SÜNNET OLAN ÇOCUKLARDA BUPİVAKAİN İLE DORSAL PENİL BLOK KAUDAL BLOK VE ORAL İBUPROFEN'İN ETKİNLİĞİNİN KARŞILAŞTIRILMASI
Amaç: Bu çalıflmada pediatrik hastalarda sünnet sonrası bupivakain ile yapılan kaudal blok, dorsal penil blok ve oral ibuprofenin analjezik etkinliği ve yan etki profili değerlendirildi. Yöntem: 2-7 yaflları arasında sünnet planlanan 90 çocuk çalıflmaya alındı. Hastalar üç gruba ayrıldı; Grup Kdaki (n=30) hastalara kaudal blok, Grup Ddeki (n=30) hastalara dorsal penil blok, Grup deki (n=30) hastalara oral ibuprofen uygulandı. Kaudal blok grubunda, anestezist tarafından 22G kaudal iğne kullanılarak 1 ml kg-1 % 0.25lik bupivakain ile kaudal blok uygulanırken, dorsal penil blok grubunda cerrah tarafından 23G iğne kullanılarak 0.3 ml kg-1 %0.5lik bupivakain ile dorsal penil blok yapıldı. buprofen grubunda ise 10 mg kg-1 oral ibuprofen ifllemden önce verildi. Postoperati f dönemde, derlenme ünitesinde, 1., 4., 8., 12., 24. saatlerdeki modi fiye pediatrik objekti f ağrı skalası (MPOPS), ilk analjezik talep zamanları, toplam parasetamol ihtiyacı kaydedildi. Komplikasyonlar ve aile memnuniyeti sorgulandı. Bulgular: Gruplar arası demografik veriler benzerdi. lk saatte ağrı skoru, Grup Kda, Grup D ve ye göre daha iyi bulundu (p=0.002). Sonraki 24 saatte gruplar arasında ağrı skorları bakımından fark bulunmadı (p>0.05). Grup Kda ilk analjezik talep zamanı uzundu (p=0.001). Tüketilen toplam parasetamol miktarı gruplar arasında benzerdi (p=0.967). Komplikasyonlar bakımından gruplar arasında fark bulunmadı(p=0.266). Sonuç: Sünnette ağrı kontrolünde, ilk saatte bupivakain ile yapılan kaudal blok avantajlı gibi görünse de; bupivakain ile yapılan dorsal penil blok, kaudal blok ve oral ibuprofen ile etkin ağrı kontrolü sağlanmıfltır
COMPARISON OF DORSAL PENILE BLOCK AND CAUDAL BLOCK WITH BUPIVACAINE AND ORAL IBUPROFEN IN CHILDREN UNDERGOING CIRCUMCISION
Objective: In this study, we evaluated the postcircumcision analgesic efficacy and adverse effect profile of caudal block, dorsal penil block with bupivacaine and oral ibuprofen in pediatric patients. Method: Ninety boys, between ages of 2-7 years undergoing circumcision, were enrolled in the study. The patients were divided into three groups: Group K (n=30), Group D (n=30) and Group I(n=30) were applied caudal block, dorsal penile block and oral ibuprofen respectively. In caudal block group, anesthesiologist performed caudal block of 1 ml kg-1 0.25% bupivacaine with 22 G caudal needle and in dorsal penile block group, the surgeon performed penile block of 0.3 ml kg-1 0.5% bupivacaine with 23 G needle. In ibuprofen group, preoperative oral 10 mg kg-1 ibuprofen was administered. Postoperative modi fied pediatric objective pain scale (MPOPS) at the post anesthetic care unit at 1st, 4th, 8th, 12th and 24th hours, time to first analgesic request, total paracetamol consumption were recorded. Complications and family satisfaction were questioned. Results: Demographic data were similar in groups. At the first hour pain score in Group K was better than Group I and Group D (p=0.002). After the first hour there was no di fference between the groups in terms of pain scores (p>0.05). Time to first analgesic request was longer in Group K (p= 0.001). The amount of the total paracetamol consumption was similar between groups (p = 0.967). There was no di fference between the groups in terms of complications (p = 0.266). Conclusion: For pain control in circumcision although caudal block with bupivacaine seems more adventageous for the first hour; effective pain control was provided with dorsal penile block, caudal block made with bupivacaine and oral ibuprofen.
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