Spinal anestezi uygulanan sezaryen operasyonlarında bilateral TAP bloğun analjezik tüketimine etkisi
Öz
Amaç: Çalışmamızda spinal
anestezi altında uygulanan Transvers Abdominis Plain (TAP) bloğun; sezaryen
operasyonlarında postoperatif analjezi ve opioid tüketimine etkisini
retrospektif olarak incelemeyi amaçladık.
Gereç ve Yöntem: 2016
mayıs-ekim ayları arasında hastanemizde elektif şartlarda spinal anestezi
altında sezaryen operasyonu olan hastaların dosyaları retrospektif olarak
incelendi. Hastalar medikal tedavi alanlar ile TAP blok uygulananlar olarak iki
gruba ayrıldı. Demografik veriler, postoperatif 1, 2, 4, 6, 9, 12 ve 24. saatte
bakılan vizüel analog skala (VAS) değerleri, NSAİİ (Nonsteroid Anti inflamatuar
İlaç) ve opioid tüketimleri incelendi. Blok uygulanan ve uygulanmayan
hastalardaki ilk analjezik ve opioid tüketim saatlerine bakıldı.
Bulgular: Kayıtlarına
ulaşılabilen 58 hastadan medikal tedavi yapılan
hastaların (27 hasta) postoperatif 1. ve 4. saat VAS değerleri TAP blok yapılan
hastalara (31 hasta) göre anlamlı derecede yüksek bulundu. Yalnızca
medikal tedavi alan hastalarda (Grup 1) opioid ihtiyacının TAP blok uygulanan
hastalara (Grup 2) göre yüksek olduğu saptandı (p<0,05). Opioid uygulama
süresi ise Grup 1 de ortalama 200,27 dakika, Grup 2 de ise 263,33 dakika olarak
bulunmuştur (p<0,05). Opioid uygulanan hasta oranları Grup 1 de %66,66 Grup
2 de ise %29,03 olarak bulundu.
Tartışma ve Sonuç: Sezaryen
operasyonları gibi alt abdominal cerrahi operasyonları sonrası ağrı kontrolünde
TAP blok uygulanmasının opioid tüketimini azalttığını saptadık.
Anahtar Kelimeler
postoperatif analjezi transvers abdominis plain blok Sezeryan
Kaynakça
- 1-Leung AY. Postoperative pain management in obstetric anesthesia–new challenges and solutions. J Clin Anesth 2004; 16(1): 57-65.
- 2-Tan TT, Teoh WH, Woo DC, et al. A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia. Eur J Anaesthesiol 2012; 29(2): 88-94.
- 3-Lowder JL, Shackelford DP, Holbert D et al. A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage. Am J Obstet Gynecol 2003; 189 (6): 1559-1562.
- 4-Ismail S. Multimodal analgesia for cesarean section: Evolving role of transversus abdominis plane block. J Obstet Anaesth Crit Care 2012; 2 (2): 67.
- 5-Srivastava U, Verma S, Singh TK, et al. Efficacy of trans abdominis plane block for post cesarean delivery analgesia: A double-blind, randomized trial. Saudi J Anaesth. 2015; 9(3): 298-302.
- 6-Aydogmus MT, Sinikoglu SN, Naki MM, et al. Comparison of analgesic efficiency between wound site infiltration and ultra-sound-guided transversus abdominis plane block after cesarean delivery under spinal anaesthesia. Hippokratia 2014; 18 (1): 28-31.
- 7-Wolfson A, Lee AJ, Wong RP, et al. Bilateral multi-injection iliohypogastric-ilioinguinal nerve block in conjunction with neuraxial morphine is superior to neuraxial morphine alone for postcesarean analgesia. J Clin Anesth 2012; 24 (4): 298-303.
- 8- Patel SA, Gotkin J, Huang R, et al. Transversus abdominis plane block for postoperative analgesia after cesarean delivery. The Journal of Maternal-Fetal & Neonatal Medicine 2012; 25(11): 2270-2273.
- 9-Niraj G, Searle A, Mathews M, et al. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth 2009; 103(4): 601-605.
- 10- Carney J, McDonnell JG, Ochana A et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth & Analg 2008; 107 (6): 2056-2060.
The effect of bilateral TAP block administration on analgesic consumption in cesarean operations under spinal anesthesia
Öz
Backround: The purpose of this study
was determine the efficacy of ultrasound guided Transverse Abdominis Plane
(TAP) block in patients after cesarean operation under spinal anesthesia.
Methods: İn this retrospective study, we reviewed the patient files which was elective cesarean operation under spinal anesthesia between 2016 may and october. Fifty-eight patients who were fully informed were included in the study. The patients were divided into two groups as medical treatment subjects (Group 1) and TAP blockers (Group 2).
Demographic data, visual analogue scale (VAS) values, NSAID (Nonsteroidal Anti-inflammatory Drug) and opioid consumption were examined at postoperative 1.2, 4, 6, 9, 12 and 24 hours. The time of first analgesic and opioid consumption in the patients was checked.
Results: Postoperative 1 and 4 hour VAS values were significantly higher in group 1 patients (27 patients) than in group 2 patients (31 patients) who underwent TAP block. In patients receiving only medical treatment (Group 1), the need for opioids was found to be higher than patients receiving TAP block (Group 2), (p <0.05). The mean duration of opioid application was 200,27 minutes in group 1 and 263,33 minutes in group 2 (p<0,05). In Group 1, 66.66% of the patients were treated with opioid and 29.03% in Group 2.
Conclusions: We found that the TAP block decreased the postoperative VAS values and the opioid consumption.after cesarean operation under spinal anesthesia.
Anahtar Kelimeler
Postoperative analgesia transverse abdominal plain block cesarean
Kaynakça
- 1-Leung AY. Postoperative pain management in obstetric anesthesia–new challenges and solutions. J Clin Anesth 2004; 16(1): 57-65.
- 2-Tan TT, Teoh WH, Woo DC, et al. A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia. Eur J Anaesthesiol 2012; 29(2): 88-94.
- 3-Lowder JL, Shackelford DP, Holbert D et al. A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage. Am J Obstet Gynecol 2003; 189 (6): 1559-1562.
- 4-Ismail S. Multimodal analgesia for cesarean section: Evolving role of transversus abdominis plane block. J Obstet Anaesth Crit Care 2012; 2 (2): 67.
- 5-Srivastava U, Verma S, Singh TK, et al. Efficacy of trans abdominis plane block for post cesarean delivery analgesia: A double-blind, randomized trial. Saudi J Anaesth. 2015; 9(3): 298-302.
- 6-Aydogmus MT, Sinikoglu SN, Naki MM, et al. Comparison of analgesic efficiency between wound site infiltration and ultra-sound-guided transversus abdominis plane block after cesarean delivery under spinal anaesthesia. Hippokratia 2014; 18 (1): 28-31.
- 7-Wolfson A, Lee AJ, Wong RP, et al. Bilateral multi-injection iliohypogastric-ilioinguinal nerve block in conjunction with neuraxial morphine is superior to neuraxial morphine alone for postcesarean analgesia. J Clin Anesth 2012; 24 (4): 298-303.
- 8- Patel SA, Gotkin J, Huang R, et al. Transversus abdominis plane block for postoperative analgesia after cesarean delivery. The Journal of Maternal-Fetal & Neonatal Medicine 2012; 25(11): 2270-2273.
- 9-Niraj G, Searle A, Mathews M, et al. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth 2009; 103(4): 601-605.
- 10- Carney J, McDonnell JG, Ochana A et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth & Analg 2008; 107 (6): 2056-2060.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 10 Sayı: 2 |
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