Tek Doz İntraartiküler Lokal Anestezik ile İnterskalen Brakiyal Pleksus Bloğunun Postoperatif Ağrı Üzerine Etkisi

Year 2022, , 692 - 698, 30.09.2022

Erdinç Koca , Bünyamin Arı

https://doi.org/10.16899/jcm.1118024

Abstract

Amaç: Omuz cerrahisi şiddetli ağrıya neden olduğu için ameliyat sonrası ağrı yönetimi önemlidir. Bu çalışmada amacımız, artroskopik omuz cerrahisi geçirecek olgularda ultrasonografi eşliğinde interskalen blok ve perioperatif intraartiküler lokal anestezik enjeksiyonunun postoperatif ağrı üzerine etkilerinin karşılaştırılmasını incelemektir.
Gereç ve Yöntem: Prospektif randomize kontrollü bir çalışma olarak planlandı. Lokal etik kurul onayından sonra hastalarımız rastgele iki gruba ayrıldı ve bir gruba (Grup ISBPB) ultrasonografi eşliğinde interskalen blok uygulandıktan sonra genel anestezi uygulandı. Diğer grupta (Grup LA) cerrahi işlem genel anestezi altında yapıldı ve peroperatif olarak tek doz eklem içi lokal anestezik uygulandı. Postoperatif analjezi gereksinimi, süresi, VAS skorları, hasta ve cerrah memnuniyeti kaydedildi.
Bulgular: Çalışmaya alınan katılımcılarda cinsiyet, taraf, komorbidite, ek prosedür ve yaş değişkenlerine göre grup LA ve grup ISBPB grupları arasında istatistiksel olarak anlamlı bir fark elde edemedik (p>0.05). Çalışmaya alınan katılımcılarda ilk analjezi gereksinimi ve hasta memnuniyeti değişkenleri açısından Grup LA ve Grup ISBPB grupları arasında sayısal olarak anlamlılık gözlendi (p<0.05).
Sonuç: İnterskalen blok uygulamasının intraartiküler tek doz lokal anestezik uygulamasına göre postoperatif analjezi gereksinimini önemli ölçüde azalttığını gözlemledik. Ultrason rehberliğinde interskalen blok uygulaması ile oluşabilecek komplikasyonları azaltma olasılığı ve tek doz intraartiküler lokal anestezik ile kondroliz olasılığı konusundaki endişeler interskalen bloğu ön plana çıkarmaktadır.

Keywords

Omuz artroskopisi, ortopedik cerrahi, lokal anestezik.

The Effect of Interscalene Brachial Plexus Block with a Single-dose Intra-articular Local Anesthetic on Postoperative Pain

Abstract

Aim: Postoperative pain management is important because shoulder surgery causes severe pain. In this present study our aim was to analyse the comparison of the influences of ultrasonography-guided interscalene block and perioperative intra-articular local anesthetic injection on postoperative pain in cases who will undergo arthroscopic shoulder procedure.
Material and Method: It was planned as a prospective randomized controlled trial. After the confirmation of the local ethical committee, our cases were randomly divided into two groups and one group (Group ISBPB) was administered general anesthesia after ultrasonography guided interscalene block. In the other group (Group LA), surgical procedure was carried out under general anesthesia and a single dose of intra-articular local anesthetic was administered peroperatively. Postoperative analgesia requirement, time, VAS scores, patient and surgeon satisfaction were registered.
Results: We could not obtain a statistically significance between group LA and group ISBPB groups according to gender, side, comorbidity, additional procedure and age variables in the participants included in the study (p>0.05). A numerically significance was observed between Group LA and Group ISBPB groups in terms of first analgesia requirement and patient satisfaction variables in the participants included in the study (p<0.05).
Conclusions: We observed that the application of interscalene block considerably decreased the requirement for postoperative analgesia compared to the application of intra-articular single dose local anesthetic. Concerns about the possibility of reducing the complications that may occur with ultrasound-guided interscalene block application and the possibility of chondrolysis with a single dose of intra-articular local anesthetic bring interscalene block to the fore.

Keywords

Shoulder arthroscopy, orthopedic surgeon, local anesthetic.

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