there was a significant difference in terms of side effects (nausea, vomiting, motor and sensory deficit) were analyzed. Results: The highest VAS score in group 1 was 2.95±1.31, in group 2 it was 2.84±1.06, and there was no significant difference between them. The mean consumption of tramadol was 197.04±92.03 mg in group 1 and 208.05±85.06 mg in group 2. There was no difference between the demand and consumption of tramadol and side effects. Conclusion: 20 mL 0.25% bupivacaine for the femoral block provided the equivalent analgesic efficacy to the same volume of 0.50% bupivacaine. We think that the use of 0.25% bupivacaine is a more reliable option to reduce systemic side effects, motor block risk and complications.

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