İnguinal herni cerrahisi geçiren çocuklarda ultrason kılavuzluğunda uygulanan rektus kılıf bloğu ile intravenöz tramadol'ün postoperatif ağrı üzerindeki etkilerinin karşılaştırılması

Year 2017, Volume: 42 Issue: 3, 459 - 464, 30.09.2017

Ersel Güleç , Mediha Türktan Zehra Hatipoğlu Dilek Özcengiz

https://doi.org/10.17826/cutf.296419

Abstract

maç: Rektus kılıf bloğu postoperatif ağrı kontrolünde kullanılan bir rejyonal anestezi tekniğidir. Açık inguinal herni tamiri cerrahisi geçiren çocuklarda ultrason kılavuzluğunda rektus kılıf bloğu ve intravenöz tramadol’ün postoperatif ağrı üzerindeki etkilerini karşılaştırmayı amaçladık.

Gereç ve Yöntem: Genel anestezi altında inguinal herni cerrahisi geçirecek olan 2-7 yaşları arasındaki 40 hasta prospektif randomize çalışmaya dahil edildi. Hastalar iki gruba ayrıldı. Grup UR’ deki (n=20) hastalara cerrahi öncesi 0,2 mg/kg dozunda %0,25 levobupivakain ile ultrason kılavuzluğunda rektus kılıf bloğu uygulandı. Grup T’ deki (n=20) hastalara ise intravenöz 1 mg/kg tramadol uygulandı. Çalışmanın birincil sonucu postoperatif ağrı derecesidir. Postoperatif ağrı skorları, sedasyon seviyesi, ek analjezik gereksinimi ve yan etkiler kaydedildi.

Bulgular: Ağrı skorları 5. dakika (UR 1.90 [95% confidence interval [CI], 1.05–2.74] ; T 5.50 [95% CI, 4.31–6.68; P < 0.001]), 15. dakika (UR 1.00 [95% CI, 0.27–1.72] ; T 4.65 [95% CI, 3.56–5.73; P < 0.001]), 30. dakika (UR 0.85 [95% CI, 0.08–1.61] vs T 3.05 [95% CI, 2.14–3.95; P < 0.001])  ve 60. dakikada  (UR 0.20 [95% CI, -0.12–0.52] vs T 0.95 [95% CI, 0.41–1.48; P=0.008]) Grup T’ye göre Grup UR’de daha düşüktü. Ek analjezik ihtiyacını Grup T’de 15 hasta gösterirken Grup UR’de hiçbir göstermedi.

Sonuç: İnguinal herni tamiri geçiren çocuklarda ultrason kılavuzluğunda rektus kılıf bloğu etkili postoperatif analjezi sağlar. Bu etki tramadol ile karşılaştırıldığında özellikle postoperatif ilk 1 saat boyunca daha belirgin ortaya çıkmaktadır.

Keywords

tramadol, Çocuk, inguinal herni, levobupivakain, ultrason

Ultrasound guided rectus sheath block vs intravenous tramadol on postoperative analgesia in children undergoing inguinal hernia repair

Abstract

Purpose: Rectus sheath block is a regional anesthesia technique for postoperative pain control. We aimed to evaluate the effects of ultrasound-guided rectus sheath block on postoperative pain relief comparing with intravenous tramadol in children undergoing open inguinal hernia repair.

Material and Methods: Forty children, aged between 2-7 years, scheduled for inguinal hernia repair were enrolled into this prospective assessor blinded randomized study. Patients were allocated into one of two groups to receive ultrasound-guided rectus sheath block with a dose of 0.2 ml/kg, levobupivacaine 0.25% (group UR, n=20) or tramadol IV of 1 mg/kg (group T, n=20) under general anesthesia. The primary endpoint was the postoperative pain degree. Postoperative pain scores, sedation levels, supplemental analgesic requirements, and side effects were recorded. 

Results: Pain scores were lower in group UR compared to group T at postoperative 5 min (UR 1.90 [95% confidence interval [CI], 1.05–2.74] vs T 5.50 [95% CI, 4.31–6.68; P < 0.001]), 15 min (UR 1.00 [95% CI, 0.27–1.72] vs T 4.65 [95% CI, 3.56–5.73; P < 0.001]), 30 min (UR 0.85 [95% CI, 0.08–1.61] vs T 3.05 [95% CI, 2.14–3.95; P < 0.001]) and 60 min (UR 0.20 [95% CI, -0.12–0.52] vs T 0.95 [95% CI, 0.41–1.48; P=0.008]). Fifteen patients required supplemental analgesic in group T whereas group UR patients did not require it.

Conclusion: Ultrasound-guided rectus sheath block produces an effective postoperative pain relief in children undergoing inguinal hernia repair surgery, noticeably for the first postoperative hour, compared with tramadol.

