Nurhan ERDOĞAN, Banu AYHAN, Fatma SARICAOĞLU, Almıla Gülsün PAMUK, Şennur UZUN, Seda B. AKINCI, Ülkü AYPAR

Total abdominal histerektomi olgularında ultrason tekniği eşliğinde yapılan transversus abdominis düzlem bloğunun postoperatif analjezik etkinliği

Amaç: Transvers abdominal düzlem (TAP) blok uygulamaları, abdominal cerrahilerde, postoperatif analjezi amacıyla efektif olarak kullanılmaktadır. Çalışmamızda, spinal anestezi ile total abdominal histerektomi yapılan hastalarda, epidural analjezi ile ultrason eşliğinde uygulanan TAP bloğunun analjezik etkinliğini değerlendirmeyi amaçladık. Yöntem: Çalışmamız randomize ve çift kör olarak planlanmıştır. 40 hasta; spinal anestezi uygulaması sonrası epidural analjezi uygulananlar (Grup I, n: 20) ve spinal anestezi sonrası epidural analjezi ile birlikte TAP blok uygulananlar (Grup II, n: 20) olarak iki gruba ayrıldılar. TAP blok; bilateral olarak %0,25'lik bupivakain kullanılarak uygulandı. Spinal anestezi için bupivakain ve postoperatif hasta kontrollü epidural analjezi için levobupivakain ile birlikte fentan.il kullanıldı. Postoperatif analjezik ihtiyacı, ağrı skorlamaları, bulantı-kusma, idrar retansiyonu, hipotansiyon ve ağrı tedavisinin memnuniyet derecesi kaydedildi. Bulgular: 48 saat içinde kullanılan levobupivakain+fentanil miktarı, Grup II'de; Grup I ile karşılaştırıldığında düşük olarak bulunmuştur (Ort ±SD; Grup II'de Levobupivakain: 150±43 mg ve Fentanil: 240 ± 68 $\mu{g}$; Grup T de Levobupivakain: 428±90 mg ve Fentanil: 685±145 $\mu{g}$ (p< 0,05). Grup II'de, tüm zamanlarda bakılan VAS değerlerinin, Grup T e göre düşük olduğu saptanmıştır (p< 0,05). Sonuç: Ultrason eşliğinde yapılan TAP blok; total abdominal histerektomilerden sonra, levobupivakain+fentanil ihtiyacını ve ağrı skorlarını azaltarak hasta memnuniyetini arttırır.

The postoperative analgesic effect of ultrason-guided transversus abdominis plane block for patients undergoing total abdominal hysterectomy

Background: Transversus abdominis plane (TAP) block is an effective method of providing postoperative analgesia in patients undergoing abdominal surgery. We evaluated the analgesic efficacy of the ultrasound-guided TAP block with compared epidural analgesia in patients undergoing total abdominal hysterectomy under spinal anesthesia. Methods: A randomized, double-blind trial was performed at a tertiary hospital. Forty patients were randomized to receive spinal anesthesia and epidural analgesia either without (Group I, n=20) or with TAP block (Group II, n=20). Bilateral TAP block was performed with bupivacaine 0.25%. All participants received spinal anesthesia with bupivacaine, followed by postoperative patient-controlled epidural levobupivacaine+fentanyl. Postoperative demand of levobupivacaine+fentanyl, average pain scores, nausea, vomiting, urinary retention, hypotension, satisfaction with pain relief was recorded. Results: Total levobupivacaine + fentanyI use in 48 hours was reduced in group II (mean ± SD Levobupivacaine: 150±43 mg and Fentanyl: -240±68 $\mu{g}$) compared with group I (mean ± SD Levobupivacaine: 428±90 mg and Fentanyl: 685±145 $\mu{g}$) (p<0.05). VAS scores were significantly lower in group II at all times, than in group I (p<0.05). Conclusions: The ultrasound-guided TAP block reduces levobupivacaine+fentanyl requirements, decreases pain scores and increases patient satisfaction after total abdominal hysterectomy.

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