Ahmet Murat YAYIK, Ali AHISKALIOĞLU, Muhammet Mustafa SULAK, Elif Oral AHISKALIOĞLU, Muhammet AHMET KARAKAYA, Erkan Cem ÇELİK, Erdem KARADENİZ, Hacı Ahmet ALICI

Modifiye Radikal Mastektomi ve Aksiller Lenf Nodu Diseksiyonunda Ultrason Eşliğinde Yapılan Yüzeyel Serratus Plan Bloğunun Akut Postmastektomi Ağrısına Etkisi: Randomize Kontrollü Çalışma

Amaç: Meme kanseri kadınları etkileyen en yaygın kanser türüdür. Her yıl binlerce hasta meme ve aksil- ler bölgeden cerrahi geçirmektedir. Bu cerrahi sırasında çok ciddi akut postoperatif ağrı meydana gel- mektedir. Ultrasonografini kullanımının son yıllarda rejyonal anestezi pratiğinde artmasıyla birlikte plan blokları da oldukça popüler hale gelmiştir. Bunlardan birisi de serratus kasının üzerine veya altına lokal anestezik yayılımı ile tanımlanan serratus plane bloğudur (SPB). Bu çalışmanın amacı, meme kanseri nedeniyle modifiye radikal mastektomi ve lenf nodu diseksiyonu yapılacak hastalarda yüzeyel SPB’nun postoperatif opioid tüketimine etkisini araştırmaktır. Yöntem: Etik onam alındıktan sonra 18-65 yaş arası, ASA I-III modifiye radikal mastektomi ve aksiller lenf nodu diseksiyonu yapılacak olan 48 hasta randomize olarak serratus blok (grup SPB, n=24) veya kontrol grubu (grup K, n=24) olarak 2 gruba ayrıldı. SPB grubuna ultrasound eşliğinde 30 mL %0.25’lik bupivakain serratus kası üzerine SPB uygulandı. Grup K’ya ise ultrasound eşliğinde 2 mL salin subkutan cerrahi öncesi uygulandı. Postoperatif dönemde 12 saatte bir 50 mg deksketoprofen trometamol ve intravenöz fentanil ile hasta kontrollü analjezi düzenlendi. Aktif ve pasif visual analog skala (VAS) ile postoperatif analjezi değerlendirildi. Opioid tüketimi, ek analjezi gereksinimi ve opioid ile ilişkili yan etkiler ilk 24 saatte kaydedildi. Bulgular: SPB grubu 24 saatlik fentanil tüketimi açısından kontrol grubundan anlamlı olarak daha düşük bulunmuştur (123.96±72.04 vs 345.83±207.56 sırasıyla p

The Effect of Ultrasound-Guided Superficial Serratus Plane Block For Acute Postmastectomy Pain After Modified Radical Mastectomy and Axillary Lymph Node Dissection: A Randomized Controlled Study

Objective: Breast cancer is the most common type of cancer affecting women. Every year thousands of patients undergo surgery from breast and axillary region. Extremely severe acute postoperative pain occurs during this surgery. In recent years together with increasing use of ultrasound in regional anesthesia prac- tice, plane blocks have become popular in anesthesiology practice. One of them is the serratus plane block (SPB) defined by the dissemination of local anesthetic superficial or deep to the serratus muscle. The aim of this study is to investigate the effect of superficial SPB on postoperative opioid consumption in patients who would undergo modified radical mastectomy and axillary lymph node dissection. Methods: After ethics committee approval,48 patients, aged 18-65 years, undergoing ASA I-III modified radical mastectomy, and axillary lymph node surgery were randomized into 2 groups. Control Group (Group C, n=24); received ultrasound-guided subcutaneus injection of 2 mL 0.9% saline before the surgery, Group SPB (Group S, n=24) received ultrasound-guided injection of 0.25 % bupivacaine 30 mL on the serratus muscle. Postoperatively, patient-controlled analgesia was performed intravenously in the 2 groups at 12 hour-intervals with 50 mg dexketoprofen trometamol and fentanyl. Postoperative analgesia was evaluated using the visual analog scale (VAS). Opioid consumption, requirement for additional analgesia and opioid related side effects were recorded during the first 24 hours after surgery. Results: The 24-hour opioid consumption was significantly lower in the SPB group compared with the control group (123.96±72.04 mcg vs 345.83±207.56 mcg, p

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