Keywords

Children, inguinal hernia, levobupivacaine, tramadol, ultrasonography

References

• 1. Schleich DL: Schmerzlose Operationen. 4th ed. Berlin, Springer Verlag. 1899.
• 2. Finnerty O, Carney J, McDonnell JG. Trunk blocks for abdominal surgery. Anaesthesia. 2010;65:76-83.
• 3. Willschke H, Bosenberg A, Marhofer P, Johnston S, Kettner SC, Wanzel O et al. Ultrasonography-guided rectus sheath block in paediatric anaesthesia - a new approach to an old technique. Br J Anaesth. 2006;97:244-9.
• 4. Gurnaney HG, Maxwell LG, Kraemer FW, Goebel T, Nance ML, Ganesh A. Prospective randomized observer-blinded study comparing the analgesic efficacy of ultrasound-guided rectus sheath block and local anaesthetic infiltration for umbilical hernia repair. Br J Anaesth. 2011;107:790-5.
• 5. Dingeman RS, Barus LM, Chung HK, Clendenin DJ, Lee CS, Tracy S et al. Ultrasonography-guided bilateral rectus sheath block vs local anesthetic infiltration after pediatric umbilical hernia repair: a prospective randomized clinical trial. JAMA Surg. 2013;148:707-13.
• 6. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7-17.
• 7. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293-7.
• 8. Courreges P, Poddevin F, Lecoutre D. Para-umbilical block: a new concept for regional anaesthesia in children. Pediatr Anaesth. 1997;7:211-4.
• 9. Ferguson S, Thomas V, Lewis I. The rectus sheath block in paediatric anaesthesia: new indications for an old technique? Pediatr Anaesth. 1996;6:463-6.
• 10. Kumar A, Wilson GA, Engelhardt TE. Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy. Saudi J Anaesth. 2014;8:229-32.
• 11. Bailie K, Cullen A, Eggleton A. Ultrasound-guided rectus sheath blocks for open pyloromyotomy: a chance to turn down the gas. Pediatr Anaesth. 2014;24:356-7.
• 12. Breschan C, Jost R, Stettner H, Feigl G, Semmelrock S, Graf G et al. Ultrasound-guided rectus sheath block for pyloromyotomy in infants: a retrospective analysis of a case series. Pediatr Anaesth. 2013;23:1199-204.
• 13. Hamill JK, Liley A, Hill AG. Rectus sheath block for laparoscopic appendicectomy: a randomized clinical trial. ANZ J Surg. 2015;12:951-6.
• 14. Mugita M, Kawahara R, Tamai Y, Yamasaki K, Okuno S, Hanada R et al. Effectiveness of ultrasound-guided transversus abdominis plane block and rectus sheath block in pain control and recovery after gynecological transumbilical single-incision laparoscopic surgery. Clin Exp Obstet Gynecol. 2014;41:627-32.
• 15. Azemati S, Khosravi MB. An assessment of the value of rectus sheath block for postlaparoscopic pain in gynecologic surgery. J Minim Invasive Gynecol. 2005;12:12-5.
• 16. Crosbie EJ, Massiah NS, Achiampong JY, Dolling S, Slade RJ. The surgical rectus sheath block for post-operative analgesia: a modern approach to an established technique. Eur J Obstet Gynecol Reprod Biol. 2012;160:196-200.
• 17. Flack SH, Martin LD, Walker BJ, Bosenberg AT, Helmers LD, Goldin AB et al. Ultrasound-guided rectus sheath block or wound infiltration in children: a randomized blinded study of analgesia and bupivacaine absorption. Pediatr Anaesth. 2014;24:968-73.
• 18. Rajwani KM, Butler S, Mahomed A. In children undergoing umbilical hernia repair is rectus sheath block effective at reducing post-operative pain? Best evidence topic (bet). Int J Surg. 2014;12:1452-5.
• 19. Isaac LA, McEwen J, Hayes JA, Crawford MW. A pilot study of the rectus sheath block for pain control after umbilical hernia repair. Pediatr Anaesth. 2006;16:406-9.
• 20. Padmanabhan J, Niaz A, Chojnowska E, Baig MK, Woods WGA. Does rectus sheath infusion of bupivacaine reduce postoperative opioid requirement? Ann R Coll Surg Engl. 2007;89:229-32.
• 21. Burlacu CL, Buggy DJ. Update on local anesthetics: focus on levobupivacaine. Ther Clin Risk Manag. 2008;4:381-392.
• 22. Stoving K, Rothe C, Rosenstock CV, Aasvang EK, Lundstrm LH, Lange KH. Cutaneous sensory block area, muscle-relaxing effect, and block duration of the transversus abdominis plane block: a randomized, blinded, and placebo-controlled study in healthy volunteers. Reg Anesth Pain Med. 2015;40:355-62.