Rektus kılıf bloğu ile transversus abdominis düzlem bloğu’nun intraoperatif ve postoperatif etkinliklerinin prospektif karşılaştırılması
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Date
2022
Authors
Ülker, Ozan
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Çalışmamızda göbek altı median (GAM) ve göbek üstü median (GÜM) kesi uygulanacak genel cerrahi hastalarında, transversus abdominis düzlem bloğu (TADB) ve rektus kılıf bloğu (RKB)’nun intraoperatif ve postoperatif analjezik etkinliklerini prospektif ve randomize kontrollü olarak karşılaştırmayı amaçladık. Çalışma, etik kurul onayı ve hastaların yazılı onamı sonrası, GAM-GÜM kesi uygulanacak, Amerikan Anestezistler Derneği (ASA) sınıflaması 1-3 olan, 18-75 yaş aralığında 80 hastada gerçekleştirildi. Hastalar demografik verileri kaydedilerek rutin monitorizasyon ve genel anestezi indüksiyonu sonrası, grup TADB ve grup RKB olarak ikiye ayrıldı. Hastaların hemodinamik verileri indüksiyon öncesi, indüksiyon sonrası 1. dakika ve intraoperatif 30 dakikalık periyotlarda kaydedildi. Bütün hastalara morfin ile hazırlanmış hasta kontrollü analjezi (HKA) uygulandı. Hastaların intraoperatif hemodinamik verileri ve uygulanan opioid miktarları, postoperatif istirahat ve öksürmekle görsel analog skalaları, ilk HKA dozuna gereksinim zamanı, postoperatif opioid tüketimleri, kurtarıcı analjezik gereksinimi, ilk mobilizasyona kadar geçen süreleri, opioid yan etkileri, hasta ve cerrah memnuniyeti değerlendirildi. İntraoperatif hemodinamik veriler, uygulanan opioid miktarı ve postoperatif ağrı skorları iki grupta benzer bulundu. TADB grubunda postoperatif morfin tüketimi 2. Saatte anlamlı düzeyde yüksek (p=0,041) bulundu. Takiplerinde gruplar arasında anlamlı fark saptanmadı. İstirahat ve öksürmekle postoperatif ağrı skorları ve ilk HKA dozuna gereksinim zamanı diğer çalışmalar göz önüne alındığında düşük ancak iki grup arasında benzer olarak bulundu. Ek analjezik ihtiyacı iki grupta benzerdi (p=0,633). İlk mobilizasyona kadar geçen süre TADB ve RKB grupları arasında benzer olduğu (p=0,798) ve opioide bağlı yan etkilerin de benzer olduğu (p=0,239) bulundu. Hasta memnuniyeti iki grupta benzerdi (p=0,415). Cerrah memnuniyeti iki grupta benzerdi (p=1,0). Sonuç olarak GAM-GÜM kesi uygulanan hastalarda TADB’nin ve RKB’nin etklinliğinin benzer olduğu kanısına varıldı.
In our study, we aimed to compare the intraoperative and postoperative analgesic efficacy of transversus abdominis plane block (TAPB) and rectus sheath block (RSB) in a prospective and randomized controlled manner in patients undergoing subumbilical and supraumbilical median incisions in general surgery cases. The study was conducted in 80 patients aged between 18-75 years, with the American Society of Anesthesiologists (ASA) classification 1-3, who would undergo subumbilical and supraumbilical median incision after ethics committee approval and written consent from the patients. The demographic data of the patients were recorded and after routine monitoring and general anesthesia induction, they were divided into two groups as group TAPB and group RSB. Hemodynamic data of all patients were recorded pre-induction, post-induction 1. minute and intraoperative 30-minute periods. Patientcontrolled analgesia (PCA) prepared with morphine was administered to all patients. Patients intraoperative hemodynamic data and administered opioid dose, postoperative visual analogue scales (VAS) at rest and coughing, time to first PCA dose, postoperative opioid consumption, need for rescue analgesics, duration time until first mobilization, opioid side effects, patient and surgeon satisfaction were evaluated. Intraoperative hemodinamical data, opioid drug administered and postoperative pain scores were smiliar in two groups. Post-operative morfin administration at 2. hour was higher and statisticly significant (p=0,041) in TAPB group. There was no statisticly significant data on follow ups between groups. When other studies are considered, Post-operative pain scores and first dose of PCA administration at rest and during coughing were similar and low between two groups. Additional analgesia requirement was similar in both groups (p=0,633). It was found that the time to first mobilisation was similar in both TAPB and RSB groups (p=0,798) and opioid side effects were similar (p=0,239). Surgeon satisfaction were similar in both groups. As a result it was found that TAPB and RSB has similar efficiency on patients who underwent surgery with subumbilical and supraumblicial median incision.
In our study, we aimed to compare the intraoperative and postoperative analgesic efficacy of transversus abdominis plane block (TAPB) and rectus sheath block (RSB) in a prospective and randomized controlled manner in patients undergoing subumbilical and supraumbilical median incisions in general surgery cases. The study was conducted in 80 patients aged between 18-75 years, with the American Society of Anesthesiologists (ASA) classification 1-3, who would undergo subumbilical and supraumbilical median incision after ethics committee approval and written consent from the patients. The demographic data of the patients were recorded and after routine monitoring and general anesthesia induction, they were divided into two groups as group TAPB and group RSB. Hemodynamic data of all patients were recorded pre-induction, post-induction 1. minute and intraoperative 30-minute periods. Patientcontrolled analgesia (PCA) prepared with morphine was administered to all patients. Patients intraoperative hemodynamic data and administered opioid dose, postoperative visual analogue scales (VAS) at rest and coughing, time to first PCA dose, postoperative opioid consumption, need for rescue analgesics, duration time until first mobilization, opioid side effects, patient and surgeon satisfaction were evaluated. Intraoperative hemodinamical data, opioid drug administered and postoperative pain scores were smiliar in two groups. Post-operative morfin administration at 2. hour was higher and statisticly significant (p=0,041) in TAPB group. There was no statisticly significant data on follow ups between groups. When other studies are considered, Post-operative pain scores and first dose of PCA administration at rest and during coughing were similar and low between two groups. Additional analgesia requirement was similar in both groups (p=0,633). It was found that the time to first mobilisation was similar in both TAPB and RSB groups (p=0,798) and opioid side effects were similar (p=0,239). Surgeon satisfaction were similar in both groups. As a result it was found that TAPB and RSB has similar efficiency on patients who underwent surgery with subumbilical and supraumblicial median incision.
Description
Keywords
Transversus abdominis düzlem bloğu, Rektus kılıf bloğu, Ağrı yönetimi, Median laparotomi, Transversus abdominis plane block, Rectus sheath block, Pain management, Median laparotomy
Citation
Ülker, O. (2022). Rektus kılıf bloğu ile transversus abdominis düzlem bloğu’nun intraoperatif ve postoperatif etkinliklerinin prospektif karşılaştırılması. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.