İnguinal herni operasyonlarında ultrasonografi eşliğinde ilioinguinal-iliohipogastrik blok, transversus abdominis plan bloğu ve kuadratus lumborum bloğunun postoperatif analjezik etkinliğinin karşılaştırılması
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İnguinal herni, özellikle erkek cinsiyette c?ok sık tespit edilen ve alt batın cerrahilerinin en sık nedenidir. Postoperatif akut ag?rı gelişmesi ve o?zellikle de akut ag?rının kronik ag?rıya do?nu?s?mesi postoperatif do?nemin en önemli problemidir. Bu c?alıs?mada, spinal anestezi altında inguinal herni cerrahisinin yapılacag?ı hastalarda postoperatif analjeziyi etkin kılmak, ag?rının kronikles?mesini önlemek, ag?rı skorlarında azalmayı sag?lamak, toplam opioid tu?ketimi ile opioid ilişkili gelis?en yan etkileri azaltmak amac?lanmıs?tır. Çalışmaya 18-75 yas? aralıg?ında, ASA sınıflaması 1 ve 2, tek taraflı inguinal herni operasyonu uygulanan 80 hasta dahil edildi. Hastalar spinal anestezi sonrası ilioinguinal-iliohipogastrik blok uygulananlar, TAP blok uygulananlar, KLB uygulananlar ve kontrol grubu olmak üzere 4 gruba ayrıldı. Blok uygulanan her 3 grupta da bloklar preoperatif do?nemde 20 mL %0,25 bupivakain kullanılarak uygulandı. Hastaların hepsine ameliyat ic?in 15 mg %0,5 hiperbarik bupivakain kullanılarak spinal anestezi uygulandı ve postoperatif do?nemde de tramadol ile hasta kontrollu? analjezi (HKA) (100 mL serum izotonik ic?ine 300 mg tramadol konularak 3mg/cc olacak s?ekilde hazırlanarak, 3 mL/saat infu?zyon dozu, 5 mLbolus doz, 4 saat kilit zamanı ve 24 saat takılı kalacak s?ekilde ayarlanarak) uygulandı. HKA ile tramadol bolusu yapılmasına rag?men istirahat vizu?el analog skala (VAS) skoru >4 oldug?unda ek analjezik olarak IV parasetamol uygulandı. O?lc?u?m olarak, hastaların ameliyat sonrası postoperatif bakım u?nitesi (PABÜ), 1, 2, 6, 12 ve 24. saatlerdeki istirahat ve hareket halinde VAS skorları, HKA ile opioid kullanımına bag?lı bulantı-kusma gibi yan etkilerin olup olmadıg?ı, kullanılan tramadol bolus ve infu?zyon toplam doz miktarı ve ek analjezik olarak yapılan parasetamol miktarı kullanıldı. İliooinguinal-iliohipogastrik blok, TAP blok ve KLB grubunda kontrol grubuna göre VAS skorları, postoperatif 24 saatlik tramadol tu?ketimi, opioid kullanımına bag?lı gelis?en yan etkiler ve ek analjezik gereksinimi ortalama olarak daha düşük bulundu ancak istatistiksel olarak anlamlı değildi. İlioinguinal-iliohipogastrik blok grubunda ortalama VAS skorları ve ek analjezik gereksinimi TAP blok ve KLB grubuna go?re daha du?s?u?k bulundu ancak bu fark da istatiksel olarak anlamlı bulunmadı. C?alıs?mamızda multimodal analjezinin bir parc?ası olarak ultrasonografi es?lig?inde uygulanan ilioinguinal-iliohipogastrik bloğun TAP blok ve KLB'ye göre spinal anestezi ile inguinal herni cerrahisi yapılan hastalarda VAS skorlarını düşük tuttuğunu ve her üç bloğun da analjezi kalitesini iyileştirdiğini ve hasta konforunu arttırdığını gözlemledik. Sonuç olarak her üç bloğun da spinal anestezi kalitesini arttırdığı ve kullanılabilir olduğu kanısına vardık. Anahtar kelimeler: İnguinal herni; İlioinguinal-iliohipogastrik blok; Transversus abdominis plan bloğu; Kuadratus lumborum blok
Inguinal hernia, especially common in males, is frequently detected and is one of the primary reasons for lower abdominal surgeries. The development of postoperative acute pain, especially its transformation into chronic pain, is a significant issue in the postoperative period. This study aims to effectively implement postoperative analgesia in patients undergoing inguinal hernia surgery under spinal anesthesia, prevent the chronicization of pain, reduce pain scores, and decrease opioid-related side effects. Eighty patients between the ages of 18 and 75, classified as ASA class 1 and 2, who underwent unilateral inguinal hernia surgery were included in the study. The patients were divided into four groups: those who applied ilioinguinal-iliohypogastric block after spinal anesthesia, those who applied TAP block, those who applied QLB and a control group. Blocks in all three groups were administered using 20 mL of %0,25 bupivacaine during the preoperative period. All patients received spinal anesthesia for surgery using 15 mg of %0,5 hyperbaric bupivacaine, and patient-controlled analgesia (PCA) with tramadol was applied postoperatively (prepared by adding 300 mg tramadol to 100 mL isotonic serum to achieve a concentration of 3 mg/cc, with an infusion rate of 3 mL/hour, a bolus dose of 5 mL, a lockout time of 4 hours, and a total duration of 24 hours). Despite the administration of tramadol bolus via PCA, IV paracetamol was administered as additional analgesia when the