Ersagun TUGCUGIL, Dilek KUTANİS, Ahmet BEŞİR, Müge KOŞUCU, Ahmet MENTEŞE, Suleyman Caner KARAHAN, SELİM DEMİR, Sedat SAYLAN, Ali AKDOGAN

The Effects of Axillary Nerve Block and Intravenous Regional Anesthesia on Ischemia-Reperfusion Injury Induced By Tourniquet

Objective: We aimed to compare the effects of axillary nerve block and IVRA (Intravenous Regional Anesthesia) techniques used in patients planned to undergo hand surgery on tourniquet induced ischemia- reperfusion injury. Ischemia due to the use of tourniquet and the subsequent reperfusion cause oxidative stress in the organism. Oxidative stress contributes to postoperative morbidity. Method: The study included 65 patients who underwent hand surgery. The patients received axillary nerve block were assigned to Group A (n=33) and the patients received IVRA were assigned to Group I (n=32). Blood samples were collected at T1 before anesthesia, T2 immediately before tourniquet deflation, T3 5 min, T4 30 min and T5 4 hours after tourniquet deflation and serum TAS (total antioxidant level), TOS (total oxidant level), OSI (oxidant status index) and IMA (ischemia modified albümin) levels were studied. Results: Plasma concentration of IMA and OSI were significantly higher in Group A than in Group I at T2, T3, T4 time points. Plasma TOS level was higher in Group A than in Group I at time point T3. Plasma TAS level was significantly higher in Group I than in Group A at time points of T2, T3, T4. Conclusion: IVRA was more effective than axillary block in preventing ischemia- reperfusion injury induced by tourniquet used in hand surgery, but there was no difference between these two techniques in the fourth hour of reperfusion.

Aksiller Sinir Bloğu ve İntravenöz Rejyonal Anestezinin Turnike Sonucu Gelişen İskemi-Reperfüzyon Hasarına Etkileri

Amaç: El cerrahisi planlanan hastalarda kullanılan aksiller sinir bloğu ve IVRA (İntravenöz Bölgesel Anestezi) tekniklerinin turnikenin oluşturduğu iskemi reperfüzyon hasarı üzerine etkilerini karşılaştırmayı amaçladık. Turnike kullanılması ve sonraki reperfüzyondan kaynaklanan iskemi, organizmada oksidatif strese neden olur. Oksidatif stres ise postoperatif morbiditeye katkıda bulunur. Yöntem: Çalışmaya el cerrahisi uygulanan 65 hasta dahil edildi. Aksiller sinir bloğu alan hastalar Grup A (n=33), IVRA alan hastalar Grup I (n=32) olarak ifade edildi. Kan örnekleri anestezi öncesi T1’de, turnike deflasyonundan hemen önce T2, turnike deflasyonundan 5 dk sonra T3, 30 dak sonra T4 ve 4 saat sonra T5 alındı. Bulgular: Plazma IMA ve OSI konsantrasyonları Grup A’da Grup I’den T2, T3, T4 zaman dilimlerinde anlamlı olarak yüksekti. Plazma TOS düzeyi Grup A’da Grup I’den T3 zaman diliminde daha yüksekti. Plazma TAS düzeyi Grup I’de Grup A’dan T2, T3, T4 zaman dilimlerinde anlamlı olarak yüksekti. Sonuç: IVRA, el cerrahisinde kullanılan turnike tarafından oluşturulan iskemi reperfüzyon hasarını önlemede aksiller bloktan daha etkiliydi, ancak bu iki teknik arasında reperfüzyonun dördüncü saatinde bir fark yoktu.

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