Ersel GÜLEÇ, Zehra HATİPOĞLU, Dilek ÖZCENGİZ, Aydın HALEFOĞLU

Effect of Ultrasound Guided Rectus Sheath Block on Postoperative Analgesia after Laparotomy with Transverse Incision in Children

Amaç: Rektus kılıf bloğu abdominal cerrahi geçirecek olan erişkin hastalarda postoperatif ağrı kontrolünde kullanılmaktadır. Çalışmamızda levobupivakain ile ultrason kılavuzluğunda rektus kılıf bloğunun çocuklarda transvers insizyon ile uygulanan laparatomide intraoperatif anestezik gaz tüketimi ve postoperatif analjezi üzerine etkisini araştırmayı amaçladık. Materyal ve Metod: Çalışmamızda 3-7 yaşları arasında ve fizik durumu ASA I-II olan transvers insizyon ile laparatomi uygulanacak 40 çocuk hasta rastlantısal olarak iki gruba yerleştirildi. Hastaların tamamına genel anestezi uygulandı. Grup RSB' deki hastalara cerrahi başlamadan hemen önce 0,2 ml/kg, %0,25 levobupivakain ile ultrason kılavuzluğunda rektus kılıf bloğu uygulandı. Grup M'deki hastalara da cerrahi bitmeden 30 dakika önce intravenöz yolla 0,1 mg/kg morfin uygulandı. Tüm hastalara postoperatif dönemde 0,01 mg/kg morfin bolus doz ve 30 dakika kilit süresi olan bir analjezik ilaç pompası kuruldu. İntraoperatif kullanılan sevofluran konsantrasyonları ve tüketilen miktarları, hemodinamik değişkenler, periferik oksijen satürasyonlar kaydedildi. Postoperatif dönemde morfin tüketim miktarı, FLACC ağrı skorları, sedasyon seviyeleri, yan etkiler ve ek analjezik tüketimleri de kaydedildi. Bulgular: Demografik veriler ve hemodinamik değişkenler her iki grupta birbirine benzerdi. Ancak sistolik arter basınçları grup RSB'de grup M'ye göre anlamlı olarak daha düşüktü. Kullanılan sevofluran konsantrasyon seviyeleri ve tüketilen miktarları grup RSB'de grup M'ye göre anlamlı olarak düşüktü. Ortalama sevofluran tüketim miktarları grup RSB'de 18,7±2,1 ml/saat iken grup M'de 21,5 ±2,9 ml/saat idi (p

Transvers Kılavuzluğunda Rektus Kılıf Bloğunun Postoperatif Analjezi Üzerine Etkisi

Purpose: Rectus sheath block have been used for postoperative pain control in adult patients undergoing abdominal surgery. To investigate the effect of the ultrasound guided rectus sheath block (RSB) with levobupivacaine on both intraoperative sevoflurane consumption and postoperative analgesia after laparotomy with transverse incision in children. Material and Methods: Forty patients with ASA I-II physical status, aged 3-7 years and undergoing laparotomy with transverse incision were randomly allocated into two groups. Patients were administered general anesthesia and before the beginning of surgery ultrasound guided RSB with 0.2 mL/kg, 0.25% of levobupivacaine and thirty minutes before the surgery the loading dose of morphine of 0.1 mg/kg intravenously were received in group RSB and group M, respectively. Analgesic drug pump with 0.01 mg/kg bolus doses of morphine and 30 minutes lockout interval was set up postoperatively in both groups. Concentrations (%) and consumed amounts (mL/h) of sevoflurane during the surgery and systolic and diastolic blood pressure, heart rate, and peripheral oxygen saturation values were recorded both intraoperative and postoperative period in each groups. Analgesic consumption with postoperative analgesic drug pump, FLACC pain scores, sedation level, nausea, vomiting, supplemental analgesic requirement and side effects were also recorded. Results: Demographic data and hemodynamic parameters were similar in both groups excepting that systolic arterial pressure values were reduced in group RSB than in group M. Inhaled concentration and consumed amounts of sevoflurane were decreased in group RSB compared with group M. Averages of consumptions of sevoflurane were 18.7±2.1 mL/h and 21.5 ±2.9 mL/h in group RSB and group M, respectively (p

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