Lomber Disk Hernisi Cerrahisinde Uygulanan Farklı Anestezi Yöntemlerinin Karşılaştırılması

Giriş: Lomber disk hernisi cerrahisi beyin cerrahisi pratiğinde sık yapılan ameliyatlardan biri olup sıklıkla genel anestezi altında yapılmaktadır. Genel anesteziye alternatif yöntem olan spinal anestezi, tüm spinal cerrahi işlemlerinde uygulanabildiği gibi pek çok avantaja sahiptir. Kliniğimizde lomber disk hernisi cerrahisinde uygulanan farklı anestezi yöntemlerinin etkinliklerini karşılaştırmayı amaçladık. Yöntemler: Bu çalışma hastane yönetimi onayı alındıktan sonra anesteziyoloji ve reanimasyon kliniğinde yapılmıştır. Kliniğimizde Mart 2017–Temmuz 2019 tarihleri arasında lomber disk hernisi nedeni ile spinal ya da genel anestezi altında elektif olarak opere edilen, ASA I-III, 18-70 yaş arası 234 hasta dosyaları retrospektif olarak incelendi. Hastaların demografik verileri, ameliyat süresileri, ilk mobilizasyon zamanları, efedrin yapılan hasta sayısı, postoperatif deksketorofen tüketimleri, postoperatif tramadol tüketimleri, herniasyon seviyeleri, spinal anestezi blok başarı oranı ve post spinal baş ağrısı gelişen hasta sayısı, hemodinamik parametreleri, operasyon anında ya da sonrasında gelişen komplikasyonlar kaydedildi. Bulgular: Toplamda 234 hasta çalışmaya dahil edildi. Bu hastalardan 212 tanesi spinal anestezi, 22 tanesi genel anestezi altında ameliyat oldu. 3 hastada post spinal başağrısı gelişti. Postoperatif ilk analjezik ihtiyacı zamanı, total deksketorofen tüketimi, total tramadol tüketimi ve ameliyat süresi spinal anestezi grubunda anlamlı bir şekilde daha düşük bulundu. Sonuç: Lomber disk cerrahisinde spinal anestezi etkili, güvenli ve iyi bir postoperatif ağrı konforu sağlamakla birlikte, ameliyatın uzun sürmemesinin beklendiği tek seviye herniasyonlarda daha yaygın bir şekilde kullanılabileceği düşüncesindeyiz.

Comparison of Different Anesthetic Methods Used in Lumbar Disc Herniation Surgery

Objective: Lumbar disc herniation surgery is one of the common surgeries conducted in the brain surgery practice and is often performed under general anesthesia. As an alternative method to general anesthesia, spinal anesthesia can be used in all spinal surgical procedures and has several advantages. We aimed to compare different anesthetic methods used in the lumbar disk herniation surgery in our clinic. Method: This study was carried out at the anesthesiology and reanimation department after approval of the hospital management. 234 ASA I-III patients between the age of 18 and 70 years who had undergone elective operation under spinal o r g eneral a nesthesia d ue t o l umbar d isc h erniation b etween M arch 2 017 and J uly 2 019 i n o ur c linic w ere retrospectively examined and included in the study. Patients' demographic data, operative time, the first mobilization times, the number of patients treated with ephedrine, postoperative deksketorofen consumptions, postoperative tramadol consumption, herniation levels, spinal anesthesia block success r ate a nd n umber o f p atients d eveloping postspinal headache, hemodynamic parameters, intraoperative or postoperative complications was recorded. Findings: Data of 234 patients were evaluated. 212 of these patients underwent surgery under spinal anesthesia while 22 of them received general anesthesia. Post spinal headache developed in 3 patients. The time to the first postoperative analgesic request,total deksketorofen consumption, total tramadol consumption andsurgery timewere found significantly lower in the spinal anesthesia group. Conclusion: As well as providing an effective, safe and good postoperative pain comfort in lumbar disk surgery, spinal anesthesia can be more commonly used in single-level herniations for which surgery is not considered to take too long.

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