Ayak cerrahisinde kullanılan periferal sinir blok uygulamasında iki metodun karşılaştırılması: USG yardımlı ve anatomic landmark yardımlı.
Abstract
Amaç: Ayak bileği periferik sinir bloğu iki yöntemle uygulanır. Bunlar; USG yardımlı periferik blok ve USG kullanımına ihityaç duymayan anatomik landmark’lar kullanılarak yapılan periferik bloktur. Biz de çalışmamızda ayak ameliyatlarında uygulanan bu iki yöntemi retrospektif olarak karşılaştırmayı amaçladık.
Yöntem : 2017 yılından itibaren ayak bileği periferik blok ile ameliyat edilen hastaların bilgilerine ulaşıldı. USG yardımıyla yapılan periferik blok hastaları (grup 1) 20 kişi, USG kullanılmadan, anatomik landmarklara göre yapılan periferik blok hastaları (grup 2) 20 kişiydi. Her iki grupta 40 cc’lik karışım kullanıldı (bupivakain+lidocain). Hastaların kayıt altına alınan bilgileri şunlardı: demografik bulgular, blok uygulanma süresi (BUS), operasyona hazır olma süresi (OHOS), operasyon süresi (OS), blok anestezi süresi (BAS) ve intraoperatif-postoperatif VAS skoru. Ameliyat sonrası hastalara uygulanan vizüel analog skalası (VAS) sonuçlarına ulaşıldı. Hastalara telefonla ulaşılıp anesteziden memnun olup olmadıkları soruldu.
Bulgular : Grup 1’deki hastaların BUS ve BAS değerleri yüksekti. Grup 2’deki hastaların OHOS ve VAS 6 değerleri yüksekti. Diğer parametrelerde gruplar arasında anlamlı bir farklılığa rastlanılmadı. İntraoperatif dönemde grup 1’de ek doz anestezik maddeye ihtiyaç olmamıştır. Grup 2’de ise 3 hastada intraoperatif hafif ağrı hissetmeleri üzerine lokal ek doz uygulanmıştır.
Sonuç : USG kullanılarak uygulanan periferik blok hazırlığı uzun sürmektedir. Anestezistlerin tecrübesi arttıkça bu sürenin kısalacağı kanaatindeyiz. Ancak cerrahi sırasında daha konforludur. Ameliyat süresinin herhangi bir sebepten uzama ihtimali ve postoperatif erken dönem ağrı kontrolü göz önüne alınınca USG eşliğinde yapılan periferik blok daha avantajlıdır.
References
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- 2. Williams BA, Spratt D, Kentor ML. Continuous nerve blocks for outpatient knee surgery. Techniques in Regional Anesthesia and Pain Management. 2004;8(2):76-84 doi:10.1053/j.trap.2004.06.001 .
- 3. Chelly JE, Ben-David B, Williams BA, Kentor ML. Anesthesia and postoperative analgesia: outcomes following orthopedic surgery. Orthopedics. 2003;26(8 Suppl):s865-71. doi: 10.3928/0147-7447-20030802-08.
- 4. Chan T, Wilkinson A, Hendrick S. A Technique Guide in Ultrasound Guided Regional Ankle Blocks. J Foot Ankle Surg. 2021;60(4):817-823. doi: 10.1053/j.jfas.2021.03.008.
- 5. Mineo R, Sharrock NE. Venous levels of lidocaine and bupivacaine after midtarsal ankle block. Reg Anesth. 1992;17(1):47-9. PMID: 1599895
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- 7. Sertçakacılar G, Pektaş Y, Çetingök H, Sabaz MS, Bostancı İ, Çukurova Z, et al. Retrospective Investigation of the Efficacy of Blocks for Analgesia in Lower Extremity Surgery. Medical Journal of Bakirköy. 2019;15(4):376-82. doi: 10.4274/BTDMJB.galenos.2018.20181207100323.
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- 11. Chin KJ, Wong NWY, Macfarlane AJR, Chan VWS. Ultrasound-Guided Versus Anatomic Landmark-Guided Ankle Blocks: A 6-Year Retrospective Review. Reg Anesth Pain Med. 2011;36(6):611-18. doi: 10.1097/AAP.0b013e31822b1291.
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- 14. Ilfeld BM, Eisenach JC, Gabriel RA. Clinical Effectiveness of Liposomal Bupivacaine Administered by Infiltration or Peripheral Nerve Block to Treat Postoperative Pain. Anesthesiology. 2021;134(2):283-344. doi: 10.1097/ALN.0000000000003630.
