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

Yıl 2022, , 692 - 698, 30.09.2022

Erdinç Koca , Bünyamin Arı

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

Öz

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.

Anahtar Kelimeler

Omuz artroskopisi, ortopedik cerrahi, lokal anestezik.

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

Öz

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.

Anahtar Kelimeler

Shoulder arthroscopy, orthopedic surgeon, local anesthetic.

Kaynakça

• Garrett WE, Swiontkowski MF, Weinstein JN, et al. American board of orthopaedic surgery practice of the orthopaedic surgeon: Part-II, certification examination case mix. J Bone Joint Surg Am 2006;88:660-67.
• Tuominen M, Pitkänen M, Rosenberg PH. Postoperative pain relief and bupivacaine plasma levels during continuous interscalene brachial plexus block. Acta Anaesthesiol Scand 1987;31:276-8.
• Wilson AT, Nicholson E, Burton L, Wild C. Analgesia for day-case shoulder surgery. British Journal of Anaesthesia 2004;92:414–5.
• Ilfeld BM, Morey TE, Wright TW, Chidgey LK, Enneking FK. Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, doubleblinded, placebo-controlled study. Anesthesia and Analgesia 2003;96:1089–95.
• Hughes MS, Matava MJ, Wright RW, Brophy RH, Smith MV. Interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review. J Bone Joint Surg Am 2013;95:1318–24.
• Axelsson K, Gupta A, Johanzon E, et al. İntra-articular administration of ketorolac, morphine, and ropivacaine combined with intra-articular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomize double-blind study. Anesth Analg 2008;106:328-33.
• Wu CL, Rouse LM, Chen JM, Miller RJ. Comparison of postoperative pain in patients receiving interscalene block or general anesthesia for shoulder surgery. Orthopedics 2002;25:45-8.
• Çelik MY. Nasıl? - Biyoistatistik Bilimsel Araştırma – SPSS. İstanbul;2011.
• Alpa R. Spor, Sağlık ve Eğitim Bilimlerinde Örneklerle Uygulamalı İstatistik ve Geçerlik-Güvenirlik. Detay Yayıncılık: Ankara; 2020.
• Karagöz Y. SPSS ve AMOS uygulamalı, nitel – nicel – karma bilimsel araştırma yöntemleri ve yayın etiği. Nobel Yayıncılık: İstanbul; 2017.
• Navarro RA, Lin CC, Foroohar A, Crain SR, Hall MP. Unplanned emergency department or urgent care visits after outpatient rotator cuff repair: potential for avoidance. J Shoulder Elbow Surg 2018:27;993–97.
• Cho CH, Song KS, Min BW, Jung GH, Lee YK, Shin HK. Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy 2015;23:542-47.
• Coghlan JA, Forbes A, McKenzie D, Bell SN, Buchbinder R. Efficacy of subacromial ropivacaine infusion for rotator cuff surgery. A randomized trial. J Bone Joint Surg 2009;91:1558–67.
• Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010;65:608-24.
• Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis Anesth Analg 2015;120:1114–29.
• Winnie AP. Interscalene brachial plexus block. Anesth Analg 1970;49: 455–66.
• Borgeat A, Dullenkopf A, Ekatodramis G, Nagy L. Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery. Anesthesiology 2003;99:436–42.
• Chan VWS. Applying ultrasound imaging to interscalene brachial plexus block. Reg Anesth Pain Med 2003;28:340-3.
• Spence BC, Beach ML, Gallagher JD, Sites BD. Ultrasound guided interscalene blocks: understanding where to inject the local anaesthetic. Anaesthesia 2011;66:509-14.
• Kempen PM, O’Donnell J, Lawler R, Mantha V. Acute respiratory insufficiency during interscalene plexus block. Anesth Analg 2000;90:1415-6.
• Urmey WF. Interscalene block: the truth about twitches. Regional Anesth Pain Med 2000;25:340–2
• Wedel DJ. Peripheral nerve blocks. In: Wedel DJ, ed. Orthopedic Anesthesia. New York, NY: Churchill Livingstone 1993;255-62.
• Malik O, Brovman EY, Urman RD. The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions. Reg Anesth Pain Med 2018;43:25–35
• Choi S, Kim T, Kwon YS, Kang H. Intra-operative effect of interscalene brachial plexus block to arthroscopic rotator cuff repair surgery. Int Orthop 2019;43:2117–24.
• Fredrickson MJ, Stewart AW. Continuous interscalene analgesia for rotator cuff repair: a retrospective comparison of effectiveness and cost in 205 patients from a multiprovider private practice setting. Anaesth Intensive Care 2008;36:786–91.
• Scoggin JF 3rd, Mayfield G, Awaya DJ, Pi M, Prentiss J, Takahashi J. Subacromial and intra-articular morphine versus bupivacaine after shoulder arthroscopy. Arthroscopy 2002;18:464–68.
• Bailie DS, Ellenbecker T. Severe chondrolysis after shoulder arthroscopy: a case series. J Shoulder Elbow Surg 2009;18;742–7.
• Barber FA. Suprascapular nerve block for shoulder arthroscopy. Arthroscopy 2005; 21:1015.
• Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthroscopic shoulder surgery: A comparison of intra-articular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesth Analg 2004;99:589-92.
• Barber FA, Herbert MA. The effectiveness of an anesthetic continuous-infusion device on postoperative pain control. Arthroscopy 2002;18:76-81.
• Harvey GP, Chelly JE, AlSamsam T, Coupe K. Patient-controlled ropivacaine analgesia after arthroscopic subacromial decompression. Arthroscopy 2004;20:451-5.
• Lee SM, Park SE, Nam YS, Han SH, Lee KJ, Kwon MJ, et al. Analgesic effectiveness of nerve block inshoulder arthroscopy: comparison between interscalene, suprascapular andaxillary nerve blocks. Knee Surg Sports Traumatol Arthrosc 2012;20:2573–8.
• Nisar A, Morris MW, Freeman JV, Cort JM, Rayner PR, Shahane SA. Subacromial bursa block is an effective alternative to interscalene block for postoperative paincontrol after arthroscopic subacromial decompression: a randomized trial. J Shoulder Elbow Surg 2008;17:78-84.
• Ghodki PS, Singh ND. Incidence of hemidiaphragmatic paresis after peripheral nerve stimulator versus ultrasound guided interscalene brachial plexus block. J Anaesthesiol Clin Pharmacol 2016;32:177-81.