Rektus kılıf bloğu yönteminin etkinliğinin araştırılması
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Dosyalar
Tarih
2017
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Ameliyat sonrası dönemde mortalite ve morbiditeyi etkileyen en önemli problemlerden biri postoperatif ağrıdır. Son yıllarda, abdominal cerrahi sonrası ağrı kontrolünde ultrasonografi eşliğinde yapılan rektus kılıf bloğu yöntemi yeni ve etkin bir teknik olarak uygulanmaktadır. Biz de retrospektif olarak yaptığımız bu çalışmada abdominal patoloji nedeniyle umblikus üstü-altı median kesi yapılarak opere olmuş hastalarda ultrasonografi eşliğinde yapılan rektus kılıf bloğu yönteminin etkinliğini araştırmayı amaçladık. Gereç ve Yöntem: Temmuz 2014-Mart 2016 tarihleri arasında opere olmuş 235 hastanın dosyasını taradık. Bu dosyalardan; 18-75 yaş arası abdominal patoloji nedeniyle umblikus üstü-altı median kesi yapılarak ameliyat olmuş, postoperatif analjezi için tramadol uygulanmış ve ameliyat sonrası dönemde i.v hasta kontrollü analjezi cihazı ile morfin uygulanan Amerikan Anestezistler Cemiyeti (ASA) fiziksel statüsü 1-3 hastalar belirlendi. Bu kriterleri karşılayan 93 hastadan 13 tanesi takip bilgileri eksik olduğu için çalışmaya dahil edilmedi. Belirlenen 80 hasta intraoperatif rektus kılıf bloğu yöntemi kullanılması yönünden değerlendirildi. Rektus kılıf bloğu uygulanan 40 hasta ve rektus kılıf bloğu uygulanmayan 40 hasta olarak iki farklı grup oluşturuldu. Belirlenen bu iki grup hastada postoperatif ağrı takip formuna kaydedilmiş olan vizuel analog skala (VAS) değeri ve Hasta Kontrollü Analjezi (HKA) cihazından kaydedilmiş olan analjezik sunumu (DEL) ve analjezik isteği (DEM) değerleri karşılaştırıldı. Ayrıca hastanın ifade etmiş olduğu bulantı, kusma ve kabızlık şikayetleri değerlendirildi. Bulgular: Postoperatif VAS değerleri (postoperatif 1, 12, 24. saat p<0.001), DEM değerleri (postoperatif 1, 12 ve 24. saat p<0.001) ve tüketilen toplam morfin miktarına (postoperatif 1, 12 ve 24. saat p<0.001) bakıldığında rektus kılıf bloğu yapılmış hastalarda anlamlı düzeyde daha az olduğu görüldü. Ayrıca rektus kılıf bloğu yapılmış hastalarda postoperatif 1 ve 12. saatlerde bulantı görülen hasta sayısı daha az idi (1. saat p=0.014, 12. saat p=0.034). Yine rektus kılıf bloğu yapılan hastalarda postoperatif 1. saatte kusma görülen hasta sayısı daha az idi (p=0.007). Postoperatif ilk 24 saatte rektus kılıf bloğu uygulanmış 8 hastada kabızlık görülürken, blok uygulanmamış 30 hastada kabızlık görüldü. Sonuç: Ultrasonografi eşliğinde yapılan rektus kılıf bloğunun postoperatif ağrı kontrolünde etkili bir yöntem olduğu sonucuna varılmıştır. Anahtar Kelimeler: Ultrasonografi, rektus kılıf bloğu, postoperatif analjezi.
