Total abdominal histerektomi yapılan hastalarda farklı volümlerde uygulanan erektör spina düzlem bloğunun postoperatif opioid tüketimi ve analjezi üzerine etkinliğinin karşılaştırılması: randomize, prospektif, çift kör çalışma
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Tarih
2022
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç; Bu araştırma total abdominal histerektomi geçiren hastalarda etkinliği kanıtlanmış olan erektör spina düzlem bloğunun farklı volümlerde uygulanmasının postoperatif opioid tüketimi ve ağrı üzerine etkisi araştırıldı. Çalışmanın birincil amacı postoperatif ilk 24 saatte toplam morfin tüketimi olacaktır. İkincil amacı; 5 farklı zaman noktasında (postoperatif 30.dakika, 2.saat, 6.saat, 12.saat ve 24.saat) istirahat ve dinamik NRS skorları, intraoperatif remifentanil tüketimi ve postoperatif ilk 24 saatte toplam kurtarma analjezik gereksinimi olacaktır.
Yöntem; Çalışmaya 18-65 yaş arası Amerikan Anestezistler Derneği (ASA) fiziksel statüsü I-III olan, elektif total abdominal histerektomi cerrahisi geçirecek olan hastalar dahil edildi. Hastalar iki gruba randomize edildi. Preoperatif bilateral erektör spina düzlem bloğu %0,25 lik 20 ml bupivakain ile yapılan hastalar Grup I’i; %0,25 lik 30 ml bupivakain ile yapılan hastalar Grup II’yi oluşturdu. Hastaların postoperatif 30.dakika, 2.saat, 6.saat, 12.saat ve 24.saatteki NRS değerleri ve 30.dk, 2.saat, 6.saat, 12.saat, 24.saat morfin tüketimleri kaydedildi. NRS 4 ve üstü değerde ise yetersiz analjezi olarak kabul edildi ve kurtarıcı analjezik uygulandı.
Bulgular; Değerlendirilen gruplarda Grup II’deki hastalarda Grup I hastalara göre postoperatif NRS skorları daha düşük ve istatiksel olarak anlamdı fark bulundu(p<0,05). Postoperatif değerlendirilen zamanlarda morfin tüketimi Grup II de Grup I den daha az ve istatiksel olarak anlamlı fark bulundu(p<0,05). Tutulan dermatom sayıları Grup II de daha fazla iken istatistiksel olarak anlamlı idi(p<0,05). Postoperatif bulantı kusma ve kurtarıcı analjezik ihtiyacı açısından da anlamlı fark tespit edilmedi (p>0,05).
Sonuç; Total abdominal histerektomi cerrahisi geçiren hastalarda aynı konsantrasyonda farklı volümlerde uygulanan erektör spina düzlem bloğu opioid tüketimi ve postoperatif analjezi üzerinde fark oluşturmuştur. Optimal doz konsantrasyon ve hacim değerlerin bulunabilmesi için daha geniş kapsamlı, prospektif, randomize ve kontrollü çalışmalara ihtiyaç vardır.
Objective; In this study, the effect of the application of erector spina plane block in different volumes on postoperative opioid consumption and pain in patients undergoing total abdominal hysterectomy was investigated. The primary objective of the study will be total morphine consumption in the first 24 hours postoperatively. Secondary purpose; There will be resting and dynamic NRS scores, intraoperative remifentanil consumption, and total rescue analgesic requirement in the first 24 hours postoperatively at 5 different time points (postoperative 30th minute, 2nd hour, 6th hour, 12th hour, and 24th hour). Method; Patients aged 18-65 years, with the American Society of Anesthesiologists (ASA) physical status I-III and undergoing elective total abdominal hysterectomy surgery were included in the study. Patients were randomized into two groups. Group I of patients who underwent preoperative bilateral erector spina plane block with 20 ml of %0.25 bupivacaine; Patients with %0,25 30 ml bupivacaine formed Group II. NRS values of the patients at the postoperative 30th minute, 2nd hour, 6th hour, 12th hour and 24th hour, and morphine consumption at 30 minutes, 2 hours, 6 hours, 12 hours, and 24 hours were recorded. An NRS of 4 and above was considered insufficient analgesia and rescue analgesic was administered. Results; In the evaluated groups, postoperative NRS scores were lower and statistically significant difference was found in Group II patients compared to Group I patients (p<0.05). Morphine consumption was found to be less in Group II than Group I at the times evaluated postoperatively, and there was a statistically significant difference (p<0.05). While the number of dermatomes involved was higher in Group II, it was statistically significant (p<0.05). There was no significant difference in terms of postoperative nausea, vomiting and need for rescue analgesics (p>0.05). Conclusion; In patients undergoing total abdominal hysterectomy surgery, erector spina plane block applied in different volumes at the same concentration made a difference on opiod consumption and postoperative analgesia. More comprehensive, prospective, randomized and controlled studies are needed to find optimal dose concentration and volume values.
Objective; In this study, the effect of the application of erector spina plane block in different volumes on postoperative opioid consumption and pain in patients undergoing total abdominal hysterectomy was investigated. The primary objective of the study will be total morphine consumption in the first 24 hours postoperatively. Secondary purpose; There will be resting and dynamic NRS scores, intraoperative remifentanil consumption, and total rescue analgesic requirement in the first 24 hours postoperatively at 5 different time points (postoperative 30th minute, 2nd hour, 6th hour, 12th hour, and 24th hour). Method; Patients aged 18-65 years, with the American Society of Anesthesiologists (ASA) physical status I-III and undergoing elective total abdominal hysterectomy surgery were included in the study. Patients were randomized into two groups. Group I of patients who underwent preoperative bilateral erector spina plane block with 20 ml of %0.25 bupivacaine; Patients with %0,25 30 ml bupivacaine formed Group II. NRS values of the patients at the postoperative 30th minute, 2nd hour, 6th hour, 12th hour and 24th hour, and morphine consumption at 30 minutes, 2 hours, 6 hours, 12 hours, and 24 hours were recorded. An NRS of 4 and above was considered insufficient analgesia and rescue analgesic was administered. Results; In the evaluated groups, postoperative NRS scores were lower and statistically significant difference was found in Group II patients compared to Group I patients (p<0.05). Morphine consumption was found to be less in Group II than Group I at the times evaluated postoperatively, and there was a statistically significant difference (p<0.05). While the number of dermatomes involved was higher in Group II, it was statistically significant (p<0.05). There was no significant difference in terms of postoperative nausea, vomiting and need for rescue analgesics (p>0.05). Conclusion; In patients undergoing total abdominal hysterectomy surgery, erector spina plane block applied in different volumes at the same concentration made a difference on opiod consumption and postoperative analgesia. More comprehensive, prospective, randomized and controlled studies are needed to find optimal dose concentration and volume values.
Açıklama
Anahtar Kelimeler
Total abdominal histerektomi, Erektör Spina Düzlem Bloğu, Volüme, Postoperatif Analjezi, Total abdominal hysterectomy, Erector Spina Plane Block, Volume, Postoperative Analgesia
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Künye
Çekdemir. H. (2022). Total abdominal histerektomi yapılan hastalarda farklı volümlerde uygulanan erektör spina düzlem bloğunun postoperatif opioid tüketimi ve analjezi üzerine etkinliğinin karşılaştırılması: randomize, prospektif, çift kör çalışma. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyon Anabilim Dalı, Konya.
