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Brakiyal pleksus bloğu için ultrason eşliğinde uygulanan aksiller yaklaşım, midhumeral yaklaşıma göre blok başlangıç süresini azaltır

Yıl 2020, Cilt: 11 Sayı: 2, 1 - 5, 21.03.2020
https://doi.org/10.18663/tjcl.646807

Öz

Amaç: Ultrasonografi
eşliğinde yapılan brakial pleksus bloğu el, el bileği ve ön kol cerrahisi için,
sık kullanılan, başarılı bir anestezi yöntemidir. Brakial pleksus bloğu,
aksiller yaklaşım ya da midhumeral yaklaşım ile uygulanabilmektedir. Biz bu
çalışmada, ultrasonografi eşliğinde uyguladığımız brakial pleksus bloğunda
aksiller yaklaşım ile midhumeral yaklaşımın, intraoperatif ve postoperatif
anestezik ve analjezik özelliklerini karşılaştırmayı amaçladık.

Gereç ve Yöntemler: Randomize, kontrollü,
çift kör ve tek merkezli olarak planlanan bu çalışma, ASA I-III risk grubu,
18-70 yaş arası, el, el bileği ve ön kol cerrahisi geçiren, toplam 90
hastayı  kapsadı.

Grup I deki hastalara, aksiller
yaklaşım ile blok uygulanırken Grup II deki hastalara da midhumeral yaklaşım
ile blok uygulandı. Duyusal bloğu değerlendirmede soğuk testi, motor bloğu
değerlendirmede 3 nokta skalası kullanıldı. Hastanın operasyon sonrası dönemde
ağrısı visual analog skala ile değerlendirildi.

Bulgular: Çalışma kapsamına alınan hastaların yaş, boy,
kilo, BMI ve cinsiyet özellikleri arasında istatistiksel olarak fark yoktu. Hem
duyu hem de motor muayenede blok başlangıç sürelerinde ve blok gerileme
sürelerinde gruplar arasında istatistiksel olarak anlamlı fark yoktu
(p>0,05). Çalışmamızın en temel sonucu, aksiller yaklaşımın hem duyusal hem
de motor muayenesinde tam blok başlangıç süresini kısaltmasıydı (p <0.05).
Bir diğer önemli sonuç, aksiller yaklaşımın midhumeral  yaklaşıma göre anlamlı olarak daha iyi cerrah
ve hasta memnuniyeti düzeyleri sağlamasıydı (p <0.05).









Sonuç:
Brakial
pleksus bloğunda her iki yaklaşım da başarı ile uygulanabilen ve elektif
cerrahilerde etkin olarak kullanılabilen tekniklerdir.  Brakial pleksus bloğu için aksiller yaklaşım
tekniği uygulanan hastalarda, midhumeral yaklaşım tekniği uygulanan  hastalara göre, tam blok başlangıç zamanı
daha erkendir. Bu nedenle acil cerrahi girişim gerektiren durumlarda aksiller
yaklaşım tekniği  tercih edilebilir.

