Handan HEYBELİ, MENŞURE KAYA, Gülçin ÖZALP, Gonca TUNCEL, Serpil ŞAVLI, Özgür CANOLER, Nihal KADIOĞULLARI

Total kalça artroplastisinde psoas kompartman bloğu: Kontinü infüzyon ve hasta kontrollü analjezi tekniklerinin karşılaştırılması

Amaç: Total kalça artroplastisi sonrası psoas kompartman blok için 3 farklı hasta kontrollü analjezi tekniğinin etkinliğini değer- lendirmek amaçlandı. Hasta memnuniyeti ve lokal anestezik tüketimi karşılaştırıldı. Yöntem: Tek taraflı total kalça protezi planlanan ASA I-III 60 olgu çalışmaya alındı. Genel anesteziden önce, üç grupta da Chayen tekniği kullanılarak 0.5 mA veya daha az uyarı ile kuadriseps kasında kontraksiyon görüldükten sonra psoas kompartman kateteri yerleştirildi. Kateterden 40 mL % 0.25 bupivakain verilerek duyu ve motor bloğun dağılımı değerlendirildi ve hasta kontrollü analjezi cihazı bağlandı. Olgular randomize olarak üç gruba ayrıldı. Grup 1: % 0.125 bupivakain 10 mL sa-1 kontinü infüzyon; Grup 2: % 0.125 bupivakain 5 mL sa-1 infüzyon + 5 mL bolus (60 dk kilit süresi); Grup 3: % 0.125 bupivakain 10 mL bolus (60 dk kilit süresi). 48 saat süreyle postoperatif ağrı skorları, duyu bloğunun dağılımı, ek analjezik gereksinimi, total bu- pivakain tüketimi, hasta memnuniyeti ve yan etkiler kaydedildi. Bulgular: Üç grupta da postoperatif 48 saat yeterli analjezi ve hasta memnuniyeti sağlandı. Ağrı skorları, ek analjezik kullanımı ve duyu bloğunun dağılımı benzer bulundu. Bupivakain tüketimi açısından üç grup arasında istatistiksel fark saptandı (sırası ile 440 ± 35.0, 367.7 ± 76.0, 179.2 ± 92.3 mL, p

Psoas compartment block for total hip arthroplasty: A comparison of continuous infusion and patient controlled analgesia

Objective: The aim of the present study was to assess the efficacy of 3 different patient-controlled analgesia techniques for psoas compartment block after total hip arthroplasty. Patient satisfaction and local anesthetic consumption were compared. Methods: Sixty ASA I-III patients scheduled for unilateral total hip arthroplasty were included in the study. Before general anaesthesia, the psoas compartment catheters were placed in the patients of all three groups using the Chayen technique after a contraction of quadriceps muscle was obtained with a stimulus of 0.5 mA or less. Forty mL of 0.25 % bupivacaine with adrenaline was given through the catheter and the distribution of the sensory and motor block was evaluated. The patient-controlled analgesia device was connected to the catheter postoperatively. The patients were randomly assigned to three groups: Group 1= 0.125 % bupivacain continuous infusion at a rate of 10 mL h-1 , Group 2 = 0.125 % bupivacain continuous infusion at the rate of 5 mL h-1 plus 5 mL bolus with a 60 min lock-out period and Group 3 = 10 mL boluses of 0.125 % bupivacain with a 60 min lock-out period. The postoperative pain scores, distribution of sensory block, additional analgesic requirement, total bupivacaine consumption, patient satisfaction and side effects were recorded for 48 hours. Results: Sufficient analgesia and patient satisfaction were obtained in both groups during the first postoperative 48 hour period. Pain scores, additional analgesic requirement and distribution of sensory block were found to be similar. Bupivacaine consumption was significantly different among the three groups; (440 ± 35, 367.7 ± 76.0, 179.2 ± 92.3 mL respectively, p<0.05). Conclusion: The patient controlled analgesic program with 10 mL boluses and 60 min lockout time was found to reduce local anesthetic use while providing sufficient analgesic and patient satisfaction.

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