- 15. Bertini L, Borghi B, Grossi P, Casati A, Fanelli G. Continuous peripheral block in foot surgery. Minerva Anestesiol. 2001;67(9 Suppl 1):103-8. PMID: 11778103.
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- 19. Rudkin GE, Rudkin AK, Dracopoulos GC. Bilateral ankle blocks: a prospective audit. ANZ J Surg. 2005;75(1-2):39-42. doi: 10.1111/j.1445-2197.2005.03286.x
- 20. Lauf JA, Huggins P, Long J, Al-Issa M, Byrne B, Large BP, et al. Regional Nerve Block Complication Analysis Following Peripheral Nerve Block During Foot and Ankle Surgical Procedures. Cureus. 2020;12(7):e9434. doi: 10.7759/cureus.9434.
- 21. Kopka A, Serpell M. Distal nerve blocks of the lower limb. Continuing Education in Anaesthesia Critical Care & Pain. 2005;5(5):166-70. doi: 10.1093/bjaceaccp/mki044.
- 22. Catalani B, Jones J. Peripheral Nerve Block Complications in Children. Orthop Clin North Am. 2022;53(2):179-86. doi: 10.1016/j.ocl.2021.11.004
- 23. Ori A, Jindal A, Nwazota N, Pearson ACS, Yalamuru B. Peripheral Nerve Injections. Phys Med Rehabil Clin N Am. 2022;33(2):489-517. doi: 10.1016/j.pmr.2022.02.004.
Comparison of two methods in the peripheral nerve block application used in foot surgery: USG-guided and anatomical landmark-guided.
Abstract
Aim: Ankle peripheral nerve block is applied by two methods. These are peripheral block that is performed using USG-assisted and anatomical landmarks that do not require the use of Ultrasonography (USG). In our study, we aimed to compare these two methods applied in foot surgeries retrospectively.
Methods :Peripheral block patients performed with the USG-guided (group 1) were 20, anatomical landmarks- guided (group 2) were 20. In both groups, 40 cc of anesthetic mixture was used (bupivacaine + lidocaine). The recorded information of the patients were as follows: Block application time (BAT), surgery readiness time (SRT), duration of surgery (DoS), duration of block anesthesia (DBA) and intraoperative-postoperative Visual Analogue Scale (VAS). The results of the VAS applied to the patients postoperatively were obtained. Patients were contacted by phone and asked if they were satisfied with the anesthesia.
Results : The BAT and DBA values of the patients in Group 1 were high. SRT and VAS 6 values of the patients in group 2 were high. No significant difference was found between the groups in other parameters. No additional dose of anesthetic was needed in group 1 during the intraoperative period. In group 2, local additional dose was administered to 3 patients.
Conclusion: Peripheral block preparation USG-guided takes a long time. However, it is more comfortable during surgery. The USG-guided peripheral nerve block is more advantageous when considering the possibility of prolonging the duration of surgery for any reason and early postoperative pain control after surgery.
References
- 1. Latifzai K, Sites BD, Koval KJ. Orthopaedic anesthesia - part 2. Common techniques of regional anesthesia in orthopaedics. Bull NYU Hosp Jt Dis. 2008;66(4):306-16. PMID: 19093908.
- 2. Williams BA, Spratt D, Kentor ML. Continuous nerve blocks for outpatient knee surgery. Techniques in Regional Anesthesia and Pain Management. 2004;8(2):76-84 doi:10.1053/j.trap.2004.06.001 .
- 3. Chelly JE, Ben-David B, Williams BA, Kentor ML. Anesthesia and postoperative analgesia: outcomes following orthopedic surgery. Orthopedics. 2003;26(8 Suppl):s865-71. doi: 10.3928/0147-7447-20030802-08.
- 4. Chan T, Wilkinson A, Hendrick S. A Technique Guide in Ultrasound Guided Regional Ankle Blocks. J Foot Ankle Surg. 2021;60(4):817-823. doi: 10.1053/j.jfas.2021.03.008.
- 5. Mineo R, Sharrock NE. Venous levels of lidocaine and bupivacaine after midtarsal ankle block. Reg Anesth. 1992;17(1):47-9. PMID: 1599895
- 6. 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(3):479-86. doi: 10.1097/00000542-199709000-00005.
- 7. Sertçakacılar G, Pektaş Y, Çetingök H, Sabaz MS, Bostancı İ, Çukurova Z, et al. Retrospective Investigation of the Efficacy of Blocks for Analgesia in Lower Extremity Surgery. Medical Journal of Bakirköy. 2019;15(4):376-82. doi: 10.4274/BTDMJB.galenos.2018.20181207100323.
