Artroskopik Diz Cerrahisinde Kombine Siyatik Femoral Blok Uygulanan Hastalarda Bupivakain ile Alkalinize Bupivakainin Etki Başlangıç Sürelerinin Karşılaştırılması

  • Levent Ozturk Yıldırım Beyazit Tıp Anesteziyoloji
  • Aslı Yılmaz Vural
  • Tulin Gümüş
  • Orhan Kanbak

Abstract

Giriş: Artroskopik diz cerrahisinde kombine siyatik femoral blok uygulanan hastalarda bupivakain ile alkalinize bupivakaini,  motor blok ve duysal blok etki başlangıç süreleri açısından karşılaştırmayı amaçladık. Materyal Metod: ASA I/II grubundan 20-60 yaşları arasında 40 hasta çalışmaya alınıp, hastalar rastgele yöntemle siyatik sinir bloğunun 20 ml %5’lik bupivakain+0,1 ml %0,9’lık NaCl, femoral sinir bloğunun 20 ml %0,5’lik bupivakain+0,1 ml %0,9’luk NaCl ile yapılacağı grup (Grup 1) ve siyatik sinir bloğunun 20 ml %0,5’lik bupivakain+0,1 ml % 8,4’lük sodyum bikarbonat, femoral sinir bloğunun 20 ml %0.5’lik bupivakain+0,1 ml % 8,4’lük sodyum bikarbonat ile yapılacağı grup (Grup 2) olarak  iki eşit gruba ayrıldı. Bulgular: Siyatik sinir için duysal blok değerlendirmesinde uyluğun arka kısmında S1-2 dermatom sahasına uygun alan ve femoral sinir duysal blok değerlendirmesinde uyluğun ön yüzünde L2-4 dermatom sahasına uygun alan pinprick testi ile değerlendirildi. Motor blok bromage skalası ile değerlendirildi. Başlangıç, 1., 3., 5., 10., 15., 20., 30. dakikalardaki veriler kaydedildi. Sonuç: Artroskopik diz cerrahisinde kombine siyatik femoral blok uygulanan hastalarda bupivakain ile alkalinize bupivakaini, motor blok ve duysal blok etki başlangıç süreleri açısından karşılaştırdık ve fark olmadığını belirledik.

References

Goranson BD, Lang S, Cassidy JD, Dust WN, McKerrell J. A comparison of three regional anaesthesia techniques for outpatient knee arthroscopy. Can J Anaesth 1997; 44: 371-376.

Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 1997; 87: 479-486.

Fanelli G, Casati A, Aldegheri G, Beccaria P, Berti M, Leoni A et all. Cardiovascular effects of two different regional anaesthetic techniques for unilateral leg surgery. Acta Anaesthesiol Scand 1998; 42: 80-84.

Wedel DJ. Nerve Blocks. In: Miller RD (ed) Anesthesia, 5th edition, New York, Chuchhill-Livingstone, 2000: 1520-1548

McMorland GH, Douglas MJ, Jeffery WK, Ross PL, Axelson JE, Kim JH. Effect of pH-adjustment of bupivacaine on onset and duration of epidural anagesia in parturients. Can Anaesth Soc J 1986; 33: 537-541.

Fulling PD, Peterfreund RA. Alkalinization and precipitation characteristics of 0.2% ropivacaine. Regional Anesthesia and Pain Medicine 2000: 25; 518-521.

Berde CB, Strichartz GR. Local Anesthetics. In: Miller RD (ed) Anesthesia, 5 th edition, New York, Chuchhill-Livingstone, 2000: 491-521.

Milner QJW, Guard BC, Allen JG. Alkalinization of amide local anaesthetics by addition of 1% sodium bicarbonate solution. European Academy of Anaesthesiology 2000; 17: 38-42

Bedder MD, Kozody R, Craig DB. Comparison of bupivacaine and alkalinized bopivacaine in brachial plexus anesthesia. Anesth Analg 1988; 67: 48-52

Difazio CA, Carron H, Grosslight KR, Moscicki JC, Bolding WR, Johns RA. Comparison of pH-adjusted lidocaine solutions for epidural anesthesia. Anesth Analg 1986; 65: 760-764

Ritchie JM, Ritchie B, Greengard P. The effect of the nevre sheath on the action of local anesthetics. J Pharmacol Exp Ther 1965; 150: 160-164

Peterfreund R, Datta S, Ostheimer G. pH adjustment of local anesthetic solutions with sodium bicarbonate: Labaratory evaluation of alkalinization and precipitation. Reg Anesth1989; 14: 265-270

