Ali AHISKALIOĞLU, Murat AKSUN, Mürsel EKİNCİ, Özgür BAYSAL, Bilgehan ÇATAL, Pınar KARACA BAYSAL, Birzat Emre GÖLBOYU

OMUZ ARTROSKOPİ AMELİYATLARINDA İNTERSKALEN BLOK İLE TEK DOZ EKLEM İÇİ LOKAL ANESTEZİK UYGULAMASININ POSTOPERATİF ANALJEZİK ETKİNLİKLERİNİN KARŞILAŞTIRILMASI

Amaç: Omuz cerrahisi uygulanan hastalarda postoperatif ağrı önemli bir sorundur. Çalışmamızda artroskopi omuz cerrahisinde interskalen blok ile, tek doz perioperatif eklem içi lokal anestezik uygulamasının postoperatif analjezik etkinliklerinin karşılaştırılması amaçlandı.Yöntem ve Gereçler: Etik kurul ve hasta onayı sonrası ASA I-II 36 hasta randomize olarak ikiye ayrıldı. Grup I'deki hastalara tek doz interskalen blok uygulaması yapıldı ve Grup II'deki hastalara tek doz perioperatif eklem içi lokal anestezik uygulaması yapıldı. Hastaların postoperatif vizuel analog skala (VAS) değerleri 0, 1, 4, 8, 12 ve 24. saatlerde sorgulandı, ilk analjezik uygulama zamanı, ek analjezik ihtiyaçları ve 24'üncü saat sonunda hasta memnuniyeti ve yan etkiler sorgulandı.Bulgular: Çalışmadaki grupların yaş, cinsiyet, ASA I/II dağılımı ve cerrahi süreleri karşılaştırıldığında istatistiksel olarak anlamlı fark görülmedi. Her iki grupta da tüm hastalarda yeterli analjezi sağlandı (VAS< 4). Grup 1'in VAS değerleri tüm zamanlarda daha düşüktü; sadece postoperatif 8., 12. ve 24. saatlerde iki grup arasında istatistiksel fark yoktu. Grup 1'de 4 hastanın (% 22) ve Grup 2 'de 8 hastanın (% 44) ek analjezik ihtiyacı oldu. Ek analjezik ihtiyacı açısından Grup 1 ile Grup 2 arasında fark yoktu. Hasta memnuniyetine bakıldığında Grup 1'de hasta memnuniyeti 9±0.65 ve Grup 2'de 8±0.86 olup gruplar arasında istatistiksel açıdan anlamlı fark vardı (p=0.036).Tartışma ve Sonuç: Artroskopik omuz cerrahisinde interskalen blok uygulaması post operatif dönemde oldukça etkili bir analjezi sağlamaktadır; bunun yanında tek doz perioperatif eklem içi lokal anestezik uygulamasının postoperatif ağrı tedavisinde kullanımının yan etki ve komplikasyona neden olmaması, işlemin kolay uygulanması ve etkin bir analjezi sağladığından dolayı iyi bir seçenek olabileceği sonucuna varılmıştır.

Comparison of Post-Operative Analgesic Efficacy Between Single Dose Intra-Articular Local Anesthetic and Interscalene Block in Arthroscopic Shoulder Surgery

Introduction: Post-operative pain is a prominent problem in shoulder surgery patients. In our study it was aimed to compare post-operative analgesic efficacy between single dose peri-operative intra-articular local anesthetic and single shot interscalene block in arthroscopic shoulder surgery.Methods: After obtaining ethical committee approval and informed consents totally 36 ASA 1-2 patients were randomly held in two groups. The patients in group 1 were performed single shot interscalene block while patients in group 2 received only a single dose peri-operative intraarticular local anesthetic. The postoperative VAS( visual analog scale) scores of the patients were measured for postoperative 0, 1., 4., 8., 12. And 24. Hours. Some other factors including time of first analgesic administration, additional analgesia consumption, patient satisfaction at 24. hour and side effects were also asked. Results: There was no statistically significant difference according to comparison of the factors regarding age, gender, ASA1-2 scores and surgery durations between two groups. Adequate analgesic effects were measured for both groups (VAS

