Fahri ACAR, Semih BAŞKAN, Hidayet ÜNAL, Gökhan DEMİRELLİ

Ultrasonografi Eşliğinde İnfraklaviküler Brakial Pleksus Blok Uygulamasında Kullanılan 3 Farklı Bupivakain Konsantrasyonunun Karşılaştırılması

Amaç: Bu çift kör, randomize, prospektif çalışmada üst ekstremite cerrahisinde ultrason kılavuzluğunda infraklaviküler blok uygulamasında 3 farklı bupivakain konsantrasyonunun karşılaştırılması amaçlandı. Yöntem: Bu klinik çalışma 18-65 yaşlarında dirsek, önkol, el bileği veya el cerrahisi geçiren 150 hasta üzerinde yapıldı. Hastalar eşit ve randomize olarak 3 gruba ayrıldı (n=50). Birinci gruba 20 mL %0.5 bupivakain, 2. gruba 20 mL %0.375 bupivakain ve 3. gruba 20 mL %0.25 bupivakain uygulandı. Duyusal ve motor blok başlangıç zamanı, cerrahi süresince motor blok skoru, ek anestetik ve analjezik gereksinimi, duyu ve motor blok gerileme zamanı, hasta ve cerrah memnuniyeti kaydedildi. Bulgular: Duyusal blok, motor blok ve cerrahiye uygunluk süresi başlangıcı %0.25 grubunda diğer gruplara göre anlamlı olarak daha uzundu (p≤0.05). Motor blok skoru da %0.25 bupivakain gruplarında daha düşüktü. En erken duyusal motor blok gerileme zamanı ve analjezik gereksinimi %0.25 bupivakain grubunda kaydedildi. Hasta ve cerrah memnuniyeti farklı değildi. Sonuç: Bu veriler sonucunda %0.25 bupivakain konsantrasyonu dezavantajlı olmasına rağmen, etkili duyusal blokaj nedeniyle tam motor bloğun istenmediği hasta gruplarında tercih edilebilir. Erken postoperatif motor muayeneye olanak vermesi ve fizyoterapi planlanması açısından önemlidir.

Comparison of 3 Different Bupivacaine Concentrations Used in the Ultrasound Guided Infraclavicular Brachial Plexus Block

Objective: This double-blinded, randomized, prospective study compared 3 different concentrations of bupivacaine using the same total volume for ultrasound-guided infraclavicular blockapplied in the upper extremity surgery.Methods: This clinical trial was conducted on 150 patients aged between 18-65 years who underwent elbow, forearm, wrist, or hand surgery. The patients were equally and randomly distributedinto three groups (n=50). Under ultrasound guidance, the first group received 20 mL of 0.5%bupivacaine, the second group 20 mL of 0.375% bupivacaine and the third group 20 mL of 0.25%bupivacaine injected into the brachial plexus cords. The onset time of sensory and motor block,surgical compliance time (SCT), motor block score at SCT, additional requirement for anestheticand analgesic agents, sensory and motor block regression time, patient and surgeon satisfactionwere recorded.Results: The onset of sensory block, motor block and SCT were significantly longer in the 0.25%bupivacaine group than the other groups (p≤0.05). Motor block score at SCT was also lower inthe 0.25% bupivacaine group. The earliest sensory-motor block regression time and requirementfor analgesia were recorded in the 0.25% bupivacaine group. The patient and surgeon satisfaction was not different between groups.Conclusion: Although 0.25% bupivacaine concentration is disadvantageous as a result of thisdata, it can be preferred in patient groups in which full motor block is not wanted due to effectivesensory blockade which is important for early postoperative motor examination and planning ofphysiotherapy.

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