Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
The Effects of Interscalene Block Performed Alone or with Ultrasonography-Guided Peripheric Nerve Stimulator on Block Success, Hemodynamic Parameters and Perfusion Index
Yalnız Başına veya Ultrasonografi Eşliğinde Periferik Sinir Stimülatörü ile Gerçekleştirilen İnterskalen Bloğun Blok Başarısı, Hemodinamik Parametreler ve Perfüzyon İndeksine Etkileri
Caner Erman KARTa, Ahmet Cemil İSBİRb, Onur AVCIb, İclal ÖZDEMİR KOLb, Kenan KAYGUSUZb, Sinan GÜRSOYb
aKaraman State Hospital, Clinic of Anesthesiology and Reanimation, Karaman, TURKEY
bSivas Cumhuriyet University Faculty of Medicine, Department of Anesthesiology and Reanimation, Sivas, TURKEY
Turkiye Klinikleri J Cardiovasc Sci. 2020;32(1):37-44
doi: 10.5336/cardiosci.2019-71793
Article Language: EN
ABSTRACT
Objective: We aimed the comparison between traditional methods and perfusion index (PI) on evaluating the block success and sufficiency of interscalene block that we applied to shoulder surgery cases by using ultrasonography (USG) and peripheric nevre stimulator or only peripheric nerve stimulator only. Material and Methods: After ethics committee and patient approvals; ASA I-III, 50 adult patients (18-70 ages) who underwent shoulder, arm surgery were allocated to this prospective research. Interscalene block was applied to all patients by using USG and peripheric nerve stimulation or peripheric nerve stimulation with bupivacaine 0.5% 1 mg/kg+prilocaine 2% 4 mg/kg+NaCl 0.9% to complete the anesthetic solution to 30 mlt. We recorded heart rate, mean arterial pressure, peripheric oxygen saturation, PI, motor block times and pin-prick test values of the patients. Results: When the PI values of the patients on different times were compared, the difference between the groups was insignificant. Loss of cold sensation time was 10.3±3.9 min in Group 1 and 11.3±4.3 min in Group 2. Pin-prick test time to be positive was 16.3±3.8 min in Group 1 and 17.6±5.1 min in Group 2. Motor block onset time was 14.2±3.7 min in Group 1 and 16.1±4.3 min in Group 2. Conclusion: Using USG enables us to benefit from local anesthetic more effectively and to encounter fewer complications. Another conclusion can be about PI parameters which significantly increase with block success in time within the groups. So, PI can be used due tobeing easily applicable and non-invasive technique for predicting the block success.

Keywords: Interscalene block; perfusion index; ultrasonography; regional block
ÖZET
Amaç: Bu çalışmada; ultrasonografi (USG) rehberliğinde periferik sinir stimülatörüyle veya yalnızca periferik sinir stimülatörüyle uyguladığımız interskalen bloğun, hemodinamik parametrelerle birlikte, blok başarısını ve yeterliliğini değerlendirmede perfüzyon indeksi (Pİ)?ne etkilerinin karşılaştırılması amaçlandı. Gereç ve Yöntemler: Etik kurul ve hastaların onayı alındıktan sonra omuz, kol ve dirsek cerrahisi geçirecek ASA I-III grubuna giren 18-70 yaş arası 50 hasta prospektif olarak çalışmaya alındı. Tüm hastalara; 1 mg/kg %0,5 bupivakain +4 mg/kg %2 prilokain + toplamda 30 mlt?ye tamamlanacak şekilde %0,9?luk NaCl eklenerek lokal anestezik solüsyon ile USG ve periferik sinir stimülatörü veya periferik sinir stimülatörü eşliğinde interskalen blok uygulandı. Hastaların kalp atım hızı, ortalama arteryal kan basınçları, periferik oksijen saturasyonları, Pİ, motor blok başlama zamanı, tam motor blok oluşma zamanı, soğuk duyusu kaybı zamanı ve pin prick testi pozitif olma zamanı değerlendirilerek veriler kaydedildi. Bulgular: Çalışmaya alınan bireylerin değişik zamanlarda ölçülen PI değerleri karşılaştırıldığında, gruplar arasındaki farklılık önemsiz bulundu (p>0,05). Soğuk duyusu kaybı zamanı; Grup 1?de 10,3±3,9 dk ve Grup 2?de 11,3±4,3 dk olarak bulundu. Pin-prick testi pozitif olma zamanı; Grup 1?de 16,3±3,8 dk ve Grup 2?de 17,6±5,1 dk olarak bulundu. Motor blok başlangıç zamanı; Grup 1?de 14,2±3,7 dk ve Grup 2?de 16,1±4,3 dk olarak bulundu. Sonuç: USG kullanımı; lokal anestezik ilaçlardan daha etkin yararlanmamızı ve daha az komplikasyonla karşılaşmamızı sağlar. Gruplar içindeki zamana göre blok başarısı ile önemli ölçüde artan Pİ, blok başarısını tahmin etmek için kolay uygulanabilir ve invazif olmayan bir teknik olarak kullanılabilir.

Anahtar Kelimeler: İnterskalen blok; perfüzyon indeksi; ultrasonografi; rejyonel blok
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