Postoperative pain is one of the most important problems affecting mortality and morbidity in the postoperative period. In recent years, ultrasound guided rectus sheath block method is applied as a new and effective technique for pain control after abdominal surgery. In this retrospective study, we aimed to investigate the efficacy of ultrasound guided rectus sheath block method in patients who had undergone lower-upper umblical median incision due to abdominal pathology. Material and Methods: We scanned 235 patients' files who underwent abdominal surgery between July 2014 and March 2016. From these files; patients who was between the ages of 18-75 years and had American Society of Anesthesiologists (ASA) physical status 1-3, who had an operation with an lower-upper umblical median incision performed due to abdominal pathology, who received tramadol for postoperative analgesia and who underwent morphine treatment with i.v patient controlled analgesia device after surgical operation were selected. Of the 93 patients who met the criteria above 13 patients were excluded because of lack of follow-up information. The selected 80 patients were evaluated for the use of an intraoperative rectus sheath block method. Two different groups were formed as forty patients with rectus sheath block and forty patients without rectus sheath block. In these two groups of patients visual analogue scale (VAS) values recorded from the postoperative pain follow-up form and analgesic delivery (DEL) and analgesic demand (DEM) values recorded from Patient Controlled Analgesia (PCA) device were compared. In addition, complaints of nausea, vomiting and constipation were evaluated. Results: The VAS values (postoperative 1, 12 and 24 hours p <0.001), the DEM values (postoperative 1, 12 and 24 hours p <0.001) and the total amount of morphine consumed (postoperative 1, 12 and 24 hours p <0.001) were significantly lower in patients with rectus sheath block. Also, in patients with rectus sheath block, nausea was less at postoperative 1 st and 12 th hours (1 hour p = 0.014, 12 hour p = 0.034). Likewise, in patients with rectus sheath block, vomiting was less at 1 st hour postoperatively (p=0.007). In the first 24 hours after surgery, constipation was seen in 8 patients with rectus sheath block and in 30 patients without rectus sheath block. Conclusions: It was concluded that ultrasound guided rectus sheath block is an effective method for postoperative pain control. Key Words: Ultrasonography, rectus sheath block, postoperative analgesia.
Postoperative pain is one of the most important problems affecting mortality and morbidity in the postoperative period. In recent years, ultrasound guided rectus sheath block method is applied as a new and effective technique for pain control after abdominal surgery. In this retrospective study, we aimed to investigate the efficacy of ultrasound guided rectus sheath block method in patients who had undergone lower-upper umblical median incision due to abdominal pathology. Material and Methods: We scanned 235 patients' files who underwent abdominal surgery between July 2014 and March 2016. From these files; patients who was between the ages of 18-75 years and had American Society of Anesthesiologists (ASA) physical status 1-3, who had an operation with an lower-upper umblical median incision performed due to abdominal pathology, who received tramadol for postoperative analgesia and who underwent morphine treatment with i.v patient controlled analgesia device after surgical operation were selected. Of the 93 patients who met the criteria above 13 patients were excluded because of lack of follow-up information. The selected 80 patients were evaluated for the use of an intraoperative rectus sheath block method. Two different groups were formed as forty patients with rectus sheath block and forty patients without rectus sheath block. In these two groups of patients visual analogue scale (VAS) values recorded from the postoperative pain follow-up form and analgesic delivery (DEL) and analgesic demand (DEM) values recorded from Patient Controlled Analgesia (PCA) device were compared. In addition, complaints of nausea, vomiting and constipation were evaluated. Results: The VAS values (postoperative 1, 12 and 24 hours p <0.001), the DEM values (postoperative 1, 12 and 24 hours p <0.001) and the total amount of morphine consumed (postoperative 1, 12 and 24 hours p <0.001) were significantly lower in patients with rectus sheath block. Also, in patients with rectus sheath block, nausea was less at postoperative 1 st and 12 th hours (1 hour p = 0.014, 12 hour p = 0.034). Likewise, in patients with rectus sheath block, vomiting was less at 1 st hour postoperatively (p=0.007). In the first 24 hours after surgery, constipation was seen in 8 patients with rectus sheath block and in 30 patients without rectus sheath block. Conclusions: It was concluded that ultrasound guided rectus sheath block is an effective method for postoperative pain control. Key Words: Ultrasonography, rectus sheath block, postoperative analgesia.
Açıklama
Anahtar Kelimeler
Analjezi, Analgesia, Analjezikler, Analgesics, Ağrı, Pain, Ağrı-postoperatif, Pain-postoperative
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Karaarslan, E. (2017). Rektus kılıf bloğu yönteminin etkinliğinin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyon Anabilim Dalı, Konya.
