Talay ŞAHİN YILDIZ, ONUR BALABAN, Bülent ŞAHİN, Mine SOLAK, Kamil TOKER

Gebede lomber ultrasonografi eşliğinde subaraknoid blok

Amaç: Subaraknoid blok, elektif sezaryenlerde tercih edilen bir rejyonal anestezi yöntemidir. Günümüzde gebelerde interspinöz aralığı tespit etmek oldukça zordur. Bu çalışma ile gebelerde blok öncesi iğne derinliğini tahmin etmede ve en uygun giriş noktasını belirlemede lomber ultrasonografinin katkısını değerlendirmeyi amaçladık. Yöntem: Çalışmaya, hastane etik kurulu ve hastaların onamları alındıktan sonra, ASA I-II, subaraknoid blok ile sezaryen operasyonu geçirecek 68 gebe dâhil edildi. Hastalara oturur pozisyonda, aynı anestezist tarafından L4-L5 interspinöz aralığın tespiti için lomber ultrasonografi yapıldı. Tujfier hattının gebede gerçekte hangi aralığa denk geldiği US ile tespit edilerek kaydedildi. Cilt-Ligamentum Flavum (LF) , cilt-subdural mesafe (US derinliği) arası mesafeler hem paramedian hem de transvers düzlemlerde ölçüldü. Bulgular: işlem sırasında ölçülen iğne derinliği ile US ile ölçülen cilt-subdural mesafe arasında güçlü bir korelasyon tespit edildi (r- 0,71 p< 0,001). US ile ölçülen cilt-subdural mesafe (US derinliği) ortalaması 5,3 cm iken, iğne mesafesi 6,1 cm olarak ölçüldü. Subaraknoid aralık vakaların %92,6'sında başarıyla tespit edildi. Yönlendirme yapmadan ilk denemede başarı oranı ise %83,7 olarak tespit edildi. Sonuç: Ultrason ile ölçülen cilt-subdural mesafe ile iğne derinliği arasında güçlü bir korelasyon tespit ettik. Sonuç olarak; ultrasonografinin gebelerde subaraknoid bölgeye iğne girişinde güvenilir bir rehber olabileceğini düşünmekteyiz.

Ultrasound guidance for subarachnoid block in parturient

Objective: Subarachnoid blocks have become the technique of choice for elective cesarean sections. Current techniques to identfy a safe interspace have limitations. In this study, we assessed prepuncture lumbar ultrasound scanning as a tool for estimating the depth to the subdural space and determining the optimal insertion point in parturients. Method: After approval by the Ethics Committe and written informed consent, ASA I-II, sixty-eight term pregnant women scheduled to receive subarachnoid blockade for Caesarean section were included in the study. With the patients in the sitting position, the same anesthesiologist performed a lumbar spine ultrasound scan to identfy the L4-L5 interspace. The intercristal line (Tujfier's line) were assessed by ultrasound to detect its clinical level. The distances from the skin to the ligamentum flavum and from skin to the subdural space (ultrasound depth, UD) were measured in the paramedian and transverse planes. Results: There was a high correlation between the ultrasound depth and the needle depth (ND) (r= 0.71 p< 0.001). The mean ultrasound depth was 5.3 cm, whereas the needle depth was 6.1 cm. Successful identification of the subarachnoid space was accomplished in 92.6% of the cases. First attempt success rate was 83.7%. Conclusion: We found a good correlation between the ultrasound depth and the needle depth. This suggests that ultrasound can be a reliable guide to facilitate subarachnoid needle placement in parturients

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