İNFRAKLAVİKÜLER BRAKİYAL PLEKSUS BLOKAJINDA EŞİT KONSANTRASYON VE VOLÜMDEKİ BUPİVAKAİN İLE LEVOBUPİVAKAİNİN ETKİNLİĞİNİN KARŞILAŞTIRILMASI

Abstract

AMAÇ Çalışmamızda; periferik sinir sitimülatörü ile gerçekleştirilen, infraklaviküler brakiyal pleksus blokajı uygulamasında, eşit konsantrasyon ve volümdeki bupivakain ile levobupivakaini; hemodinamik stabilite, duyusal ve motor blok başlama ve bitiş süreleri, ilk analjezik gereksinim zamanı ve cerrah memnuniyeti açısından karşılaştırılması amaçlanmıştır. MATERYAL VE METOD Etik kurulundan onay alındıktan sonra, tek taraflı el veya kol cerrahisi geçirecek hastalar seçildi. ASA I-II-III grubu, 18-70 yaş arası 40 olgu çalışmaya dahil edildi. Hastaların kan basınçları (sistolik, diyastolik ve ortalama arter basınçları), kalp tepe atımı (KTA) ve periferik oksijen satürasyonu (SpO2) monitörize edildi. Bütün olgulara vertikal infraklaviküler teknikle ve periferik sinir stimülatörü kullanılarak, brakiyal pleksus blokajı yapıldı. Çalışmaya alınan olgular 20 kişilik 2 gruba ayrıldı. Grup I’e 30 ml (% 0.5; 5 mg/ml) levobupivakain, grup II’ye 30 ml (% 0.5; 5 mg/ml) bupivakain uygulandı. Uygulama yapıldıktan 5 dakika sonra operasyon bölgesi 5 dakikalık aralıklarla pin-prick testi ile kontrol edilmeye başlandı. Blok yerleşince operasyon başlatıldı. Anestezinin yerleşme süresi pin-prick testi ile anestezi ve motor blok kalitesi ise Holmenn skalası ile değerlendirilerek kaydedildi. Tüm hastaların; blok başlama süresi, motor ve duyusal blok süreleri kaydedildi. BULGULAR Gruplar arasında demografik özellikler açısında istatistiksel olarak anlamlı bir fark saptanmadı. (p>0.05) Grupların hemodinamik parametreleri karşılaştırıldığında istatistiksel olarak anlamlı bir fark bulunmadı. (p>0.05) Gruplar arasında, blok başlama süresi, duyusal blok ve motor blok süreleri, analjezik etkinlik açısından anlamlı bir farklılık bulunmadı. (p>0.05) SONUÇ Sonuç olarak üst ekstremite cerrahisinde; ekonomik, çevreci, yan etki ve komplikasyonu az bir teknik olan infraklaviküler brakiyal pleksus blokajının güvenli bir yöntem olduğu, levobupivakain ile bupivakainin birbirlerine üstünlüklerinin olmadığı gösterilmiştir.

Keywords

• bupivakain
• brakial plexus blokajı
• levobupivakain

COMPARISON OF THE EFFECTIVENESS OF BUPIVACAINE AND LEVOBUPIVACAINE IN EQUAL CONCENTRATION AND VOLUME IN IFRACLAVICULAR BRACHIAL PLEXUS BLOCKAGE

Abstract

AIM In our study, it was aimed to compare bupivacaine and levobupivacaine at equal concentration and volume in terms of hemodynamic stability, sensory and motor block onset and end times, first analgesic requirement time, and surgeon satisfaction in the application of infraclavicular brachial plexus blockade performed with a peripheral nerve stimulator. MATERIAL AND METHOD After obtaining approval from the ethics committee, patients who would undergo unilateral hand or arm surgery were selected. Forty patients in the ASA I-II-III group, aged between 18-70 years, were included in the study. The patients' blood pressures (systolic, diastolic and mean arterial pressures), heart rate (HR) and peripheral oxygen saturation (SpO2) were monitored. Brachial plexus blockade was performed in all cases using a vertical infraclavicular technique and a peripheral nerve stimulator. The cases included in the study were divided into 2 groups of 20 people. Group I received 30 ml (0.5%; 5 mg/ml) of levobupivacaine, and group II received 30 ml (0.5%; 5 mg/ml) bupivacaine. 5 minutes after the application, the operation area was started to be controlled with a pin-prick test at 5-minute intervals. When the block was settled, the operation was started. The settling time of anesthesia was recorded using the pin-prick test, and the quality of anesthesia and motor block was evaluated with the Holmenn scale. Block onset time, motor and sensory block times were recorded for all patients. RESULTS There was no statistically significant difference between the groups in terms of demographic characteristics. (p>0.05) There was no statistically significant difference between the hemodynamic parameters of the groups. (p>0.05) There was no significant difference between the groups in terms of onset of block, duration of sensory and motor block, and analgesic efficacy. (p>0.05) CONCLUSION In conclusion, it has been shown that infraclavicular brachial plexus blockade, which is an economical, environmental friendly technique with less side effects and complications, is a safe method in upper extremity surgery, and that levobupivacaine and bupivacaine are not superior to each other.