- 8. Yang LL, Ji JS, Zhao ZW, Wang W, Luo S, Mo YC, et al. Effect comparison of ultrasound-guided lower extremity nerve block and spinal anesthesia in ankle surgery. Zhonghua Yi Xue Za Zhi. 2016;96(41):3337-3341. doi:10.3760/cma.j.issn.0376-2491.2016.41.013.
- 9. Redborg KE, Antonakakis JG, Beach ML, Chinn CD, Sites BD. Ultrasound improves the success rate of a tibial nerve block at the ankle. Reg Anesth Pain Med. 2009;34(3):256-60. doi: 10.1097/AAP.0b013e3181a343a2.
- 10. Antonakakis JG, Scalzo DC, Jorgenson AS, Figg KK, Ting P, Zuo Z, et al. Ultrasound does not improve the success rate of a deep peroneal nerve block at the ankle. Reg Anesth Pain Med. 2010;35(2):217-21. doi: 10.1097/aap.0b013e3181c75db1.
- 11. Chin KJ, Wong NWY, Macfarlane AJR, Chan VWS. Ultrasound-Guided Versus Anatomic Landmark-Guided Ankle Blocks: A 6-Year Retrospective Review. Reg Anesth Pain Med. 2011;36(6):611-18. doi: 10.1097/AAP.0b013e31822b1291.
- 12. Wiederhold BD, Garmon EH, Peterson E, Stevens JB, O'Rourke MC. Nerve Block Anesthesia. 2023 Jan 29. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 28613761.
- 13. Liszka H, Gądek A, Wordliczek J. The impact of the type of anesthesia on postoperative pain after surgical correction of hallux valgus deformity. Przegl Lek. 2016;73(1):11-4. PMID: 27120942.
- 14. Ilfeld BM, Eisenach JC, Gabriel RA. Clinical Effectiveness of Liposomal Bupivacaine Administered by Infiltration or Peripheral Nerve Block to Treat Postoperative Pain. Anesthesiology. 2021;134(2):283-344. doi: 10.1097/ALN.0000000000003630.
- 15. Bertini L, Borghi B, Grossi P, Casati A, Fanelli G. Continuous peripheral block in foot surgery. Minerva Anestesiol. 2001;67(9 Suppl 1):103-8. PMID: 11778103.
- 16. Gurkan Y, Kus A, Aksu C, Ohtaroglu C, Solak M, Toker K. Changing trends and regional anesthesia practices in Turkey. Agri. 2014;26(3):131-7. doi:10.5505/agri.2014.26056.
- 17. Urfalıoğlu A, Gokdemir O, Hanbeyoglu O, Bilal B, Öksüz G, Korkmaz Toker M, vd. A comparison of ankle block and spinal anesthesia for foot surgery. Int J Clin Exp Med. 2015;8(10):19388-93. PMID: 26770580.
- 18. Lawson IR, Ingman SR, Masih Y, Freeman B. Reliability of Palpation of Pedal Pulses As Ascertained by the Kappa Statistic. J Am Geriatr Soc. 1980;28(7):300-3. doi: 10.1111/j.1532-5415.1980.tb00619.x.
- 19. Rudkin GE, Rudkin AK, Dracopoulos GC. Bilateral ankle blocks: a prospective audit. ANZ J Surg. 2005;75(1-2):39-42. doi: 10.1111/j.1445-2197.2005.03286.x
- 20. Lauf JA, Huggins P, Long J, Al-Issa M, Byrne B, Large BP, et al. Regional Nerve Block Complication Analysis Following Peripheral Nerve Block During Foot and Ankle Surgical Procedures. Cureus. 2020;12(7):e9434. doi: 10.7759/cureus.9434.
- 21. Kopka A, Serpell M. Distal nerve blocks of the lower limb. Continuing Education in Anaesthesia Critical Care & Pain. 2005;5(5):166-70. doi: 10.1093/bjaceaccp/mki044.
- 22. Catalani B, Jones J. Peripheral Nerve Block Complications in Children. Orthop Clin North Am. 2022;53(2):179-86. doi: 10.1016/j.ocl.2021.11.004
- 23. Ori A, Jindal A, Nwazota N, Pearson ACS, Yalamuru B. Peripheral Nerve Injections. Phys Med Rehabil Clin N Am. 2022;33(2):489-517. doi: 10.1016/j.pmr.2022.02.004.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | May 28, 2023 |
| Publication Date | June 21, 2023 |
| Submission Date | November 8, 2022 |
| Acceptance Date | May 9, 2023 |
| Published in Issue | Year 2023 Volume: 7 Issue: 1 |
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