Opere edilecek meme kanseri hastalarında postoperatif analjezi amacıyla yapılan erektör spina plan bloğu ve buna eklenmiş pektoralis sinir bloğunun etkinliğinin karşılaştırılması
Küçük Resim Yok
Tarih
2023
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Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Meme kanseri, kadın cinsiyette çok sık tespit edilen bir kanser çeşidi olup cerrahi sonrası akut ağrı ve özellikle de akut ağrının kalıcı ağrıya dönüşmesi postoperatif dönemin en ciddi sorunudur. Bu çalışmada, meme kanseri cerrahisinin yapılacağı hastalarda postoperatif analjeziyi etkin kılmak, ağrının kronikleşmesini engellemek, ağrı skorlarında düşüşü sağlamak, opioid tüketimini ve opioidlere bağlı gelişen yan etkileri azaltmak amaçlanmıştır. Meme kanseri cerrahisi uygulanan 50 hasta (Kadın cinsiyet, 18-75 yaş, hematolojik hastalığı olmayan) çalışmaya dahil edildi. Hastalar erektör spina plan bloğu uygulananlar ve erektör spina plan bloğuna eklenmiş pektoralis sinir bloğu uygulananlar olarak ikiye ayrıldı. Her iki grupta da bloklar preoperatif dönemde 20 ml %0,25 bupivakain kullanılarak uygulandı. Hastaların hepsine ameliyat için genel anestezi verildi ve postoperatif dönemde de tramadol ile hasta kontrollü analjezi (HKA) (tramadol 300 mg, 100 cc serum izotonik içine 3mg/cc olacak şekilde konuldu, 3 cc/saat infüzyon, bolus doz 5 cc, kilitli kalma süresi 4 saat olacak ve 24 saat takılı kalacak şekilde) uygulandı. Tüm hastalara ekstübasyon öncesi tenoksikam yapıldı. HKA'dan tramadol talebine rağmen istirahat vizüel analog skala (VAS) skoru >4 olduğunda ek analjezik olarak iv parasetamol uygulandı. Ölçüm olarak, hastaların ameliyat sonrası postoperatif bakım ünitesi (PABÜ) 30. dakika, 1, 2, 4, 8, 12 ve 24. saatlerdeki VAS skorları, HKA ile opioid kullanımına bağlı bulantı, kusma, antiemetik ihtiyacı, kabızlık, kaşıntı, idrar retansiyonu, ağız kuruluğu gibi yan etkilerin olup olmadığı, 0-4 saat, 4-8 saat, 8-24 saat aralıklarında ve totalde; kullanılan tramadol bolus dozu miktarı, bolus ve infüzyon toplam doz miktarı ve ek analjezik olarak yapılan parasetamol miktarı kullanıldı. Erektör spina plan bloğuna eklenmiş pektoralis bloğu grubunda VAS skorları, postoperatif 24 saatlik tramadol tüketimi, opioid kullanımına bağlı gelişen yan etkiler ve ek analjezi gereksinimi erektör spina plan bloğu grubuna göre istatiksel olarak da anlamlı şekilde daha düşük bulundu. Çalışmamızda multimodal analjezinin bir parçası olarak ultrasonografi eşliğinde uygulanan erektör spina plan bloğuna eklenmiş pektoralis sinir bloğunun meme kanseri cerrahisi yapılan hastalarda postoperatif akut ağrı üzerine etkili bir analjezi sağladığı gösterilmiştir.
Breast cancer is a type of cancer detected very frequently in the female gender, and acute pain after surgery, especially the transformation of acute pain into permanent pain, is the most severe problem in the postoperative period. This study aimed to activate postoperative analgesia, prevent chronic pain, decrease pain scores, and reduce opioid consumption and opioid-related side effects in patients undergoing breast cancer surgery. Fifty patients (Female gender, aged 18-75 years, without hematological disease) who underwent breast cancer surgery were included in the study. The patients were divided into those who underwent erector spina plane block and those who underwent pectoralis nerve block added to the erector spina plane block. In both groups, blocks were applied preoperatively using 20 ml of 0.25% bupivacaine. All patients were given general anesthesia for the surgery. In the postoperative period, patient-controlled analgesia (PCA) with tramadol (tramadol 300 mg was put into 100 cc serum isotonic at 3 mg/cc, three cc/hour infusion, bolus dose five ccs, lock-in time will be 4 hours and will stay for 24 hours) was applied. Tenoxicam was administered to all patients before extubation. When the resting visual analog scale (VAS) score was >4 despite the PCA request for tramadol, iv paracetamol was administered as rescue analgesia. As a measure, the patients' VAS scores at the postoperative 30th minute, 1, 2, 4, 8, 12, and 24 hours after surgery, PCA, and side effects such as nausea, vomiting, need for antiemetics, constipation, itching, urinary retention, dry mouth due to opioid use. Whether there are effects at intervals of 0-4 hours, 4-8 hours, 8-24 hours, and in total, The amount of tramadol bolus dose used, the total dose of bolus and infusion, and the amount of paracetamol administered as rescue analgesia was used. In the pectoralis block group added to the erector spina plane block, VAS scores, postoperative 24-hour tramadol consumption, side effects due to opioid use, and the need for rescue analgesia were found to be statistically significantly lower than in the erector spina plane block group. In our study, it has been shown that the pectoralis nerve block added to the erector spinae plan block, which is applied under the guidance of USG as a part of multimodal analgesia, provides adequate analgesia on postoperative acute pain in patients undergoing breast cancer surgery.
Breast cancer is a type of cancer detected very frequently in the female gender, and acute pain after surgery, especially the transformation of acute pain into permanent pain, is the most severe problem in the postoperative period. This study aimed to activate postoperative analgesia, prevent chronic pain, decrease pain scores, and reduce opioid consumption and opioid-related side effects in patients undergoing breast cancer surgery. Fifty patients (Female gender, aged 18-75 years, without hematological disease) who underwent breast cancer surgery were included in the study. The patients were divided into those who underwent erector spina plane block and those who underwent pectoralis nerve block added to the erector spina plane block. In both groups, blocks were applied preoperatively using 20 ml of 0.25% bupivacaine. All patients were given general anesthesia for the surgery. In the postoperative period, patient-controlled analgesia (PCA) with tramadol (tramadol 300 mg was put into 100 cc serum isotonic at 3 mg/cc, three cc/hour infusion, bolus dose five ccs, lock-in time will be 4 hours and will stay for 24 hours) was applied. Tenoxicam was administered to all patients before extubation. When the resting visual analog scale (VAS) score was >4 despite the PCA request for tramadol, iv paracetamol was administered as rescue analgesia. As a measure, the patients' VAS scores at the postoperative 30th minute, 1, 2, 4, 8, 12, and 24 hours after surgery, PCA, and side effects such as nausea, vomiting, need for antiemetics, constipation, itching, urinary retention, dry mouth due to opioid use. Whether there are effects at intervals of 0-4 hours, 4-8 hours, 8-24 hours, and in total, The amount of tramadol bolus dose used, the total dose of bolus and infusion, and the amount of paracetamol administered as rescue analgesia was used. In the pectoralis block group added to the erector spina plane block, VAS scores, postoperative 24-hour tramadol consumption, side effects due to opioid use, and the need for rescue analgesia were found to be statistically significantly lower than in the erector spina plane block group. In our study, it has been shown that the pectoralis nerve block added to the erector spinae plan block, which is applied under the guidance of USG as a part of multimodal analgesia, provides adequate analgesia on postoperative acute pain in patients undergoing breast cancer surgery.
Açıklama
Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
