Alt Ekstremite Periferik Sinir Blokları Lower Extremity Peripheral Nerve Blocks

Öz

Özet Alt ekstremite cerrahisi anestezi pratiğinde yaygın olarak karşılaşılan bir cerrahi türüdür. Genellikle anestezi tercihi genel ya da nöroaksiyel blok yöntemlerinden biri olmaktadır. Ancak, son yıllarda nüfus yaşlanmasına paralel olarak başta kalça ve diz olmak üzere alt ekstremite cerrahisinde anestezi uygulanması gereken yaşlı hasta sayısında büyük bir artış gözlenmektedir. Yaşlı hastaların beraberinde pek çok ek hastalık ve kırılgan bir fizyolojiye sahip olmaları, bu hastalarda uygulanacak anestezi yönteminde ciddi zorluklara yol açmaktadır. Özellikle ultrasonun anestezide kullanımı, periferik sinir bloklarının uygulanmasında başarı ve güvenlikte artış sağlayarak bu blokların yaygınlaşmasına katkı sağlamıştır. Sempatik blokaja duyarlı kırılgan ve yüksek riskli hastalarda periferik sinir bloklarının perioperatif morbidite ve mortaliteyi azaltmak için önemli bir seçenek olabileceği göz ardı edilmemelidir. Bu derleme genel ya da nöroaksiyel anesteziye bir alternatif olabilecek mevcut alt ekstremite periferik sinir bloklarına güncel bir bakış açısı sunmaktadır.

Anahtar Kelimeler

• Anestezi
• sinir bloğu
• alt ekstremite
• ultrasonografi

Lower Extremity Peripheral Nerve Blocks

Öz

Lower extremity surgery is a type of surgery commonly encountered in anesthesia practice. Generally, the choice of anesthesia is one of the general or neuraxial block methods. However, in recent years, in parallel with the aging of the population, a great increase has been observed in the number of elderly patients who need anesthesia in lower extremity surgery, especially in the hip and knee. The fact that elderly patients have many additional diseases and a fragile physiology cause serious difficulties in the anesthesia method to be applied in these patients. In particular, the use of ultrasound in anesthesia has contributed to the spread of peripheral nerve blocks by increasing the success and safety of the application. It should not be overlooked that peripheral nerve blocks may be an important option to reduce perioperative morbidity and mortality in frail and high-risk patients susceptible to sympathetic blockade. This review provides an updated perspective on existing lower extremity peripheral nerve blocks, which may be an alternative to general or neuraxial anesthesia.

Anahtar Kelimeler

• Anesthesia
• nerve block
• lower extremity
• ultrasonography

Kaynakça

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