NURTEN İNAN, Esma TEZER, Handan GÜLEÇ, Aysel ER, Nurşen GÜRSOY, Hülya BAŞAR

İnguinal herni operasyonlarında, levobupivakain ve bupivakain ile ilioinguinal-iliohipogastrik sinir bloğu ve kesi yerinin lokal anestezikle infiltrasyonunun bloğunun etkinliği

Amaç: Spinal anestezi altında yapılan inguinal herni operasyonlarında, postoperatif analjezi amacı ile levobupivakain ve bupivakain kullanılarak yapılan ilioinguinal-iliohipogastrik sinir bloğu (İİHB) ve keşi yeri infiltrasyon bloğunun postoperatif analjezik ihtiyacına ve ağrı düzeyine etkisini incelenmesi amaçlanmıştır. Aynı zamanda lokal anesteziklerin etkinlik karşılaştırması da yapılmış ve gruplarda görülen yan etkiler de değerlendirilmiştir. Gereç ve Yöntem: ASA I-II, 60 hasta rastgele 20 hastalık 3 gruba ayrıldılar. Tüm hastalara %0.5 hiperbarik bupivakain ile spinal anestezi uygulandı. Operasyon bitiminde, Grup L'ye 40 mL %0.25 levobupivakain ile İİHB (20 mL) ve infiltrasyon bloğu (20 mL) uygulandı. Grup B'ye aynı işlemler %0.25 bupivakain ile, Grup P'ye ise %0.9 NaCl ile uygulandı. Ek analjezik olarak 75mg diklofenak, yetersiz kalır ise im 50 mg meperidin intramüsküler (im) yapıldı. Gruplar postoperatif dönemde VAS düzeyi, ek analjezik tüketimi ve yan etkiler açısından değerlendirildiler ve karşılaştırıldılar. Bulgular: Gruplar arası karşılaştırmada her iki ilaç grubunda istirahat ve harekette VAS değerleri ve ek analjezik tüketimi plasebo grubuna göre anlamlı olarak düşük bulundu (p0.05). Yan etkiler bakımından gruplar arasında anlamlı fark gözlenmedi (p>0.05). Sonuç: Etkili postoperatif analjezi sağlaması, ek analjezik tüketimini çok azaltması ve ek yan etki oluşturmaması nedeni ile hem levobupivakain hem de bupivakainle uygulanan bloklar, postoperatif 48 saat boyunca plasebodan üstün etkinlik sağlamıştır.

The efficacy of ilioinguinal-iliohypogastic nerve blocks and periincisional field block using levobupivacaine and bupivacaine after inguinal hernia operations

Objective: We aimed to investigate the effects of ilioinguinal-iliohypogastric nerve block (IIHB) and peri-incisional infiltration block with levobupivacaine and bupivacaine on postoperative analgesic requirement and on pain scores of the patients undergoing inguinal hernia operation under spinal anesthesia. At the same time, the efficacy of local anesthetics and side effects were compared. Material and Method: ASA I- II, 60 patients were randomized into three groups ( n=20). Spinal anesthesia was performed with hyperbaric %0,5 bupivacaine to all patients. At the end of the operation, all patients had IIHB (20 mL) and peri-incisional infiltration block (20 mL) was performed in all groups. Group L received 40 mL %0,25 levobupivacaine, Group B received 40 mL %0,25 bupivacaine and Group P received %0,9 NaCl. Diclofenac 75 mg and if required 50 mg im meperidine was used as resque analgesics. Postoperative VAS scores at rest and movement, rescue analgesic requirement and side effects were also recorded. Results: In group L andB, resting and active VAS scores were significantly lower than placebo group (p<0.05). But, there was no difference between groups L andB (p>0.05). Side effects were similer in all groups (p>0.05) Conclusion: Both levobupivacaine and bupivacaine used after in ilioinguinal-iliohypogastric nerve and periincissional infiltration blocks provided effective postoperative analgesia, reduced postoperative analgesic requirement without any additional side effects

PDF

___

1.Vintar N, Pozlep G, Rawal N, Godec M, Rakovec S. Incisional self-administration of bupivacaine or ropivacaine provides effective analgesia after inguinal hernia repair. Can J Anesth 2002: 49(5); 481-486.
2.Nielsen MB, Klarskov B, Been K, Andersen J, Kehlet H. Levobupivacaine vs bupivacaine as infiltration anaesthesia in inguinal herniorrhaphy. Br J Anaesth 1999; 82: 280-282.
3.Ausems ME, Hulsewe KW, Hooymans PM, Hoofwijk AG. Postoperative analgesia requirements at home after inguinal hernia repair: effects of wound infiltration on postoperative pain. Anaesthesia 2007: 62; 325-331.
4.Ding Y, White P. Post-herniorrhaphy pain in outpatients after preincisional ilioinguinal-iliohypogastric nerve block during monitored anaesthesia care. Can J Anaesth 1995; 42: 12-5.
5.Aasbo V, Thuen A, Raeder J. Improved long-lasting postoperative analgesia, recovery function and patient satisfaction after inguinal hernia repair with inguinal field block compared with general anesthesia. Acta Anaesth Scand 2002; 46: 674-8
6.Narchi P, Carry P, Catoire P, et al. Postoperative pain relief and recovery with ropivacaine infiltration after inguinal hernia repair. Ambul Surg 1998; 221-226.
7.Beaussier M, Weickmans H, Abdelhalim Z, Lienhart A. Inguinal herniorrhaphy under monitored anesthesia care with ilioinguinal-iliohypogastric block: The impact of adding clonidine to ropivacaine. Anesth Analg 2005; 101: 1659-62.
8.Clerc S, Vuilleumier H, Frascarolo P, Spahn DR, Gardaz JP. Is the effect of inguinal field block with %0.5 bupivacaine on postoperative pain after hernia repair enhanced by addition of ketorolac or S(+) Ketamine? Clin J Pain 2005; 21: 101-105
9.Toivonen J, Permi J, Rosenberg PH. Analgesia and discharge following preincisional ilioinguinal and iliohypogastric nerve block combined with general or spinal anaesthesia for inguinal herniorrhaphy. Acta Anaesthesiol Scand 2004; 48: 480-485.
10.Callesen T, Bech K, Nielsen R et al. Pain after groin hernia repair. BrJ Surg 1998; 85: 1412-4.
11.Lau H, Lee F. Determinant factors of pain after ambulatory inguinal herniorrhaphy: a multi-variate analysis. Hernia 2001; 5: 17-20.
12.Özgün H Kurt MN, Kurt I, Cevikel MH. Comparison of local, spinal, and general anaesthesia for inguinal herniorrhaphy. Eur J Surg 2002; 168:455-9.
13.Tverskoy M, Cozacov C, Ayache M, Bradley EL Jr, Kissin I. Postoperative pain after inguinal herniorrhaphy with different types of anesthesia. Anesth Analg 1990; 70:29-35.
14.Budego GJ, Cacamo CR, Mertens RA, Dagnino JA, Munoz HR. Preoperative percutaneous ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine for post-herniorrhaphy pain management in adults. Reg Anesth 1990; 15: 130-3.
15.Toivonen J, Permi J, Rosenberg PH. Effect of preincisional ilioinguinal and iliohypogastric nerve block on postoperative analgesic requirement in day-surgery patients undergoing herniorrhaphy under spinal anaesthesia. Acta Anaesthesiol Scand 2001; 45: 603-607.