Genel anestezi altında laparoskopik kolesistektomi vakalarında rektus kılıf bloğu ve transversus abdominis plan bloğunun sevofluran ve fentanil tüketimine etkisinin entropi ölçümüyle değerlendirilmesi: prospektif randomize çalışma
Küçük Resim Yok
Tarih
2023
Yazarlar
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Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Safra kesesi cerrahisinde en sık uygulanan teknik laparoskopik kolesistektomidir. : Günümüzde laparoskopik cerrahi girişimlerde en sık kullanılan anestezi yöntemi genel anestezidir. Postoperatif laparoskopik kolesistektomi, açık kolesistektomi göre daha az postoperatif ağrı ve daha az analjezik tüketimi olmasına rağmen, daha ağrısız bir prosedür değildir. Periferik bloklar, son yıllarda ultrasonografinin klinik kullanımının artmasıyla postoperatif analjezide mutimodal yaklaşımın önemli bir kısmını kapsar. Postoperatif erken dönemde ağrı kontrolü sağlar, sistemik opioid kullanımında azalma sağlar. Anestezi derinlik monitörizasyonu kullanımının anestezi sırasında ilaç tüketimini azalttığı, anesteziden sonra uyanma ve derlenmeyi daha hızlı sağladığı kanıtlanmıştır. Biz bu çalışma ile laparoskopik kolesistektomi vakalarında genel anestezinin ultrasonografi eşliğinde yapılan karın ön duvarı periferik sinir bloklarının (transversus abdominis ve rektus kılıf bloğu) kombine edildiği ve edilmediği vakalarda, bir anestezi derinliği monitorü olan "entropi"yi hedef aralıkta (40-60) tutan inhalasyon anesteziğinin vaka sonunda tüketilen toplam miktarı ve ek doz olarak kullanılan fentanil miktarlarını karşılaştırmayı amaçladık. Çalılmamızda ASA I-II, 18- 75 yaş arası elektif laparoskopik kolesistektomi operasyonu planlanan 80 hasta dahil edidi. Hastalar genel anesteziye transversus abdominis ve rektus kılıf bloğunun kombine edildiği hastalar ve genel anesteziye tramadol ile analjezi sağlanan hastalar olarak 2 gruba ayrıldı. Her 2 gruba da entropi monitörizasyonu uygulandı. Vaka boyunca her 2 grupta da entropi hedef değeri 40-60 arasında tutulması için MAK değeri maksimum 1,3 olacak şekilde, sevofluran konsantrasyonu ayarlaması yapılarak; başlangıç, indüksiyon öncesi ve sonrası, insizyon sonrası 1.dk, pnömoperiton 5-10-15dk pnömoperiton sonrası 1.dk, extübasyon sonrası, postop derlenme 1 ve 5.dk olmak üzere; olguların kalp hızı, sistolik kan basıncı, diastolik kan basıncı, ortalama arteryel kan basıncı, oksijen satürasyonu, orotrakeal entübasyondan sonra görülen end tidal karbondioksit değerleri, SE ve RE entropi değerleri, entropi değerini hedef aralıkta tutan endtidal sevoflurane konsantrasyonu (%) ve eş zamanlı MAK değerleri not edildi. Vaka sonunda tüketilen inhalasyon ajan miktarı ve yüzeyel anestezi/ analjezi ihtiyacı durumuda ek doz fentanil eklenen hastlarda toplam fenatil miktarı not edildi. İki grup arasında toplam vaka süresince tüketilen total inhalasyon ajan miktarı kıyaslandığında Grup I' de (kontrol grubu) 27,05±7,43 ml ve Grup II' de (Bloklu grup) 12,25±4,34 ml olarak görülmüş olup, gruplar arasında istatiksel olarak fark saptanmıştır (p:0,002; p<0,05). Vaka boyunca intraoperatif ek doz fentanil ihtiyacı hastaların yalnızca %30'unda ihtiyaç olmuştur. İntroperatif sürede ek doz fentanil ihtiyacı ve toplamda tüketilen fentanil miktarı gruplar arasında belirgin farklılık göstermiştir. Grup I' de (kontrol grubu) Grup II' ye (Bloklu grubu) göre intraoperatif daha fazla ek doz fentanil ihtiyacı olduğu ( Grup I' de 21 kişi, Grup II'de 3 kişi) saptanmıştır. Toplamda sırası ile 115±33,62 µcg ve 84±22,10 µcg fentanil tüketilmiş olup, iki grup arasında belirgin istatiksel fark saptanmıştır (p:0,000; p:0,001; p<0,05). Laparoskopik kolesistektomi vakalarında entropi monitörü ile standartize edilen genel anesteziye uygulanan bilateral transversus abdominis plan bloğu ve rektus kılıf bloğunun tüketilen inahalasyon ajan miktarını, intraoperatif ek doz ve toplam tüketilen opioid ihityacını azalttığını gözlemlemiş olduk. Anahtar Kelimeler: Laparoskopik Kolesistektomi, Transversus Abdominis Plan Bloğu, Rektus Kılıf Bloğu, Entropi
In gallbladder surgery, the most commonly applied technique is laparoscopic cholecystectomy. In contemporary surgical interventions, general anesthesia is the most frequently used anesthesia method. Postoperative laparoscopic cholecystectomy, despite resulting in less postoperative pain and lower analgesic consumption compared to open cholecystectomy, is not a completely painless procedure. Peripheral blocks, encompassing a significant portion of postoperative analgesia due to the increasing clinical use of ultrasound in recent years, provide pain control in the early postoperative period and contribute to a reduction in systemic opioid use.The use of anesthesia depth monitoring has been proven to reduce drug consumption during anesthesia and facilitate faster wake-up and recovery after anesthesia. In this study, we aimed to compare the total amount of inhalation anesthetic consumed and the additional dose of fentanyl used at the end of laparoscopic cholecystectomy cases where general anesthesia was combined with ultrasound-guided abdominal wall peripheral nerve blocks (TAP and Rectus sheath block) and cases where it was not. We aimed to compare the total amount of inhalation anesthetic consumed at the end of the procedure and the additional dose of fentanyl used, while maintaining the depth of anesthesia monitored by "entropy" within the target range (40-60) Our study included 