Major jinekolojik cerrahi geçiren hastalarda postoperatif analjezide lomber epidural analjezi, transversus abdominis plan bloğu ve cerrahi yara infiltrasyonunun karşılaştırılması

Yıl 2025, Cilt: 50 Sayı: 3, 819 - 828, 30.09.2025

Cansu Demir , Mediha Türktan , Ersel Güleç , Mete Sucu , Hülya Binokay , Hakki Ünlügenç

https://doi.org/10.17826/cumj.1709071

Öz

Amaç: Çalışmamızda major jinekolojik cerrahide lomber epidural analjezi (LEA), transversus abdominis plan (TAP) bloğu ve cerrahi yara infiltrasyonunu (SWI) postoperatif analjezi, hasta memnuniyeti ve yan etkiler açısından karşılaştırdık.
Gereç ve Yöntem: Seksen bir hasta üç gruba randomize edildi: lomber epidural blok (Grup LEA), TAP blok (Grup TAP) ve cerrahi yara infiltrasyonu (Grup SWI). Demografik veriler, cerrahi özellikler, hemodinamik değişkenler, toplam morfin tüketimi, ilk kurtarma analjezik isteğine kadar geçen süre, ağrı skorları ve yan etkiler postoperatif 1, 2, 6, 12, 24, 36 ve 48. saatlerde kaydedildi. Hasta memnuniyeti skorları da postoperatif 24 ve 48. saatlerde kaydedildi.
Bulgular: Kalp hızı Grup LEA'da diğer gruplara kıyasla daha düşüktü. Ameliyat sonrası 48 saatlik toplam morfin tüketimi Grup LEA'da (9,63±5,7 mg), Grup TAP'a (15,30±4,0 mg) ve Grup SWI'a (16,93±5,9 mg) göre anlamlı derecede düşüktü. Ameliyat sonrası ağrı skorları Grup LEA'da diğer gruplara göre anlamlı derecede düşüktü. İlk kurtarma analjezisine kadar geçen süre Grup LEA'da (47,41±24,3 dk), Grup TAP'a (27,41±11,9 dk) ve Grup SWI'ya (16,67±5,1 dk) göre anlamlı derecede uzundu. Hasta memnuniyeti skorları 24 ve 48. saatlerde Grup LEA'da (9,89±0,3 ve 9,96±0,1) Grup TAP'a (9,67±0,5 ve 9,89±0,3) ve Grup SWI'ya (9,37±0,8 ve 9,44±0,7) göre anlamlı derecede yüksekti. Postoperatif önemli bir yan etki görülmedi.
Sonuç: Majör jinekolojik cerrahi geçiren hastalarda LEA TAP blok ve SWI ile karşılaştırıldığında yan etki riskini artırmadan daha düşük morfin tüketimi, ilk kurtarma analjezi süresinde uzama ve daha yüksek hasta memnuniyet skorları ile sonuçlandı.

Anahtar Kelimeler

epidural analjezi , jinekolojik cerrahi , lokal anestezik infiltrasyonu , postoperatif ağrı yönetimi , yan etki , transversus abdominis alan bloğu

Comparison of lumbar epidural analgesia, transversus abdominis plane block, and surgical wound infiltration for postoperative pain relief in patients with major gynecologic surgery

Öz

Purpose: This study compared lumbar epidural analgesia (LEA), transversus abdominis plane (TAP) block, and surgical wound infiltration (SWI) for postoperative analgesia, patient satisfaction, and side effects in major gynecologic surgery.
Materials and Methods: Eighty-one patients were randomized into three groups: lumbar epidural block (Group LEA), TAP block (Group TAP), and SWI (Group SWI). Demographic data, surgical characteristics, hemodynamic variables, total morphine consumption, time to first rescue analgesia, pain scores, and side effects were recorded at 1, 2, 6, 12, 24, 36, and 48 hours, along with patient satisfaction scores at 24 and 48 hours postoperatively.
Results: Heart rate was significantly lower in Group LEA than in Group SWI and Group TAP. Postoperative 48-h total morphine consumption was significantly lower in Group LEA (9.63 ± 5.7 mg) than in Group TAP (15.30 ± 4.0 mg) and Group SWI (16.93 ± 5.9 mg). Postoperative pain scores were significantly lower in Group LEA than in the other groups. Time to first rescue analgesia was significantly longer in Group LEA (47.41 ± 24.3 min) than in Group TAP (27.41 ± 11.9 min) and Group SWI (16.67 ± 5.1 min). Patient satisfaction scores were significantly higher at 24 and 48 hours in Group LEA (9.89 ± 0.3 and 9.96 ± 0.1, respectively) than in Group TAP (9.67 ± 0.5 and 9.89 ± 0.3) and Group SWI (9.37 ± 0.8 and 9.44 ± 0.7). No significant side effects were noted.
Conclusion: In patients undergoing major gynecologic surgery, LEA resulted in lower morphine consumption, longer time to first rescue analgesic request, and higher patient satisfaction scores without increasing the risk of side effects compared to TAP block and SWI.

Anahtar Kelimeler

epidural analgesia , gynecologic surgery , local anesthetic infiltration , postoperative pain management , side effect , transversus abdominis plane block

Etik Beyan

This study was conducted in accordance with the Declaration of Helsinki, and approved by the faculty ethical committee (date: 8 September 2022, IRB number: 174/7).

Destekleyen Kurum

The authors received no financial support for the research, authorship, and/or publication of this article.

Kaynakça

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