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Kalça Cerrahisi Yapılan Düşkün Yaşlı Hastada Lomber Pleksus Bloğu: Olgu Sunumu

Year 2019, , 81 - 84, 25.04.2019
https://doi.org/10.30565/medalanya.513983

Abstract







 Alt ekstremite periferik sinir blokları, ortopedik cerrahi işlemler başta olmak üzere mortalite ve morbiditeyi ciddi oranda azaltabilen uygulamalardır. Bu uygulamalar, nöroaksiyal bloklar ve genel anesteziye göre daha az komplikasyona sahip olmaları, hastalara etkin postoperatif analjezi temin etmeleri ve hastaların mobilizasyonlarını hızlandırmaları nedeniyle sıklıkla kullanılan üstün anestezi ve analjezi uygulamalarıdır. Bu olgu sunumundaki geriatrik hastada lomber pleksus bloğu güvenle kullanılarak hastanın cerrahisi tamamlanmıştır. 78 yaşında 75 kg olan erkek hasta düşme sonucu sol femur fraktürü gelişmesi nedeniyle ortopedi servisine yatırılmıştır. Hastanın yapılan preoperatif değerlendirilmesinde alzheimer hastası olduğu, akut bronşit tanısıyla göğüs hastalıkları tarafından tedavi başlandığı, hipertansiyon, kardiyak aritmi, diabetes mellutus tanılarının olduğu ve tedavi aldığı öğrenildi. Bu olgu sunumunda, American Society of Anesthesiologists’e göre ASA 4 sınıflandırmasında yer alan geriatrik kalça cerrahisi yapılacak hastaya anestezi yöntemi olarak lomber pleksus bloğu uygulandı. Lomber pleksus bloğu ile hastada operasyon için etkin analjezi sağlandı. Hastanın operasyon süresince hemodinamisi stabil olarak seyretti ve güvenli bir anestezi sağlandı. Hastanın yüksek ASA’ya sahip olması genel anestezi ve spinal anestezi için riskli bulunmuştur. Bundan dolayı, geriatrik hastalarda ve ortopedik cerrahilerde periferik blokların diğer anestezi yöntemlerine göre güvenli bir alternatif olacağı düşüncesindeyiz. 

