Namık ÖZCAN, Ayşe ÖZCAN, Nurten ÜNAL, Selen TÜRKYILMAZ, Ayşe Günay KAYA, Bülent BALTACI

COMPARISON OF INFRACLAVICULAR AND AXILLARY BLOCKS FOR UPPER EXTREMITY SURGERIES

AMAÇ: Aksiller blok her ne kadar yaygın olarak kullanılsa da, yüksek oranda başarısızlık görülebilir. Bu çalışmada; korakoid ve aksiller bloğun, blok uygulama sürelerini, duyusal bloğun dağılımını, blok başarısını ve komplikasyonları karşılaştırmak üzere, üst ekstremite cerrahisi geçirecek 20'şer hasta içeren iki gruplu prospektif bir model oluşturulmuştur.GEREÇ VE YÖNTEM: Hastalar iki gruba (Grup C, n=20), (Grup A, n=20) randomize edildi. Medyan, ulnar veya radyal sinirden biri sinir stimülatörü ile bulunduktan sonra her iki grupta da 40 ml % 1.5 epinefrinsiz prilokain kullanıldı. Blok uygulama zamanları, duyusal bloğun dağılımı, analjezi süresi ve komplikasyonlar kaydedildi.BULGULAR: Blok uygulama süresi Grup C'de Grup A'da olduğundan anlamlı derecede uzundu (7.6±2.9 vs 5.6±2.9 dk, p< 0.05). Analjezi süreleri iki grupta da benzerdi (C: 218±47.5 dk, A: 212±45.2, dk, p> 0.05). Korakoid gruptaki interkostabrakial ve aksiller sinirlerin yüksek oranlı tutulumu dışında, duyusal bloğun dağılımı iki teknik arasında benzerdi (p< 0.05). Korakoid ve aksiller bloklar için başarı oranları sırasıyla %90 ve %80 idi (p> 0.05). Grup A'da bir hastada 5 dakika içinde gerileyen lokal anestezik toksisite bulguları gözlemledik. Arteryel ponksiyon Grup C'de bir hastada (%5), Grup A' da iki hastada (%10) gerçekleşti (p> 0.05). Grup A'da bir hastada 0.5 mg atropine cevap veren bradikardi gerçekleşti. Grup C'de hiçbir hastada bradikardi görülmedi (p> 0.05). SONUÇ: Korakoid blok, duyusal bloğun geniş dağılımı ile klinik olarak gecikmeye neden olmadığını düşündüğümüz, uzun uygulama süresine rağmen aksiller blok yerine kullanılabilir.

ÜST EKSTREMİTE CERRAHİLERİNDE İNFRAKLAVİKÜLER VE AKSİLLER BLOĞUN KARŞILAŞTIRILMASI

OBJECTIVE: Although the axillary block is widely preferred, it may fail in high extent. In this study we designed a prospective model with two groups of 20 patients scheduled for upper extremity surgery to compare block performance times, sensory block distributions, success and complications of coracoid and axillary blocks. MATERIALS AND METHODS: Patients were randomized into coracoid (Group C, n=20) and axillary (Group A, n=20) groups. After electrolocation of one of median, ulnar or radial nerves, 40 ml of 1.5 % prilocaine without epinephrine was used in each group. Block performance times, extent of sensorial block, duration of analgesia and complications were recorded. RESULTS: Block performance times were significantly longer in Group C than in Group A (7.6±2.9 vs 5.6±2.9 min, p< 0.05). Analgesia times were similar in both groups (C: 218±47.5 min and A: 212±45.2, p> 0.05). Sensory block distributions of the two techniques were comparable except for a higher incidence of sensory block of the intercostobrachial and axillary nerves in the coracoid group (p< 0.05). The overall success rates of coracoid and axillary blocks were 90 and 80 %, respectively (p> 0.05). In one patient in Group A we observed signs of local anesthetic toxicity which regressed in 5 minutes. Arterial puncture occurred in one patient (5 %) in Group C and in two patients (10 %) in Group A (p> 0.05). Bradycardia developed in one patient in Group A which responded to 0.5 mg of i.v. atropine. In Group C none of the patients developed bradicardia (p> 0.05).CONCLUSION: Coracoid block with its extensive distribution of sensorial block, can be used instead of axillary block in upper extremity surgeries.

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