PDF

___

1. Boss AP, Maurer T, Seiler S, et al. Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results. J Shoulder Elbow Surg 2004;13:630-634.
2. Cho, C. H., Song, K. S., Min, B. W.,et al. Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy, 2015;23:542-547
.3. Capdevila X, Dadure C, Bringuier S, et al. Effect of patient-controlled perineural analgesia on rehabilitation and pain after ambulatory orthopedic surgery: a multicenter randomized trial. Anesthesiology 2006;105:566-573.
4. Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthroscopicm shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesth Analg 2004;99:589-592.
5. Borgeat A, Schappi B, Biasca N, et al. Patientcontrolled Interscalene Analgesia versus Patient-controlled Analgesia. Anesthesiology 1997;87:1343-1347.
6. Quick DC, Guanche CA. Evaluation of an anesthetic pump for postoperative care after shoulder surgery. J Shoulder Elbow Surg 2003;12:618-621.
7. Winnie, A. P. Interscalene brachial plexus block. Anesthesia & Analgesia,1970;49(3), 455-466.
8. Koltka K, Batmaz M, Atalar AC, ve ark. Omuz Cerrahisi'nde postoperatif analjezi sağlama yöntemlerinin karşılaştırılması. Türk Anest Rean Der Dergisi 2008;36:38-44.
9. Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010;65:608-624.
10. Hughes MS, Matava MJ, Wright RW, et al. Interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review. J Bone Joint Surg Am 2013;95:1318-1324.
11. Song SY, Roh WS. Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks. Korean J Anesthesiol 2012;62:209-219.
12. Simeoforidou M, Vretzakis G, Chantzi E, et al. Effect of interscalene brachial plexus block on heart rate variability. Korean J Anesthesiol 2013;64:432-438.
13. Lee HY, Kim SH, So KY, Kim DJ. Effects of interscalene brachial plexus block to intra-operative hemodynamics and postoperative pain for arthroscopic shoulder surgery. Korean J Anesthesiol 2012;62:30-34.
14. Axelsson K, Gupta A, Johanzon E et al. Intraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study. Anesth Analg 2008;106:328-333.
15. Liu SS, Richman JM, Thirlby RC,et al. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg 2006;203:914- 932.
16. Muittari P, Nelimarkka O, Seppala T, et al. Comparison of the analgesic effects of intrabursal oxycodone and bupivacaine after acromioplasty. J Clin Anesth 1999;11:11-16.
17. Savoie FH, Field LD, Jenkins RN, et al. The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy 2000; 16: 339-42
18. Eroglu A. A comparison of patient-controlled subacromial and i.v. analgesia after open acromioplasty surgery. British Journal of Anaesthesia 2006; 96: 497-501.
19. Nisar A, Morris MW, Freeman JV, Cort JM, Rayner PR, Shahane SA. Subacromial bursa block is an effective alternative to interscalene block for postoperative pain control after arthroscopic subacromial decompression: a randomized trial. Journal of Shoulder and Elbow Surgery 2008; 17: 78-84.
20. Haltiavaara K, Laitinen J, Kaukinen S, et al. Failure of interscalene brachial plexus blockade to produce pre-emptive analgesia after shoulder surgery. Eur J Anaesthesiol 2003;20:72- 83.
21. Scoggin J, Mayfield G, Awaya D, et al. Subacromial and intraarticular morphine versus bupivacaine after shoulder arthroscopy. Arthroscopy 2002;18:464-468.
22. Hickey R, Rowley CL, Candido KD, et al. Comparative study of 0,25% ropivacaine and 0,25% bupivacaine for brachial plexus block. Anesth Analg 1992;75:6026-6030.
23. Cox CR, Checketts MR, Mackenzie N, et al. Comparison of S(-) nbupivacaine in supraclavicular brachial plexus block. British J Anaesth 1998;80:594-598.
24. Delaunay L, Souron V, Lafosse L, et al. Analgesia after arthroscopic rotator cuff repair: subacromial versus interscalene continuous infusion of ropivacaine. Regional Anesthesia and Pain Medicine 2005; 30: 117-22.
25. Hofmann-Kiefer K, Eiser T, Chappell D, et al. Does patientcontrolled continuous interscalene block improve early functional rehabilitation after open shoulder surgery? Anesthesia and Analgesia 2008; 106: 991-6.
26. Tetzlaff JE. Perpheral nerve blocks, in Morgan GE, Mikhail MS, Clinical anesthesiology Prentice Hall İnc, Toronto 1999;245-273.