Ultrason Eşliğinde Supraklaviküler Blok Deneyimimiz

Amaç: Ultrason rehberliğinde yapılan supraklaviküler blok üst ekstremite cerrahisinde sıklıkla uygulanmaktadır. Bu çalışmanın birinci amacı ultrason rehberliğinde yapılan supraklaviküler bloğun başarısı, blok uygulama süresi ve blok başlama zamanı, ikinci amacı istenmeyen yan etkilerin görülme sıklığının araştırılmasıdır. Gereç ve Yöntem: Bu çalışmaya arteriovenöz fistül cerrahisi geçiren, ASA III grubu, 31-72 yaş arası 27 hasta dahil edilmiştir. Lokal anestezik olarak tüm hastalara 20 ml %0,5’lik bupivakain ve 10 ml %2’lik lidokain uygulandı. Tüm hastalarda blok uygulama süresi, blok başlama zamanı, toplam blok süresi, blok başarısı ve hasta memnuniyeti kaydedildi. Bulgular: Hastaların yaş aralığı 31 ile 72 arasında değiştiği ve %66’sının erkek olduğu saptandı. Blok uygulama süresi ortalama 4 dakika, blok oluşma süresi ortalama 10 dakika, ortalama blok süresi 9 saat ve blok başarısı %96 olarak tespit edildi. Sonuç: Üst ekstremite cerrahisi için ultrason yardımı ile uygulanan brakial pleksus blokajı ye-terli anestezi ve analjezi sağladığı için genel anestezinin istenmeyen yan etkilerinden korunmada iyi bir alternatif olabilir.

Anahtar Kelimeler:

Supraklavikuler brakiyal pleksus bloğu, ultrasound, bupivakain, ağrı

The Results of Locally Advanced and Metastatic Non Small Cell Lung Cancer Therapies and The Comparison of The Different Chemotherapy Protocols

Non small cell lung cancer is the cause of 70-80% of all lung cancers, also it has the biggest cancer mortality ratio among all other cancer cells. Approximately 50% of patients during diagnosis are at advanced level of cancer. Because advanced stages of lung cancer is a systemic disease, the primary treatment for this is systemic chemotherapy. Nearly 5% of patients can survive one year without treatment. Because full recovery is not possible for the patients with metastatic lung cancer, the objective of chemotherapy should be at least to provide improvement in symptoms and survival of patients. Different types of chemotherapy protocols can be applied in advanced stages of lung cancer, although the typical treatment system is, to apply the combination of platinum with third generation drugs. There is several type of platinum and third generation drugs combinations, but the best combination is not clear. There were 4 different types of combinations containing platinum therapy (gemcitabin/cisplatin, paclitaxel/carboplatin, etoposid/cisplatin and docetaxel/cisplatin) applied in advanced stages (stage IIIB, stage IV), with ECOG PS 0-1, to 91 patients in total. Two kinds of side effects of the treatment are considered as the hematological and non-hematological side effects. Response rates and effectiveness of the treatment also were evaluated by analysis of survival. Statistically there is no significant difference observed at progression free survival and overall survival of patients. On the other hand, in 1 year survival rates docetaxel/cisplatin treatment is more superior than gemcitabin/cisplatin treatment (p<0.05). There were no significant differences found among the group of non-hematological side effects, in hematological side effects anemia observed more in paclitaxel/cisplatin treatment than etoposid/cisplatin treatment and thrombocytopenic observed more in gemcitabin/cisplatin treatment comparing to other types of treatments. As a result, applying four different platinum combinations to a limited number of patients in our study docetaxel/cisplatin is considered as relatively more efficient than other platinum combinations. In order to determine the optimal treatment protocol for this group of patients have poor prognosis, more number of cases should be included, also the conviction was the realization of prospective studies.

Keywords:

Non small cell lung cancer, systemic chemotherapy, cisplatin,

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