Kaynakça

  • 1. Liu SS, Ngeow J, John RS. Evidence basis for ultrasound-block characteristics: onset, quality, and duration. Reg Anesth Pain Med 2010; 35: 26-35
  • 2. Demirelli G, Baskan S, Karabeyoglu I, Aytac I, Ornek DH, Erdogmus A, Baydar M. Comparison of ultrasound and ultrasound plus nerve stimulator guidance axillary plexus block. J Pak Med Assoc 2017; 67: 508-12.
  • 3. M. Brattwall, P. Jildenstål Upper extremity nerve block: how can benefit, duration, and safety be improved? An update. F1000 Research 2016; 5: 907
  • 4. Bloc S, Mercadal L, Garnier T et al. Shoulder position influences the location of the musculocutaneous nerve in the axillary fossa. Journal of Clinical Anesthesia 2016; 33: 250-53.
  • 5. Bouaziz H, Narchi P, Mercier FJ et al. Comparison between conventional axillary block and a new approach at the midhumeral level. Anesth Analg 1997; 84: 1058–62.
  • 6. Sia S, Lepri A, Campolo MC, Fiaschi R. Four-injection brachial plexus block using peripheral nerve stimulator: a comparison between axillary and humeral approaches. Anesth Analg 2002; 95: 1075–79.
  • 7. Re´gis Fuzier, MD, Olivier Fourcade, MD, PhD, Antoine Pianezza, MD, Marie- Luce Gilbert, MD, Vincent Bounes, MD, and Michel Olivier, MD. A Comparison Between Double-Injection Axillary Brachial Plexus Block and Midhumeral Block for Emergency Upper Limb Surgery. Anesth Analg 2006; 102: 1856–58.
  • 8. Dupre LJ: Brachial plexus block through humeral approach. Cah Anesthesiol 1994; 42: 767-69.
  • 9. March X, Pardina B, Torres-Bahi S et al. A comparison of triple-injection axillary brachial plexus block with the humeral approach. Reg Anesth Pain Med 2003; 28: 504-508.

Ultrasound-guided axillary approach for brachial plexus block reduces block onset time compared to midhumeral approach

Yıl 2020, Cilt: 11 Sayı: 2, 1 - 5, 21.03.2020
https://doi.org/10.18663/tjcl.646807

Öz

Aim: Brachial plexus block
under ultrasonography guidance is a successful and frequently used anesthesia
method for hand, wrist and forearm surgery.
Brachial plexus block can be performed with axillary
or midhumeral approach technique.
In
this study, we aimed to compare the intraoperative and postoperative anesthetic
and analgesic properties of axillary or midhumeral approach in
ultrasonography-guided brachial plexus block.

Material and Methods: This randomized,
controlled, double-blind, single-center study included 90 ASA I-III risk
patients, aged 18-70 years, who underwent hand, wrist and forearm surgery.
In Group I, axillary; in Group II, midhumeral approach techniques were
performed for brachial plexus block. Cold test was used to evaluate sensory
block, and three-point scale was used to evaluate motor block. Postoperative
pain was assessed by visual analog scale.

Results: There was no
statistical difference between age, height, weight, BMI and gender
characteristics of the patients included in the study. There was no
statistically significant difference between the groups in terms of block onset
and regression times on both sensory and motor examination (p> 0.05). The
main result was that axillary approach shortens the complete block onset time
on both sensory and motor examination (p <0.05). Another important result
was that axillary approach provides higher surgeon and patient satisfaction
levels significantly comparing to mid-humeral approach (p <0.05).







Conclusion: Both approaches can be applied
successfully in brachial plexus block and can be used effectively in elective
surgeries. In patients who underwent axillary approach technique for brachial
plexus block, full block onset time is earlier than in patients undergoing
midhumeral approach technique. Therefore, axillary approach technique may be
preferred in cases requiring urgent surgical intervention.

Kaynakça

  • 1. Liu SS, Ngeow J, John RS. Evidence basis for ultrasound-block characteristics: onset, quality, and duration. Reg Anesth Pain Med 2010; 35: 26-35
  • 2. Demirelli G, Baskan S, Karabeyoglu I, Aytac I, Ornek DH, Erdogmus A, Baydar M. Comparison of ultrasound and ultrasound plus nerve stimulator guidance axillary plexus block. J Pak Med Assoc 2017; 67: 508-12.
  • 3. M. Brattwall, P. Jildenstål Upper extremity nerve block: how can benefit, duration, and safety be improved? An update. F1000 Research 2016; 5: 907
  • 4. Bloc S, Mercadal L, Garnier T et al. Shoulder position influences the location of the musculocutaneous nerve in the axillary fossa. Journal of Clinical Anesthesia 2016; 33: 250-53.
  • 5. Bouaziz H, Narchi P, Mercier FJ et al. Comparison between conventional axillary block and a new approach at the midhumeral level. Anesth Analg 1997; 84: 1058–62.
  • 6. Sia S, Lepri A, Campolo MC, Fiaschi R. Four-injection brachial plexus block using peripheral nerve stimulator: a comparison between axillary and humeral approaches. Anesth Analg 2002; 95: 1075–79.
  • 7. Re´gis Fuzier, MD, Olivier Fourcade, MD, PhD, Antoine Pianezza, MD, Marie- Luce Gilbert, MD, Vincent Bounes, MD, and Michel Olivier, MD. A Comparison Between Double-Injection Axillary Brachial Plexus Block and Midhumeral Block for Emergency Upper Limb Surgery. Anesth Analg 2006; 102: 1856–58.
  • 8. Dupre LJ: Brachial plexus block through humeral approach. Cah Anesthesiol 1994; 42: 767-69.
  • 9. March X, Pardina B, Torres-Bahi S et al. A comparison of triple-injection axillary brachial plexus block with the humeral approach. Reg Anesth Pain Med 2003; 28: 504-508.
Toplam 9 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Özgün Makale
Yazarlar