References

  • 1. Ghafoori S, Keshtkar A, Khashayar P, Ebrahimi M, Ramezani M, Mohammadi Z, et al. The risk of osteoporotic fractures and its associating risk factors according to the FRAX model in the Iranian patients: a follow-up cohort. J Diabetes Metab Disord. 2014 Oct 22;13(1):93. PMID: 25349839
  • 2. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992 Nov;2(6):285-9. PMID: 1421796
  • 3. Bleibler F, Konnopka A, Benzinger P, Rapp K, König HH. The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany-a demographic simulation model. Osteoporos Int. 2013 Mar;24(3):835-47. PMID: 22797490
  • 4. Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int. 2012 Mar;23(3):949-55. PMID: 21594756
  • 5. Schürch MA, Rizzoli R, Mermillod B, Vasey H, Michel JP, Bonjour JP. A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res. 1996 Dec;11(12):1935-42. PMID: 8970896
  • 6. Levine BR, Meere PA, DiCesare PE, Zuckerman JD. Hip fractures treated by arthroplasty. In: Callahan JJ, Rosenberg AA, Rubash HE, editors. The adult hip. Vol. 2, 3rd ed. Philadelphia: LWW; 2007. p.187-211.
  • 7. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000 Dec 16;321(7275):1493. PMID: 11118174
  • 8. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth. 2000 Apr;84(4):450-5. PMID: 10823094
  • 9. Fanelli G, Casati A, Aldegheri G, Beccaria P, Berti M, Leoni A, et al. Cardiovascular effects of two different regional anaesthetic techniques for unilateral leg surgery. Acta Anaesthesiol Scand. 1998 Jan;42(1):80-4. PMID: 9527749
  • 10. Chia N, Low TC, Poon KH. Peripheral nerve blocks for lower limb surgery-a choice anaesthetic technique for patients with a recent myocardial infarction?. Singapore Med J. 2002 Nov;43(11):583-6. PMID: 12680529
  • 11. Hadzic A, Carrera A, Clark T, Gadsden J, Karmakar M, Sala-Blanch X, Vandepitte C, Xu D, editors. Hadzic's peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia. 2nd ed. New York: McGraw-Hill; 2012. p. 144.
  • 12. Kaygusuz K, Gürsoy S, Kol Özdemir İ, Öztürk H, Mimaroğlu C. Yüksek riskli hastada kombine siyatik-femoral sinir bloğu (olgu sunumu). C. Ü. Tıp Fakültesi Dergisi. 2006;28 (1):37-40.
  • 13. Cousins MJ, Carr DB, Horlocker TT, Briderbaugh PO, editors. Cousins and Bridenbaugh's neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: LWW; 2007. p. 373-94.
  • 14. Ütebey G, Akkaya T, Alptekin A, Sayın M, Gümüş H, Ateş Y. Total kalça protez operasyonlarında lomber pleksus bloğu ve epidural bloğun total kan kaybı ile postoperatif analjeziye etkileri. Ağrı. 2009;21(2):62-68.
  • 15. Koşucu M, Beşir A, Eroğlu A. Peripheral nerve block to the lower extremity despite relative contraindication (two cases). J Anesthesiol Clin Sci. 2013;2:1-4. DOI: http://dx.doi.org/10.7243/2049-9752-2-29
  • 16. Özmen H, Aydınlı B. Kalça cerrahisinde siyatik ve femoral (1 in 3) sinir bloğu kombinasyonu. Osmangazi Tıp Dergisi. 2017;39(3):98-103. DOI: 10.20515/otd.340152
  • 17. Tran DQ, Clemente A, Finlayson RJ. A review of approaches and techniques for lower extremity nerve blocks. Can J Anaesth. 2007 Nov;54(11):922-34. DOI: https://doi.org/10.1007/BF03026798
  • 18. Topçu İ. Alt ekstremite periferik sinir blokları. Türkiye Klinikleri Anesteziyoloji Reanimasyon Dergisi-Özel Konular Sayısı. 2015;8(3):96-104.
  • 19. Naja Z, Hassan MJ, Khatib H, Ziade MF, Lonnqvist PA. Combined sciatic-paravertebral nerve block and general anaesthesia for fractured hip of elderly. Middle East J Anesthesiol. 2000;15(5):559-68. PMID: 11126507

Lumbar plexus block in fond elderly patient with hip surgery: Case Report

Year 2019, , 81 - 84, 25.04.2019
https://doi.org/10.30565/medalanya.513983

Abstract

Lower extremity peripheral nerve blocks are applications that can significantly reduce mortality and morbidity, especially orthopedic surgical procedures. These applications have less complication than neuroaxial block and general an-esthesia. They are frequently used because of the need to provide effective post-operative analgesia and to accelerate patient mobilizations. In this case report, the patient's surgery was completed using the lumbar plexus block safely. A 78-year-old male patient was admitted to the department of orthopedics due to the left femur fracture. Preoperative evaluation of the patient revealed that he had Alzheimer's Disease, acute bronchitis diagnosed by chest diseases, hypertension, cardiac arrhyth-mia, Diabetes Mellutus diagnosis and treatment. In this case report, a lumbar plexus block was applied as anesthesia to the patient to be treated by geriatric hip surgery according to American Society of Anesthesiologists ASA 4 classification. The lomber plexus block provided effective analgesia for patient during operation. During the op-eration, the hemodynamics remained stable and safe anesthesia was achieved. The high ASA of the patient was found to be risky for both general and spinal anesthesia. Therefore, we think that peripheral blocks are safer than other anesthesia methods in geriatric patients and orthopedic surgeries. 

