Acil Serviste Kalça Kırığı Olan Hastalarda Analjezi Yönetimi İçin Ultrason Rehberliğinde Supra-İnguinal Fasiya İliyaka Kompartman Bloğu ve Femoral Sinir Bloğu Karşılaştırması

Öz

Giriş: Kalça kırıkları, özellikle yaşlı hastalarda şiddetli ağrıya neden olur ve acil serviste etkin ağrı yönetimi büyük önem taşır. Opioid gereksinimini azaltmak ve analjeziyi artırmak amacıyla bölgesel anestezi tekniklerinin kullanımı giderek artmaktadır. Ancak, supra-inguinal fasiya iliaka kompartman bloğu (SİFİB) ile femoral sinir bloğunun (FSB) karşılaştırmalı etkinliği henüz netleşmemiştir. Gereç ve Yöntem: Bu prospektif, randomize çalışmaya, radyolojik olarak doğrulanmış proksimal kalça kırığı olan 18 yaş ve üzeri hastalar dahil edilmiştir. Hastalar, ultrason rehberliğinde SİFİB veya FSB uygulanmak üzere randomize edilmiştir. Ağrı şiddeti, sayısal değerlendirme skalası (NRS) ile başlangıçta ve blok sonrası 20. dakika, 2., 4., 6. ve 8. saatlerde ölçülmüştür. Opioid kullanımı, ek analjezik ihtiyacı ve advers olaylar kaydedilmiştir. Bulgular: Toplam 48 hasta (SİFİB: 27, FSB: 21) çalışmaya dahil edilmiştir. Grupların başlangıç NRS skorları benzer bulunmuştur. Blok başlangıç süresi SİFİB grubunda anlamlı şekilde daha kısaydı (p<0,001). Ancak, tüm zaman noktalarında FSB grubunda NRS skorları anlamlı olarak daha düşüktü (p<0,05). İlk ek analjezik gereksinimine kadar geçen süre FSB grubunda daha uzundu (p<0,001). Opioid kullanımı ve advers olaylar açısından anlamlı fark saptanmamıştır. Sonuç: Hem SİFİB hem de FSB kalça kırığı olan hastalarda etkili analjezi sağlamıştır. FSB uzun süreli ağrı kontrolünde üstün bulunurken, SİFİB daha hızlı etki başlangıcı sunmuştur. Bu sonuçlar, acil serviste bölgesel anestezi tekniği seçiminde klinisyenlere yol gösterici olabilir.

Anahtar Kelimeler

• Kalça kırığı
• sinir bloğu
• bölgesel anestezi
• ağrı yönetimi
• acil servis
• hastane

Ultrasound Guided Supra-Inguinal Fascia Iliaca Compartment Block Vs Femoral Nerve Block for Analgesia Management of Hip Fracture Patients in Emergency Department

Öz

Introduction: Hip fractures cause severe pain, especially in elderly patients, making effective pain management crucial in the emergency setting. Regional anesthesia techniques are increasingly used to reduce opioid requirements and improve analgesia. However, the comparative efficacy of supra-inguinal fascia iliaca compartment block (SFIB) versus femoral nerve block (FB) remains unclear. Materials and Methods: This prospective, randomized study included patients aged 18 years or older with radiologically confirmed proximal hip fractures. Patients were randomized to receive either ultrasound-guided SFIB or FB. Pain intensity was measured using the Numeric Rating Scale (NRS) at baseline and at 20 minutes, 2, 4, 6, and 8 hours after the block. Opioid consumption, additional analgesic use, and adverse events were recorded. Results: A total of 48 patients were included (SFIB: 27, FB: 21). Baseline NRS scores were similar between the groups. The onset time of the block was shorter in the SFIB group (p<0.001). FB resulted in significantly lower NRS scores at all post-block time points (p<0.05). Time to first additional analgesic requirement was longer in the FB group (p<0.001). No significant differences were found in opioid consumption or adverse events. Conclusion: Both SFIB and FB provided effective analgesia in patients with hip fractures. FB was superior for long-term pain control, while SFIB had a faster onset. These results may guide the choice of regional anesthesia techniques in the emergency department.

Anahtar Kelimeler

• Hip fracture
• nerve block
• regional anesthesia
• pain management
• Emergency service
• hospital.

Etik Beyan

The study was approved by the Kahramanmaras Sutcu Imam University Medical Faculty Clinical Research Ethics Committee (Decision no: 2017/03 on 31.05.2017).

Kaynakça

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