Gökçen EMMEZ, İrfan GÜNGÖR, Ulunay KANATLI

Kronik Pulmoner Problemli Hastalarda Kostoklavikular Brakial Pleksus Bloğu?nun? Diyafram Hareketi ve Analjeziye Etkileri: Retrospektif Analiz

Amaç: ÇeşitIi seviyeIerden yapıIan Brakial pIeksus bIokIarı, postoperatif analjezi için artroskopik omuz cerrahisinde yaygın olarak kullanılmaktadır. Ancak, bloğun uygulandığı seviyeyle ilişkili yüksek hemidiyafragmatik paralizi insidansı, pulmoner fonksiyon bozukluğu olan hastalarda kullanımı sınırlamaktadır. Paradoksal olarak, pulmoner patolojili hastalarda analjezi için kullanılacak sistemik opioidlerin oksijenasyonu bozabileceği düşünüldüğünde analjezi yönetimleri özellikli hastalardır. Son araştırmalar frenik siniri koruyucu brakial pleksus blok yaklaşım alternatiflerini araştırmaktadır. Bu retrospektif çalışma ile, ultrason eşliğinde uygulanan kostoklavikular bloğun bilinen pulmoner patolojisi olan hastalardaki analjezik etkinliğinin ve diyafram fonksiyonlarına etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya Ocak 2020-Temmuz 2022 tarihleri arasında, kronik puImoner probIemi oIan, kostokIavikuIar bIok ve geneI anestezi kombinasyonu iIe anestezi yönetimIeri gerçekIeştiriIen artroskopik omuz cerrahisi geçiren vakaIar dahiI ediIdi. Demografik veriler, cerrahi endikasyonlar, uygulanan genel anestezi yöntemi, komplikasyonlar/yan etkiler, VAS skorları, analjezi süreleri, uygulanan anestezi tekniği için hasta ve cerrah memnuniyeti ile diyafram fonksiyonları retrospektif olarak kayıtlardan incelendi. Blok uygulanan tarafta hemi- diyafram fonksiyonları; diyafram tutulumunun derecesi; > %75 ise “tam”, %25,1-74,9 ise “kısmi diyafram paralizisi” ve < %25 ise “paralizi yok” olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen 21 hastanın dördü Bankart diğerleri rotator kaf rüptürü endikasyonuyla opere edilmişti. Hastalarda komplikasyon gözlenmedi. Anestezi tekniğiyle ilgili hem hasta (%71,4) hem cerrah (%100) memnuniyet oranları yüksekti. Diyafragma ekskürsiyon oranları %25’ten düşüktü ve dolayısıyla hemi-diyafragma paralizisinin gerçekleşmediği görüldü. Kostoklavikular blokla ortalama 470 dakika postoperatif analjezi sağlandı. Sonuçlar: Kostoklavikular blok, diyafram fonksiyonunu korurken etkin cerrahi ve postoperatif analjezi sağlamıştır. Bu nedenle pulmoner patolojisi olan artroskopik omuz cerrahisi geçirecek hastalarda geleneksel interskalen bloğa bir alternatif olarak düşünülebilir. Anahtar kelimeler: brakial pleksus blok; diyafram; analjezi; akciğer hastalıklarıAbstract Aim: Brachial plexus blocks are widely used for post-operative analgesia in shoulder surgery. The high risk of hemidiaphragmatic paralysis limits its use in patients with pulmonary dysfunction. In patients with pulmonary diseases, the management of pain requires special approaches since systemic opioids may also decrease oxygenation. Latest studies search for alternative methods for phrenic nerve preserving brachial plexus block. This retrospective study aim to analyze the analgesic efficacy and diaphraghmatic effects of ultrasonography guided costoclavicular block in patients with pulmonary diseases. Material and Methods: The study includes patients with pulmonary diseases who undergone arthroscopic shoulder surgery under the combination of costoclavicular block and general anesthesia between January 2020 and July 2022. The demographic data, surgical indications, general anesthesia method, complications, VAS scores, the duration of analgesia, diaphragm functions, patient and surgeon satisfaction survey was collected from the records and analyzed retrospectively. The diaphragm functions were evaluated as complete  75%, partial 25.1-74.9%, no paralysis  25%. Results: Four of the 21 patients in the research underwent Bankart surgery, while the others were operated on for rotator cuff rupture. No complications were observed in the patients. Patient (71.4%) and surgeon (100%) satisfaction about the anesthesia method was high. Since the diaphragm excursion rates were below 25%, it was observed that hemidiaphragmatic paralysis did not occur. An average of 470 minutes of postoperative analgesia was achieved with costoclavicular block. Conclusion: While preserving diaphragmatic function, a costoclavicular block provided effective surgical and postoperative analgesia. As a result, it can be regarded as an alternative to conventional interscalene block in pulmonary pathology patients undergoing arthroscopic shoulder surgery. Key words: brachial plexus block; diaphragm; analgesia; lung diseases

Anahtar Kelimeler:

brakial pleksus blok, diyafram, analjezi, akciğer hastalıkları

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