Aylin Keske Bu kişi benim 0000-0002-1740-0161

Semih Başkan Bu kişi benim 0000-0003-0096-7097

Aytaç İsmail Bu kişi benim

Ayşe Lafçı 0000-0002-3215-4114

Yayımlanma Tarihi 21 Mart 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 11 Sayı: 2

Kaynak Göster

APA Keske, A., Başkan, S., İsmail, A., Lafçı, A. (2020). Ultrasound-guided axillary approach for brachial plexus block reduces block onset time compared to midhumeral approach. Turkish Journal of Clinics and Laboratory, 11(2), 1-5. https://doi.org/10.18663/tjcl.646807
AMA Keske A, Başkan S, İsmail A, Lafçı A. Ultrasound-guided axillary approach for brachial plexus block reduces block onset time compared to midhumeral approach. TJCL. Mart 2020;11(2):1-5. doi:10.18663/tjcl.646807
Chicago Keske, Aylin, Semih Başkan, Aytaç İsmail, ve Ayşe Lafçı. “Ultrasound-Guided Axillary Approach for Brachial Plexus Block Reduces Block Onset Time Compared to Midhumeral Approach”. Turkish Journal of Clinics and Laboratory 11, sy. 2 (Mart 2020): 1-5. https://doi.org/10.18663/tjcl.646807.
EndNote Keske A, Başkan S, İsmail A, Lafçı A (01 Mart 2020) Ultrasound-guided axillary approach for brachial plexus block reduces block onset time compared to midhumeral approach. Turkish Journal of Clinics and Laboratory 11 2 1–5.
IEEE A. Keske, S. Başkan, A. İsmail, ve A. Lafçı, “Ultrasound-guided axillary approach for brachial plexus block reduces block onset time compared to midhumeral approach”, TJCL, c. 11, sy. 2, ss. 1–5, 2020, doi: 10.18663/tjcl.646807.
ISNAD Keske, Aylin vd. “Ultrasound-Guided Axillary Approach for Brachial Plexus Block Reduces Block Onset Time Compared to Midhumeral Approach”. Turkish Journal of Clinics and Laboratory 11/2 (Mart 2020), 1-5. https://doi.org/10.18663/tjcl.646807.
JAMA Keske A, Başkan S, İsmail A, Lafçı A. Ultrasound-guided axillary approach for brachial plexus block reduces block onset time compared to midhumeral approach. TJCL. 2020;11:1–5.
MLA Keske, Aylin vd. “Ultrasound-Guided Axillary Approach for Brachial Plexus Block Reduces Block Onset Time Compared to Midhumeral Approach”. Turkish Journal of Clinics and Laboratory, c. 11, sy. 2, 2020, ss. 1-5, doi:10.18663/tjcl.646807.
Vancouver Keske A, Başkan S, İsmail A, Lafçı A. Ultrasound-guided axillary approach for brachial plexus block reduces block onset time compared to midhumeral approach. TJCL. 2020;11(2):1-5.


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