Ankilozan spondilitli bir hastada periferik sinir bloğu uygulaması
Bu olgu sunumunda, ankilozan spondilit nedeniyle diz artrozu gelişen ve diz artroplastisi planlanan hastada ultrason eşliğinde periferik sinir bloğu uygulamamızı literatür bilgileriyle tartışarak sunmayı amaçladık. Hastamız 51 yaşında ASA II sınıfına dahil erkek hastaydı. Önceki operasyonlarında yaşadığı deneyimlerine dayanarak spinal anesteziyi ve genel anesteziyi (uyanık fiberoptik entübasyon uygulanmış) kabul etmeyen hastaya ultrasonografi eşliğinde femoralsiyatik periferik sinir bloğu uygulandı. Peroperatif dönemde hemodinamik açıdan sorun yaşanmadan ve ağrı duymaksızın operasyon sonlandı. Postoperatif dönemde hasta kontrollü analjezi yöntemiyle Morfin IV infüzyon başlandı. İzleminin beşinci gününde hasta taburcu edildi. Sonuç olarak ankilozan spondilitli majör alt ekstremite cerrahisi geçirecek olan ve zor entübasyon riskine sahip olgularda periferik sinir bloklarının genel anesteziye ve nöroaksiyel anesteziye alternatif olabileceği düşüncesindeyiz.
Application of peripheral nerve block in a patient with ankylosing spondylitis
In this case report, accompanied by cases in literature, we aim to present an ultrasound-guided peripheral nerve block applied to a patient who had knee joint arthrosis due to ankylosing spondylitis and thus for whom a knee arthroplasty was planned. The patient was a 51-year-old, ASA physical status of class II, male. Ultrasound-guided femoral and sciatic nerve blocks were applied to the patient since he refused spinal or general anesthesia (awake fiber optic intubation) due to his previous experiences. The patient was hemodynamically stable and felt no pain throughout the operation. In the postoperative period, the patient was given morphine i.v. with patient controlled analgesia. He was discharged on the fifth day after the operation. As a result, we believe that peripheral nerve blocks can be an alternative to general and neuraxial anesthesia in patients with ankylosing spondylitis and the risk of difficult intubation in major lower extremity surgery.
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