Fikret SALIK, Mustafa BIÇAK, Hakan AKELMA, Sedat KAYA

İnguinal herni onarımında USG eşliğinde TAP blok, USG eşliğinde yara yeri infiltrasyonu ve intravenöz deksketoprofenin preemptif uygulanmasının postoperatif analjezik etkinliklerinin karşılaştırılması

Amaç: İnguinal herni onarımlarında ideal postoperatif analjezi yöntemi halen tartışma konusudur. Bu çalışmada, kasık fıtığı onarımlarında preemptif olarak uyguladığımız farklı analjezik yöntemlerin postoperatif analjezik etkinliğini karşılaştırmayı amaçladık. Yöntemler: Bu çalışma prospektif olarak dizayn edildi. Çalışmaya spinal anestezi eşliğinde elektif inguinal herni onarımı yapılan 18- 75 yaş arası hastalar alındı. 120 hasta cerrahi insizyondan önce uygulanan analjezik yönteme göre üç gruba ayrıldı. Grup 1: USG kılavuzluğunda Transversus abdominis plan bloğu (n = 40), Grup 2: USG kılavuzluğunda lokal anestezik infiltrasyon (n = 40) ve Grup 3 intravenöz deksketoprofen (n = 40). Postoperatif 24 saat boyunca ortalama tramadol tüketim miktarı ve kurtarıcı analjezik ihtiyacı olan hasta sayısı kaydedildi. Hastaların 30. dakika. 1, 2, 4, 8, 12, 16, ve 24. saat VAS skorları analiz edildi. Bulgular: Postoperatif ortalama tramadol tüketimi gruplar arasında istatistiksel olarak benzerdi [Grup 1: 22.5±57.6 mg; Grup 2: 20±51.6 mg; Grup 3: 27.5±59.8 (p=0.833)]. Kurtarıcı analjezik ihtiyacı olan hasta sayısı istatistiksel olarak benzerdi ( p=0.787). 30.dk, 1, 2, 4, 8. ve 12. saatlerdeki VAS skorları Grup 1’de diğer gruplara göre istatistiksel olarak daha düşük saptandı (p değerleri sırasıyla 0.003, 007, 0013, 0049, 0015, 0021). Grup 1’de 30.dk ve 2. saatteki VAS skorları Grup 2’ye göre daha düşük saptandı (p değerleri sırasıyla 0.049, 0.037). Aynı zamanda 30.dk, 1, 2, 8. ve 12. saatlerdeki VAS skorları Grup 1’de Grup 3’e göre daha düşük tespit edildi (p değerleri sırasıyla 0.003, 0.006, 0.021, 0.017, 0.016). Tüm saatlerdeki VAS skorları Grup 2 ile Grup 3 arasında istatistiksel olarak benzer bulundu. Sonuç: Bu çalışmada, inguinal herni onarımlarında postoperatif analjezi amacıyla preemptif olarak transversus abdominis plan bloğu, lokal anestezik ilaç infiltrasyonu veya intravenöz deksketoprofenin postoperatif tramadol tüketim miktarı ve kurtarıcı analjezik ihtiyacı olan hasta sayısı üzerine etkilerinin benzer olduğunu gösterdik. Ancak transversus abdominis plan bloğu, postoperatif ilk 24 saatte daha düşük VAS skorları ve daha fazla sayıda hastada mükemmel analjezi sağlamaktadır.

Comparison of postoperative analgesic efficacy of preemptive USG-guided TAP block, USG-guided local infiltration and intravenous dexketoprofen in inguin

Objective: The ideal postoperative analgesic method in inguinal hernia repairs is still controversial. We aimed in this study to comparison the postoperative analgesic efficacy of different analgesic methods that we performed preemptively in inguinal hernia repairs. Methods: This study was designed prospectively. Patients aged 18-75 years who underwent elective inguinal hernia repair under spinal anesthesia were included in the study. 120 patients were divided into three groups according to the analgesic method performed before surgical incision. Group 1: USG-guided Transversus abdominis plane block (n = 40), Group 2: USG-guided local anesthetic infiltration (n = 40) and Group 3 intravenous dexketoprofen (n = 40). The mean of tramadol consumption and number of patients in requiring rescue analgesics were recorded for 24 hours postoperatively. VAS scores were analyzed at the 30 minute, 1, 2, 4, 8, 12, 16 and 24th hours. Results: The postoperative mean tramadol consumption was statistically similar between the groups [Group 1: 22.5±57.6mg; Group 2: 20±51.6mg; Group 3: 27.5±59.8mg (p=0.833)] in groups. There was no significant difference between the number of patients requiring rescue analgesics (p=0.787). VAS scores at 30. min, 1, 2, 4, 8 and 12 hours were statistically lower in Group 1 than in the other groups (p values 0.003, 007, 0013, 0049, 0015, 0021 respectively). VAS scores at 30. min and 2. h were lower in Group 1 than Group 2 (p values 0.049, 0.037 respectively). İn addition, VAS scores at 30 min, 1, 2, 8 and 12 hours were lower in Group 1 than in Group 3 (p values 0.003, 0.006, 0.021, 0.017, 0.016 respectively). VAS scores at all hours were statistically similar between Group 2 and Group 3. Conclusion: In this study, we demonsrated that preemptive transversus abdominis plane block, local anesthetic infiltration or intravenous dexketoprofen for postoperative analgesia in inguinal hernia repairs had similar effects on postoperative tramadol consumption and number of requiring rescue analgesic patients. However, the transversus abdominis plane block block provides lower VAS scores and excellent analgesia in more patients in the first 24 hours postoperatively.

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