Serratus anterior düzlem bloğu (sapb) ve rhomboid interkostal düzlem bloğunun (ripb) meme kanseri cerrahisi uygulanan hastalarda analjezi üzerine etkilerinin karşılaştırılması
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
T.C. Maltepe Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Meme kanseri kadınlarda rastlanan kanser çeşitleri arasında ilk sırada yer almaktadır. Buna paralel olarak meme kanseri cerrahileri de sık uygulanan girişimlerdir. Bu operasyonlarda postoperatif analjezi amaçlı uygulanabilirliği kolay ve güvenli olan interfasyal plan blokları giderek yaygınlaşmaktadır. Çalışmamızda meme kanseri cerrahisi uygulanan hastalarda serratus anterior düzlem bloğu ile rhomboid interkostal düzlem bloğunun postoperatif analjezi üzerine etkilerini karşılaştırmayı hedefledik. Materyal ve metod: Çalışma, etik kurul onayı sonrası hastalardan yazılı onam alınarak, meme kanseri cerrahisi uygulanacak, 18-70 yaş arasında, ASA (American Society of Anesthesiologists) skoru I-III olarak değerlendirilen 40 hastada gerçekleştirildi. Çalışma çift kör, prospektif, randomize ve olarak planlandı. Tüm hastaların anestezi indüksiyonu aynı şekilde sağlandı ve entübe edildi. Hastalar SAPB (Grup S) ve RİPB (Grup R) olarak ikiye ayrıldı. İki gruba da postoperatif ekstübasyon öncesi 20ml %0.25 bupivakain 10ml %0,5 lidokain ve 10ml salinden oluşan lokal anestezik karışım solüsyonu enjekte edildi. Postoperatif dönemde intravenöz morfin kullanılarak hasta kontrollü analjezi (HKA) kullanıldı. Postoperatif 20., 40., 60.dakika, 3.saat, 6.saat, 12.saat, 18.saat ve 24.saat NRS (numerik ağrı skoru) skorları ve opioid tüketimleri kaydedildi. İlk analjezi gereksinimine kadar geçen süre analjezi zamanı olarak tanımlandı ve kaydedildi. Eş zamanlı olarak komplikasyonlar da (bulantı/kusma, pnömotoraks, hematom, kaşıntı) kaydedildi. Bulgular: Ultrasonografi eşliğinde yapılan serratus anterior düzlem bloğu ve rhomboid interkostal düzlem bloğu karşılaştırıldığında postoperatif tüm zamanlarda NRS skorları istatistiksel açıdan benzer idi(p>0.05). 24 saatte toplam morfin tüketim ortalaması Grup S de 3,05mg Grup R de 1,75mg olup opioid tüketimlerinin ortanca değerleri istatistiki yönden farklı bulunmadı(p>0.05). Hastalar analjezi süresi, komplikasyonlar ve kurtarıcı analjezik ihtiyacı yönünden incelendiğinde iki grupta fark tespit edilmedi(p>0.05). Sonuç: Çalışmamız sonucunda meme kanseri cerrahisinde serratus anterior plan bloğu ile rhomboid interkostal plan bloğunun opioid tüketimlerinin benzer olduğunu saptadık. Meme kanseri cerrahisinde postoperatif analjeziyi sağlamak amacıyla her iki düzlem bloğu da multimodal analjezinin bir elemanı olarak tercih edilebilir.
