0-8 yaş arası çocuklarda kaudal blok performansının FLACC ölçeği kullanılarak değerlendirilmesi

Year 2024, Volume: 49 Issue: 2, 287 - 295, 30.06.2024

Evrim Burcu Turan Akar , Filiz Üzümcügil , Başak Akça

https://doi.org/10.17826/cumj.1350618

Abstract

Amaç: Pediatride ameliyat sonrası ağrının değerlendirilmesi gerçek bir zorluktur. Kaudal blok sonrası FLACC (Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Scale) ölçeğini kullanarak ameliyat sonrası acil ağrı yönetimini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Ameliyat öncesi genel anestezi altında kaudal blok uygulanan 0-8 yaş arası çocukların anestezi kayıtları değerlendirildi. İntraoperatif ve postoperatif opioid kullanımının yanı sıra FLACC skorları elde edildi.
Bulgular: Yetmiş sekiz çocuk çalışmaya dahil edildi ve 1-24 ay (n=37) ve 24-96 ay (n=41) yaşlarına göre iki grupta değerlendirildi. Hastaların %7.7'sinde (n=6) intraoperatif opioid gereksinimi gözlendi. FLACC ≥4 olan dokuz hastada (%11,5) hemen ameliyat sonrası dönemde fentanil gerekmiştir. Sadece 1 hasta hem intraoperatif hem de hemen postoperatif dönemde opioide ihtiyaç duymuştur ve bu da %98,7'lik bir başarı oranına işaret etmektedir. Hastaların ameliyat sonrası 1., 2. ve 3. saatlerde FLACC ≥4 olmasına rağmen tek doz opioid aldıkları görülmüştür. Yaş alt grupları FLACC skorları ve postoperatif 3 saat içinde bu skorlardaki değişiklikler açısından benzerdi. İdrar retansiyonu veya motor blok görülmedi. Ancak, 24-96 aylık 4 hastada parestezi kaydedilirken, 1-24 aylık hastaların hiçbirinde parestezi kaydedilmedi. Bu farklılığa 1-24 aylıkken tanımlanamayan rahatsız edici uyuşukluk neden olmuş olabileceği gibi, herhangi bir opioid kullanımı olmaksızın yüksek FLACC skorlarına yol açmış olabilir. Sonuç: Çalışmamız anestezistlerin FLACC skalasını tek başına bir gösterge olarak değil, opioid uygulamak için ağrı değerlendirmesinin bir parçası olarak görmelerini desteklemektedir.

Keywords

Kaudal anestezi, anestezi ve analjezi, ağrı skalası, ağrı değerlendirmesi.

Supporting Institution

Yok

Project Number

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The evaluation of the caudal block performance in 0–8-year-old children using FLACC scale

Abstract

Purpose: The evaluation of postoperative pain in pediatrics is a true challenge. We aimed to evaluate the immediate postoperative pain management using FLACC (Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Scale) scale after caudal block.
Material and Methods: The anesthesia records of children aged 0–8 years who underwent caudal block under general anesthesia prior to surgery were evaluated. The intraoperative and postoperative use of opioids were obtained, as well as, the FLACC scores.
Results: Seventy-eight children were included and evaluated in two groups according to ages of 1-24 (n=37) and 24-96 months (n=41). Intraoperative requirement for opioid was observed in 7.7% (n=6) of patients. Nine patients (11.5%) required fentanyl in the immediate postoperative period with FLACC ≥4. Only 1 patient required opioids both intraoperatively and in the immediate postoperative period, suggesting a success rate of 98.7%. The patients were observed to receive single dose opioid, despite FLACC ≥4 in the following postoperative 1st,2nd and 3rd hours. The subgroups of age were similar in terms of FLACC scores and the changes in these scores within the postoperative 3 hours. There were no urinary retention or motor block. However, paresthesia was recorded in 4 patients at age of 24-96 months, whereas, in none of the patients at age of 1-24 months. The uncomfortable numbness, which could not be described at age of 1-24 months may have caused the difference, as well as, leading to high FLACC scores without any opioid use.
Conclusion: Our study supported that anesthetists consider FLACC scale as a part of pain assessment to administer opioid, not as a sole indicator.

Keywords

Regional anesthesia, Pediatric Anesthesia, Post-operative pain

Project Number

Yok

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