resting visual analog scale (VAS) score was >4. As measurements, VAS scores at rest and during movement in the postoperative care unit (PACU) at 1, 2, 6, 12, and 24 hours, the presence of side effects such as nausea and vomiting related to opioid use, the total amount of tramadol bolus and infusion administered, and the amount of paracetamol administered as additional analgesia were used. Compared to the control group, VAS scores, total tramadol consumption in the first 24 hours postoperatively, side effects related to opioid use, and the need for additional analgesia were found to be lower on average in the ilioinguinal-iliohypogastric block, TAP block, and QLB groups, but these differences were not statistically significant. In the ilioinguinal-iliohypogastric block group, average VAS scores and the need for additional analgesia were lower compared to the TAP block and QLB groups, but this difference was also not statistically significant. In our study, we observed that the ilioinguinal-iliohypogastric block, applied under ultrasound guidance as part of multimodal analgesia, kept VAS scores low in patients undergoing inguinal hernia surgery with spinal anesthesia compared to TAP block and QLB. We also observed that all three blocks improved the quality of analgesia and increased patient comfort. In conclusion, we found that all three blocks improved the quality of spinal anesthesia and were deemed feasible for use. Keywords: Inguinal hernia; Ilioinguinal-iliohypogastric block; Transversus abdominis plane block; Quadratus lumborum block
Inguinal hernia, especially common in males, is frequently detected and is one of the primary reasons for lower abdominal surgeries. The development of postoperative acute pain, especially its transformation into chronic pain, is a significant issue in the postoperative period. This study aims to effectively implement postoperative analgesia in patients undergoing inguinal hernia surgery under spinal anesthesia, prevent the chronicization of pain, reduce pain scores, and decrease opioid-related side effects. Eighty patients between the ages of 18 and 75, classified as ASA class 1 and 2, who underwent unilateral inguinal hernia surgery were included in the study. The patients were divided into four groups: those who applied ilioinguinal-iliohypogastric block after spinal anesthesia, those who applied TAP block, those who applied QLB and a control group. Blocks in all three groups were administered using 20 mL of %0,25 bupivacaine during the preoperative period. All patients received spinal anesthesia for surgery using 15 mg of %0,5 hyperbaric bupivacaine, and patient-controlled analgesia (PCA) with tramadol was applied postoperatively (prepared by adding 300 mg tramadol to 100 mL isotonic serum to achieve a concentration of 3 mg/cc, with an infusion rate of 3 mL/hour, a bolus dose of 5 mL, a lockout time of 4 hours, and a total duration of 24 hours). Despite the administration of tramadol bolus via PCA, IV paracetamol was administered as additional analgesia when the resting visual analog scale (VAS) score was >4. As measurements, VAS scores at rest and during movement in the postoperative care unit (PACU) at 1, 2, 6, 12, and 24 hours, the presence of side effects such as nausea and vomiting related to opioid use, the total amount of tramadol bolus and infusion administered, and the amount of paracetamol administered as additional analgesia were used. Compared to the control group, VAS scores, total tramadol consumption in the first 24 hours postoperatively, side effects related to opioid use, and the need for additional analgesia were found to be lower on average in the ilioinguinal-iliohypogastric block, TAP block, and QLB groups, but these differences were not statistically significant. In the ilioinguinal-iliohypogastric block group, average VAS scores and the need for additional analgesia were lower compared to the TAP block and QLB groups, but this difference was also not statistically significant. In our study, we observed that the ilioinguinal-iliohypogastric block, applied under ultrasound guidance as part of multimodal analgesia, kept VAS scores low in patients undergoing inguinal hernia surgery with spinal anesthesia compared to TAP block and QLB. We also observed that all three blocks improved the quality of analgesia and increased patient comfort. In conclusion, we found that all three blocks improved the quality of spinal anesthesia and were deemed feasible for use. Keywords: Inguinal hernia; Ilioinguinal-iliohypogastric block; Transversus abdominis plane block; Quadratus lumborum block
Açıklama
Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