References

  • 1. Ghafoori S, Keshtkar A, Khashayar P, Ebrahimi M, Ramezani M, Mohammadi Z, et al. The risk of osteoporotic fractures and its associating risk factors according to the FRAX model in the Iranian patients: a follow-up cohort. J Diabetes Metab Disord. 2014 Oct 22;13(1):93. PMID: 25349839
  • 2. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992 Nov;2(6):285-9. PMID: 1421796
  • 3. Bleibler F, Konnopka A, Benzinger P, Rapp K, König HH. The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany-a demographic simulation model. Osteoporos Int. 2013 Mar;24(3):835-47. PMID: 22797490
  • 4. Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int. 2012 Mar;23(3):949-55. PMID: 21594756
  • 5. Schürch MA, Rizzoli R, Mermillod B, Vasey H, Michel JP, Bonjour JP. A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res. 1996 Dec;11(12):1935-42. PMID: 8970896
  • 6. Levine BR, Meere PA, DiCesare PE, Zuckerman JD. Hip fractures treated by arthroplasty. In: Callahan JJ, Rosenberg AA, Rubash HE, editors. The adult hip. Vol. 2, 3rd ed. Philadelphia: LWW; 2007. p.187-211.
  • 7. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000 Dec 16;321(7275):1493. PMID: 11118174
  • 8. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth. 2000 Apr;84(4):450-5. PMID: 10823094
  • 9. Fanelli G, Casati A, Aldegheri G, Beccaria P, Berti M, Leoni A, et al. Cardiovascular effects of two different regional anaesthetic techniques for unilateral leg surgery. Acta Anaesthesiol Scand. 1998 Jan;42(1):80-4. PMID: 9527749
  • 10. Chia N, Low TC, Poon KH. Peripheral nerve blocks for lower limb surgery-a choice anaesthetic technique for patients with a recent myocardial infarction?. Singapore Med J. 2002 Nov;43(11):583-6. PMID: 12680529
  • 11. Hadzic A, Carrera A, Clark T, Gadsden J, Karmakar M, Sala-Blanch X, Vandepitte C, Xu D, editors. Hadzic's peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia. 2nd ed. New York: McGraw-Hill; 2012. p. 144.
  • 12. Kaygusuz K, Gürsoy S, Kol Özdemir İ, Öztürk H, Mimaroğlu C. Yüksek riskli hastada kombine siyatik-femoral sinir bloğu (olgu sunumu). C. Ü. Tıp Fakültesi Dergisi. 2006;28 (1):37-40.
  • 13. Cousins MJ, Carr DB, Horlocker TT, Briderbaugh PO, editors. Cousins and Bridenbaugh's neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: LWW; 2007. p. 373-94.
  • 14. Ütebey G, Akkaya T, Alptekin A, Sayın M, Gümüş H, Ateş Y. Total kalça protez operasyonlarında lomber pleksus bloğu ve epidural bloğun total kan kaybı ile postoperatif analjeziye etkileri. Ağrı. 2009;21(2):62-68.
  • 15. Koşucu M, Beşir A, Eroğlu A. Peripheral nerve block to the lower extremity despite relative contraindication (two cases). J Anesthesiol Clin Sci. 2013;2:1-4. DOI: http://dx.doi.org/10.7243/2049-9752-2-29
  • 16. Özmen H, Aydınlı B. Kalça cerrahisinde siyatik ve femoral (1 in 3) sinir bloğu kombinasyonu. Osmangazi Tıp Dergisi. 2017;39(3):98-103. DOI: 10.20515/otd.340152
  • 17. Tran DQ, Clemente A, Finlayson RJ. A review of approaches and techniques for lower extremity nerve blocks. Can J Anaesth. 2007 Nov;54(11):922-34. DOI: https://doi.org/10.1007/BF03026798
  • 18. Topçu İ. Alt ekstremite periferik sinir blokları. Türkiye Klinikleri Anesteziyoloji Reanimasyon Dergisi-Özel Konular Sayısı. 2015;8(3):96-104.
  • 19. Naja Z, Hassan MJ, Khatib H, Ziade MF, Lonnqvist PA. Combined sciatic-paravertebral nerve block and general anaesthesia for fractured hip of elderly. Middle East J Anesthesiol. 2000;15(5):559-68. PMID: 11126507
There are 19 citations in total.

Details

Primary Language Turkish
Subjects Surgery, Clinical Sciences
Journal Section Case Report
Authors

Mehtap Arda Balcı This is me

Çiğdem Şimşek This is me

Emre Atay 0000-0002-2378-1183

Ayşe Ertekin

Yahya Tahta This is me

Publication Date April 25, 2019
Submission Date January 17, 2019
Acceptance Date February 9, 2019
Published in Issue Year 2019

Cite

Vancouver Arda Balcı M, Şimşek Ç, Atay E, Ertekin A, Tahta Y. Kalça Cerrahisi Yapılan Düşkün Yaşlı Hastada Lomber Pleksus Bloğu: Olgu Sunumu. Acta Med. Alanya. 2019;3(1):81-4.

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