MENŞURE KAYA, Gülçin ÖZALP, Gonca TUNCEL, Özgür CANOLER, Sanem TURGUT, Serpil ŞAVLI, Nihal KADIOĞULLARI

Total kalça protezi cerrahisinde hasta kontrollü rejyonal analjezi: Psoas kompartman ve üçlü femoral sinir blokajının karşılaştırılması

Amaç: Total kalça protezi cerrahisinden sonra istirahatta ve hareketle artan ağrının kontrolü güç olabilmektedir. Bu çalışmada, hasta kontrollü lumbar pleksus analjezisinde, posterior yaklaşımla psoas kompartman ve anterior yaklaşımla üçlü femoral sinir blokajının analjezik etkinliği karşılaştırıldı. Yöntem: Tek taraflı total kalça protezi planlanan ASA I-III grubunda 44 olgu çalışma kapsamına alındı. Olgular psoas kompartman (grup P, n=22) ve üçlü femoral sinir (grup F, n=22) blokajı için rastgele iki gruba ayrıldı. Genel anesteziden önce, iki grupta da kateterler 0.5 mA veya daha az stimulus ile kuadriseps kasında kontraksiyon görüldükten sonra yerleştirildi. Daha sonra tüm olgulara adrenalinli 40 mi %0.25 bupivakain verilerek duyu bloğu dağılımı kontrol edildi. Postoperatif 48 saat uygulanacak hasta kontrollü analjezi, %0.125 bupivakain ile bolus dozu 10 mi, kilitli kalma süresi 60 dk olacak şekilde planlandı. Postoperatif ağrı (istirahat ve fizyoterapi sırasında), duyu bloğu dağılımı, ek analjezik gereksinimi, bupivakain tüketimi, hasta memnuniyeti ve yan etkiler kaydedildi. Bulgular: Her iki grupta da postoperatif 48 saat yeterli analjezi ve hasta memnuniyeti sağlandı. Ağrı skorları, duyu bloğu dağılımı, hasta memnuniyeti, bupivakain tüketimi ve ek analjezik kullanımı benzer bulundu. Sonuç: Total kalça protezi cerrahisinde hasta kontrollü lumbar pleksus analjezisi için psoas kompartman ve üçlü femoral sinir blokaj tekniklerinin benzer etkinlikte kullanılabileceği sonucuna varıldı.

Anahtar Kelimeler:

Sinir bloğu, Analjezi, hasta kontrollü, Artroplasti, Analjezi

Patient-controlled regional analgesia after total hip arthroplasty: Psoas compartment block versus three-in one femoral nerve block

Objective: After total hip arthroplasty, it is difficult to control pain at rest or during movement. In the present study, we compared the analgesic efficacy of psoas compartment block by posterior approach and three in one block by anterior approach during patient controlled lumbar plexus analgesia. Method: Forty-four ASA I-III patients scheduled for unilateral hip arthroplasty were allocated for the study. The patients were randomly assigned two groups as psoas compartment (P, n=22) and three in one block (F, n=22). Before standardized general anaesthesia, the catheters were placed following contraction of the quadriceps muscle was obtained with a stimulus of 0.5 mA or less in both groups. Thereafter, all patients received 40 ml bupivacaine 0.25 % with adrenaline through the catheter and the distribution of the sensory block was evaluated. The patient controlled analgesia device, which was planned to continue for 48 hr, was set up to deliver 10 ml bupivacaine 0.125 % boluses with a lock-out time of 60 min. The postoperative pain (at rest and during physiotherapy), distribution of sensory block, additional analgesic requirement, bupivacaine consumption, patient satisfaction and side effects were recorded. Results: Sufficient analgesia and patient satisfaction were obtained in both groups during the first postoperative 48 hr. Pain scores, distribution of sensory block, patient satisfaction, bupivacaine consumption and additional analgesic requirement were found to be similar. Conclusion: Psoas compartment and three in one block techniques provide similar efficacy during patient controlled lumbar plexus analgesia after total hip arthroplasty.

Keywords:

Nerve Block, Analgesia, Patient-Controlled, Arthroplasty, Analgesia,

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