Objective: Breast cancer ranks first among the cancer types encountered in women. In parallel with this, breast cancer surgeries are also frequently performed interventions. In these operations, interfascial plane blocks, which are easy to apply and safe for postoperative analgesia, are becoming increasingly common. In our study, we purposed to compare the effects of serratus anterior plane block and rhomboid intercostal plane block on postoperative analgesia in patients who was applied breast cancer surgery. Materials and Methods: The study was performed in 40 patients aged between 18-70 years with ASA (American Society of Anesthesiologists) scores between I and III, who would undergo breast cancer surgery after obtaining written consent from the patients after ethics committee confirmation. The study was designed as double-blind, prospective, randomized. Anesthesia was induced in the same way for all patients and they were intubated. Patients were divided into SAPB (Group S) and RIPB (Group R). A local anesthetic mixture solution consisting of 20ml 0.25% bupivacaine, 10ml 0.5% lidocaine and 10ml saline was injected into both groups before postoperative extubation. Patient-controlled analgesia (PCA) was used in the postoperative period using intravenous morphine. Postoperative 20th minute, 40th minute, 1st hour, 3rd hour, 6th hour, 12th hour, 18th hour and 24th hour NRS (numerical pain score) scores and opioid consumption were recorded. The time to the first analgesia necessity was described as the time to analgesia and recorded. Simultaneously, complications (nausea/vomiting, pneumothorax, hematoma, pruritus) were also recorded. Results: When the serratus anterior plane block and rhomboid intercostal plane block performed with ultrasonography were compared, the NRS scores were statistically similar at all times postoperatively (p>0.05). The mean total morphine consumption in 24 hours was 3.05mg in Group S and 1.75mg in Group R, and the median values of opioid consumption were not statistically dissimilar (p>0.05). When the patients were analyzed in terms of duration of analgesia, complications and need for rescue analgesics, no difference was found between the two groups (p>0.05). Conclusion: Consequently, we detect that the opioid consumption of serratus anterior plane block and rhomboid intercostal plane block in breast cancer surgery was similar. In order to provide postoperative analgesia in breast cancer surgery, both plane blocks can be preferred as a component of multimodal analgesia.
Objective: Breast cancer ranks first among the cancer types encountered in women. In parallel with this, breast cancer surgeries are also frequently performed interventions. In these operations, interfascial plane blocks, which are easy to apply and safe for postoperative analgesia, are becoming increasingly common. In our study, we purposed to compare the effects of serratus anterior plane block and rhomboid intercostal plane block on postoperative analgesia in patients who was applied breast cancer surgery. Materials and Methods: The study was performed in 40 patients aged between 18-70 years with ASA (American Society of Anesthesiologists) scores between I and III, who would undergo breast cancer surgery after obtaining written consent from the patients after ethics committee confirmation. The study was designed as double-blind, prospective, randomized. Anesthesia was induced in the same way for all patients and they were intubated. Patients were divided into SAPB (Group S) and RIPB (Group R). A local anesthetic mixture solution consisting of 20ml 0.25% bupivacaine, 10ml 0.5% lidocaine and 10ml saline was injected into both groups before postoperative extubation. Patient-controlled analgesia (PCA) was used in the postoperative period using intravenous morphine. Postoperative 20th minute, 40th minute, 1st hour, 3rd hour, 6th hour, 12th hour, 18th hour and 24th hour NRS (numerical pain score) scores and opioid consumption were recorded. The time to the first analgesia necessity was described as the time to analgesia and recorded. Simultaneously, complications (nausea/vomiting, pneumothorax, hematoma, pruritus) were also recorded. Results: When the serratus anterior plane block and rhomboid intercostal plane block performed with ultrasonography were compared, the NRS scores were statistically similar at all times postoperatively (p>0.05). The mean total morphine consumption in 24 hours was 3.05mg in Group S and 1.75mg in Group R, and the median values of opioid consumption were not statistically dissimilar (p>0.05). When the patients were analyzed in terms of duration of analgesia, complications and need for rescue analgesics, no difference was found between the two groups (p>0.05). Conclusion: Consequently, we detect that the opioid consumption of serratus anterior plane block and rhomboid intercostal plane block in breast cancer surgery was similar. In order to provide postoperative analgesia in breast cancer surgery, both plane blocks can be preferred as a component of multimodal analgesia.
Açıklama
Anahtar Kelimeler
meme kanseri, postoperatif analjezi, interfasyal plan blokları
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kilit, D. (2023). Serratus anterior düzlem bloğu (sapb) ve rhomboid interkostal düzlem bloğunun (ripb) meme kanseri cerrahisi uygulanan hastalarda analjezi üzerine etkilerinin karşılaştırılması / Comparison of the effects of serratus anterior plane block (sapb) and rhomboid intercostal plane block (ripb) on analgesia in patients who was applied breast cancer surgery. (Yayımlanmamış Tıpta Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.