Keywords

• bupivacaine
• levobupivacain
• brachial plexus blokage

References

1. Heath P.J., Brownlie G.S., Herrick M.J. : Latency of brachial plexus block Anaesthesia. 45: 297-301, 1990
2. Erdine S. : Sinir Blokları. Emre Matbaacılık. İstanbul 49-80, 109-128, 1993
3. Borgeat A., Kalberer F., Jacob H., Ruetsch Y.A. : Patient-Controlled Interscalene Analgesia With Ropivacaine 0,2% versus Bupivacaine 0,15% After Major Open Shoulder Surgery: The Effects on Hand Motor Function. Anesth Analg 92: 218-223, 2001
4. Eroglu A., Uzunlar H., Sener M., Akinturk Y., Erciyes N. : A Clinical Comparison of Equal Concentration and Volume of Ropivacaine and Bupivacaine for Interscalene Brachial Plexus Anesthesia and Analgesia in Shoulder Surgery. Reg. Anesthesia and Pain Med. 29: 539-543, 2004 Kayhan Z. : Klinik Anestezi Logos Yayıncılık. 439, 441-452, 1997
5. Hadzic A., Arliss J., Kerimoglu B. : A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day case surgeries Anesthesiology. 101(1):127-32, 2004
6. Vainionpa V.A., Haavisto E.T., Hulha T.M. : A Clinical cond. Pharmacokinetic comparison of ropivacain and bupivacain in axillary plexus block. Anesth Analg 81: 534-538, 1995
7. Casati A., Fanelli G., Capelleri G., Beccaria P. : A clinical comparison of ropivacain 0,75%, ropivacain 1% or bupivacain 0,5% for interscalene brachial plexus anaesthesia European Journal of Anaesthesiology 16: 784-789, 1999
8. Kilka H.G., Geiger P., Mehrkens H.H. : Infraclavicular vertical brachial plexus blockade. A new method for anesthesia of the upper extremity. Anaesthesist. 44(5):339-44, 1995

9. Krafft P., Eibengberger K., Fitzgerald R. : Ultrasound guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg. 78: 507-513, 1994
10. Neuburger M., Kaiser H., Uhl M. : Biometric data on risk of pneumothorax from vertical infraclavicular brachial plexus block. A magnetic resonance imaging study. Anaesthesist. 50(7):511-6, 2001
11. Heid F.M., Jage J., Guth M. : Efficacy of vertical infraclavicular plexus block vs. modified axillary plexus block: a prospective, randomized, observer-blinded study. Acta Anaesthesiol Scand. 2005 May;49(5):677-82
12. Rettig H.C., Gielen M.J., Boersma E., Klein J. : A comparison of the vertical infraclavicular and axillary approaches for brachial plexus anaesthesia Acta Anaeshesiol Scand. 49(10): Abstract, 2005
13. Grıstwood R.W. : Cardiac and CNS toxicity of levobupivacaine: strengths of evidence for advantage over bupivacaine. Drug Saf. 2002 ; 25 : 153-163 Casati A., Borghi B., Fanelli G., Cerchierini C. : A double-blinded, randomized comparison of either 0,5 % levobupivacaine or 0,5 % ropivacaine for sciatic nevre block. Anesth Analg. 2002 ; 94 : 987-990
14. Mcglade D.P., Kalpokas M.V., Mooney P.H. : Comparison of %0.5 Ropivacaine and %0.5 Bupivacaine in Lumbar Epidural Anaesthesia for Lower Limb Orthopaedic Surgery. Anaesth Intens. Care 1997 ; 25 : 262-266
15. Crosby E., Sandler A., Finucane B.T. : Comparison of Epidural Anaesthesia with Ropivacaine %0.5 and Bupivacaine %0.5 for Caesarean Section. Canadian Journal of Anesthesia 1998 ; 11 : 45
16. Finucane Bt., Sadler A., Mckenna J. : Comparison of Ropivacain %0.05, %0.75, %1.0 and Bupivacaine %0.5 Injected Epidurally, in Patiets Undergoing Abdominal Hysterectomy. Canadian Journal Of Anaesthesia 1996 ; 43 : 5
17. Wolff A.P., Hassesrrom L., Kerkkamp H.E. : Extradural Ropivacaine and Bupivacaine in Hip Surgery. Br. J.Anaesth. 1995 ; 74 : 4
18. E. Milanesi, S. Betinelli, M. Pedeferri, M. Allegri, F. : Epidural levobupivacaine: Its higher potency guarantees more efficacy and safety than ropivacaine to control postoperative pain? Regional Anesthesia and Pain Medicine 2004 ; 29 ( Suppl. 2 ) : 90
19. Ingelmo P.M., Locatelli B.G., Sonzogni V., Gattoni C., Cadisco A. : Caudal 0.2% ropivacaine is less effective during surgery than 0.2% levobupivacaine and 0.2% bupivacaine: a double-blind, randomized, controlled trial. Paediatr Anaesth 2006 Sep;16(9):955 61.
20. Frawley G.P., Downie S., Huang G.H. : Levobupivacaine in caudal anesthesia in children: a randomized double-blind comparison with bupivacaine. Paediatr Anaesth. 2006 Jul;16(7):754-60