80 patients scheduled for elective laparoscopic cholecystectomy, ASA I-II, aged 18-75 years. Patients were divided into two groups: those who received general anesthesia combined with TAP and rectus sheath block, and those who received general anesthesia with analgesia provided by tramadol. Entropy monitoring was applied to both groups to maintain the entropy target value between 40-60 throughout the case. Parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, oxygen saturation, end-tidal carbon dioxide values seen after orotracheal intubation, SE and RE entropy values, and end-tidal sevoflurane concentration (%) were recorded. At the end of the case, the total amount of inhalation agent consumed and the need for additional fentanyl were noted. When comparing the total amount of inhalation agent consumed throughout the entire case, it was observed to be 27.05±7.43ml in the control group and 12.25±4.34ml in the blocked group, with a statistically significant difference between the groups (p:0.002; p<0.05). Only 30% of patients required additional fentanyl during the intraoperative period. The need for intraoperative additional fentanyl and the total fentanyl consumed showed a significant difference between the groups. It was determined that more intraoperative additional doses of fentanyl were needed in Group I (control group) than in Group II (block group) (21 people in Group I, 3 people in Group II). In total, 115±33.62 µcg and 84±22.10 µcg fentanyl were consumed, respectively, and a significant statistical difference was detected between the two groups (p:0.000; p:0.001; p<0.05). In laparoscopic cholecystectomy cases, we observed that applying bilateral TAP and rectus sheath blocks standardized with an entropy monitor to general anesthesia reduced the consumption of inhalation anesthetic, intraoperative additional doses, and the total opioid requirement. Keywords: Laparoscopic Cholecystectomy, Transversus Abdominis Plane Block, Rectus Sheath Block, Entropy
In gallbladder surgery, the most commonly applied technique is laparoscopic cholecystectomy. In contemporary surgical interventions, general anesthesia is the most frequently used anesthesia method. Postoperative laparoscopic cholecystectomy, despite resulting in less postoperative pain and lower analgesic consumption compared to open cholecystectomy, is not a completely painless procedure. Peripheral blocks, encompassing a significant portion of postoperative analgesia due to the increasing clinical use of ultrasound in recent years, provide pain control in the early postoperative period and contribute to a reduction in systemic opioid use.The use of anesthesia depth monitoring has been proven to reduce drug consumption during anesthesia and facilitate faster wake-up and recovery after anesthesia. In this study, we aimed to compare the total amount of inhalation anesthetic consumed and the additional dose of fentanyl used at the end of laparoscopic cholecystectomy cases where general anesthesia was combined with ultrasound-guided abdominal wall peripheral nerve blocks (TAP and Rectus sheath block) and cases where it was not. We aimed to compare the total amount of inhalation anesthetic consumed at the end of the procedure and the additional dose of fentanyl used, while maintaining the depth of anesthesia monitored by "entropy" within the target range (40-60) Our study included 80 patients scheduled for elective laparoscopic cholecystectomy, ASA I-II, aged 18-75 years. Patients were divided into two groups: those who received general anesthesia combined with TAP and rectus sheath block, and those who received general anesthesia with analgesia provided by tramadol. Entropy monitoring was applied to both groups to maintain the entropy target value between 40-60 throughout the case. Parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, oxygen saturation, end-tidal carbon dioxide values seen after orotracheal intubation, SE and RE entropy values, and end-tidal sevoflurane concentration (%) were recorded. At the end of the case, the total amount of inhalation agent consumed and the need for additional fentanyl were noted. When comparing the total amount of inhalation agent consumed throughout the entire case, it was observed to be 27.05±7.43ml in the control group and 12.25±4.34ml in the blocked group, with a statistically significant difference between the groups (p:0.002; p<0.05). Only 30% of patients required additional fentanyl during the intraoperative period. The need for intraoperative additional fentanyl and the total fentanyl consumed showed a significant difference between the groups. It was determined that more intraoperative additional doses of fentanyl were needed in Group I (control group) than in Group II (block group) (21 people in Group I, 3 people in Group II). In total, 115±33.62 µcg and 84±22.10 µcg fentanyl were consumed, respectively, and a significant statistical difference was detected between the two groups (p:0.000; p:0.001; p<0.05). In laparoscopic cholecystectomy cases, we observed that applying bilateral TAP and rectus sheath blocks standardized with an entropy monitor to general anesthesia reduced the consumption of inhalation anesthetic, intraoperative additional doses, and the total opioid requirement. Keywords: Laparoscopic Cholecystectomy, Transversus Abdominis Plane Block, Rectus Sheath Block, Entropy
Açıklama
Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
