Cevahir ARDUC, Sükran GEZE, Engin ERTÜRK, Bahanur CEKİC, Hülya ULUSOY

Comparison of local anesthetic mixtures with tramadol or fentanyl for axillary plexus block in orthopaedic upper extremity surgery

Periferik sinir bloklarında duyusal ve motor bloğun hızlı başlaması için lokal anestezikler birlikte kullanılabilirler. Pleksus bloklarının kalite ve süresini artırmak için lokal anesteziklere adjuvan ajanlar da eklenebilir. Bu çalışmada tramadol ve fentanilin ortopedik üst ekstremite cerrahisi için aksiller pleksus blokta lokal anestezik karışımlara adjuvan ajanlar olarak eklenmesinin etkilerini karşılaştırdık. Hastane etik kurul onayı alındıktan ve hastanın yazılı onamından sonra 60 hasta çalışmaya dahil edildi. Hastalar 3 gruba ayrıldı. Kontrol Grubu (Grup C, 40 mL %0,25 levobupivakain + 40 mg lidokain n:20), Fentanil Grubu (Grup F, 40 mL %0,25 levobupivakain + 40 mg lidokain + 50 mcg fentanil n:20), Tramadol Grubu (Grup T, 40 mL %0,25 levobupivakain + 40 mg lidokaine + 100 mg tramadol n:20). Gruplar parsiyel ve tam motor ve duyusal blok, başlama, iyileşme süreleri ve postoperatif ilk aneljezik gereksinim süreleri açısından karşılaştırıldı (VAS >4). Grup Tde parsiyel duyusal blok başlama süresi Grup Cden kısa bulundu. Tam duyusal blok başlama süresi Grup C ve Grup Fden kısadır. Grup Tde tam duyusal blok iyileşme süresi Grup C ve Grup Fden uzundu. Postoperatif ilk aneljezik gereksinim süresi Grup C ile karşılaştırıldığında Grup T ve Fde anlamlı derecede uzundu ve Grup F ile karşılaştırıldığında Grup Tde anlamlı derecede uzundu. Lokal anestezik karışımlara adjuvan ajan olarak tramadol ya da fentanil eklenmesinin ortopedik üst ekstremite cerrahisi için daha iyi bir postoperatif analjezi sağladığı sonucuna vardık. Ayrıca, tramadolun blok kalitesini fentanilden daha fazla geliştirdiğini gözlemledik.

Ortopedik üst ekstremite cerrahisinde aksiller pleksus blok için fentanil veya tramadol lokal anestetik karışımlarının karşılaştırılması

The local anesthetic mixtures are performed for peripheral nerve blocks to accelerate the onset time of sensorial and motor blocks. Also adjuvant agents can be added to local anesthetics to improve the quality and duration of plexus blocks. In this study, we compared the effect of tramadol and fentanyl as adjuvant agents to local anesthetic mixtures in axillary plexus block for orthopedic upper extremity surgery. After approval of hospital ethics committee and written patient consent, sixty patients were enrolled to the study in three groups; The Control Group (Group C, 40 mL of 0.25% levobupivacaine + 40 mg lidocaine n:20), the Fentanyl Group(Group F, 40 mL of 0.25% levobupivacaine + 40 mg lidocaine + 50 mcg fentanyl n:20), the Tramadol Group (Group T, 40 mL of 0.25% levobupivacaine + 40 mg lidocaine + 100 mg tramadol n:20) for axillary plexus block. Groups were compared for partial and complete motor and sensorial block, onset time, partial and complete motor and sensorial block recover time, and postoperative first analgesic requirement time (VAS >4). In Group T partial sensorial block onset time was shorter than Group C and complete sensorial block onset time was shorter than Group C and Group F. In Group T complete sensorial block recover time was longer than Group C and Group F. The postoperative first analgesic requirement time was significantly longer in Group T and F when compared with Group C and significantly longer in Group T when compared with Group F. We conclude that the addition of tramadol or fentanyl to local anesthetic mixtures as an adjuvant agent for axillary block provide better postoperative analgesia for orthopedic upper extremity surgery. Furthermore tramadol more improves the block quality than fentanyl.

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