Evaluation of the success of supraclavicular blockade performed under general anesthesia in arthroscopic surgery of the shoulder by using Perfusion Index

Yıl 2020, Cilt: 12 Sayı: 1, 61 - 68, 01.03.2020

Ayşegül Ceylan , Mehmet Burak Eşkin

https://doi.org/10.21601/ortadogutipdergisi.626306

Öz

Aim: Supraclavicular blockade under ultrasonic-guidance has recently increased its popularity and is an alternative to anesthesia and analgesia in arthroscopic surgery of the shoulder.

The aim of this study is to evaluate the effectiveness of the perfusion index (PI) which indicates the increase in peripheral perfusion of the upper extremity in determining the success of single dose supraclavicular nerve block under general anesthesia.

Material and Methods: The PI was measured non-invasively with pulse-oximetry probe (Masimo Corp, Irvine, CA, USA) from the fingers at the same and opposite sides of blockade at the beginning, 5th, 10th, 20th, 30th minutes, postoperatively and in post anesthesia care unit (PACU). The pain scores were recorded in the PACU, post-operatively and at the 1st, 12th, and 24th hours. Preoperative and postoperative arterial pressures and pulse rates were monitored and recorded at the beginning, 5th, 10th, 20th, 30th minutes, postoperatively and in PACU.

Results: Mean PI change rate measured at the beginning was significantly higher than those measured in all other times and when compared to the initial PI change rate, the rates of change were found to increase significantly in the 5th, 10th and 20th minutes (p<0.001). Mean arterial pressure and mean heart rate values measured at the beginning were significantly higher than those measured at all times (p<0.001). No intraoperative injection of fentanyl or infusion of remifentanyl were performed. The patients had no additional requirement of narcotics during the 24-hours follow-up period postoperatively, except for routine analgesics.

Conclusions: We think that peripheral blocks; especially in multimodal anesthetic applications, have intraoperative analgesic activity in addition to postoperative efficacy. They may also contribute to hemodynamic stabilization without narcotic requirement. The success of the blockade can reliably be evaluated by the PI measurement.

Anahtar Kelimeler

supraclavicular block, perfusion index

Artroskopik omuz cerrahisinde genel anestezi altında yapılan supraklaviküler blokajın başarısının Perfüzyon İndeksi kullanılarak değerlendirilmesi

Öz

Amaç: Ultrason kılavuzluğu altındaki supraklaviküler blokaj son zamanlarda popülerliğini arttırmıştır ve omuz artroskopik cerrahisinde anestezi ve analjeziye alternatif olmaktadır.

Bu çalışmanın amacı, genel anestezi altında tek doz supraklaviküler sinir bloğunun başarısını belirlemede üst ekstremitenin periferal perfüzyonundaki artışı belirten Perfüzyon İndeks (PI) değerinin etkinliğini değerlendirmektir.

Gereç ve Yöntemler: PI değeri blokaj öncesi başlangıçta, blokajdan sonraki 5., 10., 20., 30. dakikalarda ve anestezi sonrası bakım ünitesinde (PACU) blokajın aynı ekstremite tarafından ve diğer tarafındaki parmaklarından nabız-oksimetri probu (Masimo Corp, Irvine, CA, ABD) ile non invazif şekilde ölçülmüştür. Ağrı skorları ameliyat sonrası ve 1., 12. ve 24. saatlerde PACU’da kaydedildi. Ameliyat öncesi ve ameliyat sonrası arter basınçları ve nabızları, ameliyat öncesi, ameliyat sonrası ve PACU’da 5., 10., 20., 30. dakikalarda izlendi ve kaydedildi.

Bulgular: Başlangıçta ölçülen ortalama PI değişim oranı, diğer tüm zamanlarda ölçülenlerden anlamlı derecede yüksekti ve ilk PI değişim oranı ile karşılaştırıldığında, değişim oranlarının 5., 10. ve 20. dakikalarda anlamlı şekilde arttığı bulundu (p<0,001). Başlangıçta ölçülen ortalama ​​arter basıncı, ortalama kalp atış hızı değeri diğer zamanlarda ölçülenlerden anlamlı derecede yüksekti (p<0,001). Hiçbir intraoperatif fentanil enjeksiyonu veya remifentanil infüzyonu gerçekleştirilmedi. Hastaların postoperatif 24 saatlik takiplerinde rutin analjezikler dışında ek narkotik gereksinimi yoktu.

Sonuç: Periferik bloklar özellikle multimodal anestezik uygulamalarda postoperatif etkinliğin yanı sıra intraoperatif analjezik aktiviteye sahiptir, narkotik gereksinimi olmadan hemodinamik stabilizasyona katkıda bulunabilirler ve PI ölçümü blokajın başarısının değerlendirilmesinde güvenilir bir yöntem olabilir.

Anahtar Kelimeler

supraklaviküler blok, perfüzyon indeksi

Kaynakça

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