Ebru BİRİCİK, Feride KARACAER, Demet LAFLI TUNAY, Murat Türkeün ILGINEL, Kadir OKTAY, Hakkı ÜNLÜGENÇ, Yasemin GÜNEŞ

Lomber mikrodiskektomi ameliyatı geçiren hastalarda alt torasik erektör spina bloğunun postoperatif ağrı yönetimine etkisi

Amaç: Lomber disk hernisi spinal cerrahi için çok yaygın bir nedendir ve genellikle cerrahi müdahalelerle tedavi edilir. Bu randomize kontrollü çalışmanın birincil amacı, lomber mikrodiskektomi cerrahisinde ultrason kılavuzluğunda alt torasik erektör spina plan (ESP) bloğunun postoperatif ağrı yönetimine etkisini belirlemektir. Gereç ve Yöntem: Elektif lomber mikrodiskektomi ameliyatı planlanan toplam 42 erişkin, Grup ESP ve Grup Kontrol olmak üzere iki gruba ayrıldı. Anestezi indüksiyonu propofol 2mg/kg, roküronyum 0,6 mg/kg, fentanil 2µg/kg ile sağlandı ve total intravenöz anestezi (propofol 4-8 mg/kg/sa ve remifentanil 0,03-0,05 µg/kg/dk), N2O/O2 %60/40 karışım ile tüm hastalara anestezi idamesi sağlandı. Hastalar yüzüstü pozisyondayken bilateral olarak ESP veya sham blok uygulandı. ESP grubuna 15 mL bupivacain %0,5 +5 mL lidocain %2, sham grubuna ise salin 20 mL ile omurganın T10 seviyesinden ESP uygulandı. Tüm hastalara ameliyatın son 30 dakikasında morfin 0,1 mg/kg intravenöz ve diklofenak Na 75 mg intramüsküler olarak postoperatif analjezi sağlandı. Postoperatif vizüel analog skala (VAS) skorları, meperidin gereksinimleri ve hasta memnuniyeti kaydedildi. Bulgular: Grup ESP ve Grup Kontrol arasında meperidin gereksinimi, istirahat ve bacak hareketi sırasındaki VAS skorları ve hasta memnuniyeti açısından anlamlı fark vardı. İlk analjezik ihtiyacına kadar geçen süre, Grup ESP' de ortanca 62,5 dakika (çeyrekler arası aralık 5-180) ve Grup Kontrol' de ortanca 7,50 dakika (çeyrekler arası aralık 5-10) idi. Sonuç: ESP, postoperatif ağrı skorlarını (istirahat ve bacak hareketinde VAS), meperidin gereksinimini önemli ölçüde azaltabilir ve postoperatif hasta memnuniyetini daha iyi sağlayabilir.

Anahtar Kelimeler:

Erektör spina plan bloğu, spinal cerrahi, postoperatif analjezi, alt torasik erektör spina bloğu, bölgesel analjezi, ağrı yönetimi.

Effect of low thoracic erector spinae block on postoperative pain management in patients undergoing lumbar microdiscectomy surgery

Purpose: Lumbar disk hernia is very common reason for spinal surgery and usually treats with surgical interventions. The primary aim of this randomized controlled study was to determine the effect of low thoracic ultrasound guided erector spinae plane (ESP) block on postoperative pain management in lumbar microdiscectomy surgery. Materials and Methods: Totally 42 adults scheduled for elective lumbar microdiscectomy surgery and assigned into two groups as Group ESP and Group Control. Anesthesia was induced with propofol 2mg/kg, rocuronium 0.6 mg/kg, fentanil 2µg/kg and maintained with total intravenous anesthesia (propofol 4-8 mg/kg/h and remifentanil 0.03-0.05 µg/kg/min), N2O/O2 mixture %60/40 for all patients. When patients were positioned at prone, ESP or sham block performed bilaterally. ESP performed with bupivacain 0.5% 15 mL+lidocain 2% 5 mL in ESP group and saline 20 mL for sham group at the T10 level of spine. The postoperative analgesia provided with morphine 0.1 mg/kg intravenously and diclofenac Na 75 mg intramuscularly at last 30 minutes of surgery for all patients. Postoperative visual analog scale (VAS) scores, meperidine requirements and patients’ satisfaction were recorded. Results: There were significant differences between Group ESP and Group Control in meperidine requirement, VAS scores at rest and leg movement and patients’ satisfaction. Time to first analgesic need was median 62.5 min (interquartile range 5-180) in Group ESP and median 7.50 min (interquartile range 5-10) in Group Control. Conclusion: ESP can significantly reduce postoperative pain scores (VAS at rest and leg movement), meperidine requirement and can provide better patients’ satisfaction, postoperatively.

Keywords:

Low thoracic ESP, Postoperative Analgesia, Lumbar Surgery, Microdiscectomy,

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