Gaggero G, Meyer O, Van Gessel E, Rifat K. Alkalinization of lidocaine 2% does not influence the quality of epidural anaesthesia for elective caesarian section. Can J Anaesth 1995; 42: 1080-1084

Benhamou D, Perrachon N, Labaille T, Bonhomme L. Alkalinization of epidural 0.5% bupivacaine for cesarean section. Reg Anesth 1989; 14: 240-243

Bonhomme L, Benhamou D, Jebri M, Bourget P, Martre H, Postaire E et all. Chemical stability of bupivacaine in pH-adjusted solutions. Anesthesiology 1988; 69: 754-756

Appleyard TN, Witt A, Atkinson RE, Nicholas AD. Bupivacaine carbonate and bupivacaine hydrochloride: A comparison of blood concentrations during epidural blockade for vaginal surgery. Br J Anaesth 1974; 46: 530-533

Kayaalp SO. Tıbbi Farmakoloji. Ankara, Hacettepe-Taş, 2005; 680-693

Montes FR, Zarate E, Grueso R, Giraldo JC, Venegas MP. Comparison of spinal anesthesia with combined sciatic-femoral nevre block for outpatient knee arthroscopy. Journal of Clinical Anesthesia 2008; 20: 415-420

Casati A, Cappelleri G, Fanelli G, Borghi B, Anelati D, Berti M et all. Regional anaesthesia for outpatient knee arthroscopy: a randomized clinical comparison of two different anaesthetic techniques. Acta Anaesthesiol Scand 2000; 44: 543-547

Casati A, Fanelli G, Beccaria P, Cappelleri G, Berti M, Aldegheri G et all. The effects of the single or multiple injection technique on the onset time of femoral nerve blocks with 0.75% ropivacaine. Anesth Analg 2000; 9:181-184

Yazigi A, Madi-Gebara S, Haddad F, Hayeck G, Tabet G. İntraoperative myocardial ischemia in peripheral vasculer surgery: general anesthesia vs combined sciatic and femoral nevre blocks. Journal of Clinical Anesthesia 2005; 17: 499–503

Benzon HT, Toleikis JR, Dixit P, Goodman I, Hill JA: Onset, intensity of blockade and somatosensory evoked potential changes of lumbosacral dermatomes after epidural anaesthesia with alkalinized lidocaine. Anesth Analg 1993; 76: 328-332.

Siler JN, Rosenberg H: Lidocaine hydrochloride versus lidocaine bicarbonatte for epidural anaesthesia in out patients undergoing arthroscopic surgery. J Clin Anaesth 1990; 2: 296-300.

Capogna G, Cellono D, Varrassi G, Emanuelli M, Sebastiani M, Muratori F. Epidural mepivacaine for cesarean section: effects of a pH-adjusted solution. J. Clin Anesth 1991; 3: 211-214.

Verborgh C, Claeys MA, Camu F. Onset of epidural blockade after plain or alkalinized 0.5% bupivacaine. Anesth Analg 1991; 73: 401-404.

Stevens RA, Chester WL, Grueter JA, Schubert A, Brandon D, Clayton B. The effect of pH adjustment of 0.5 % bupivacaine on the latency of epidural anesthesia. Reg Anesth 1989; 14: 236-239.

Vicente EJD, Viotto MJS, Barbosa CAA, Vicente DC. Study on anatomical relationships and variations between the sciatic nerve and piriformis muscle. Revista Brasileira de Fisioterapia, Print version ISSN 1413-3555, 2007; 11: 3

Gruber H, Peer S, Kovacs P, Marth R, Bodner G. The Ultrasonographic Appearance of the Femoral Nerve and Cases of Iatrogenic Impairment. J Ultrasound Med 2003; 22:163-172

Capogna G, Celleno D, Laudano D, Giunta F: Alkalinization of local anesthetics. Which block, which local anesthetic? Reg Anesth 1995; 20:369-377.

Quinlan JJ, Oleksey K, Murphy FL. Alkalinization of mepivacaine for axillary block. Anesth Analg 1992; 74: 371-374.

Tetzlaff JE, Yoon HJ, O’Hara JF, Reaney J, Stein D, Grimes-Rice M. Alkalinization of mepivacaine accelerates onset of interscalene block shoulder surgery. Anesth Analg 1990; 15: 242-244.

Published
2020-09-12
Section
Original Research