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Torakal paravertebral blok meme cerrahisinde etkili bir anestezi ve analjezi yöntemidir. Çalışmadaki amacımız modifiye radikal mastektomi operasyonlarında ultrason eşliğinde yapılan torakal paravertebral bloğun intraoperatif opioid ihtiyacını ve postoperatif analjezi gereksinimini azalttığını göstermektir. Çalışmamıza 2017-2018 yılları arasında modifiye radikal mastektomi tanısı ile torakal paravertebral blok yapılan 19 hasta retrospektif incelenerek dahil edildi. Hastaların demografik verileri, operasyon süreleri ve intraoperatif opioid ve postoperatif ilk 24 saat analjezik gereksinimleri değerlendirildi. İstatistiksel değerlendirme SPSS for Windows 21.0 programı ile yapıldı. p<0.05 değeri istatistiksel olarak anlamlı kabul edildi. 20-79 yaş aralığında olan hastaların yaş ortalaması 50,89 (±15,74) idi. 3 hasta ASA I, 6 hasta ASA II ve 10 hasta ASA III idi. Vücut kitle indeksi ortalama 29,92(±3,99) idi. Operasyon süresi ortalama 129,05(±66,04) dakika idi. Hastalar TPVB yapılmayan:Grup 1 (n:10) ve TPVB yapılan:Grup 2 (n:9): olarak 2 gruba ayrıldı. Gruplar arasında hastaların yaş ortalaması ve operasyon süreleri açısından fark yoktu. Grup 1’deki tüm hastaların opioid ihtiyacı oldu. 2 hastada Remifentanil infüzyonu, 4 hastada Fentanil 100 mg ve 4 hastada ise 150 mg Fentanil ihtiyacı oldu. Grup 2’de ise hiç opioid ihtiyacı olmadı. Bu durum istatistiki olarak da anlamlıydı (p<0.005). Postoperatif dönemde Grup 1’deki hastaların tümünün analjezik gereksinimi oldu. 5 hastanın Contramal 60 mg 3*1, 5 hastanın da Contramal 60 mg 4*1 ihtiyacı oldu. Grup 2’deki hastalarda hiç analjezik ihtiyacı olmadı. Bu durum istatistiki olarak da anlamlı idi (p<0.005). Modifiye radikal mastektomi olgularında ultrasonografi eşliğinde yapılan torakal paravertebral blok ile intraoperatif dönemde opioid gereksinimi olmazken postoperatif ilk 24 saate analjeziğe ihtiyaç olmamaktadır.
It is an effective method of anesthesia and analgesia in breast block surgery. Our purpose in the study is to show that the uricular paravertebral block accompanied by ultrasound in modified radical mastectomy operations reduces the need for intraoperative opioids and the need for postoperative analgesics. Our study was included with a retrospective examination of 19 patients with a modified radical mastectomy diagnosis between 2017-2018 years with the torcular paravertebral block. The demographic data of patients, the duration of the operation and the intraoperative opioid and postoperative analgesic requirements were evaluated for the first 24 hours. The statistical assessment was done with the SPSS for Windows 21.0 program. The value p<0.05 was statistically considered meaningful. The average age of patients between the ages of 20 and 79 was 50.89 (± 15.74) 3 patients were ASA I, 6 patients were ASA II and 10 patients were ASA III. The body mass index was an average of 29.92 (±3.99). The operating time was an average of 129,05 (±66,04) minutes. Patients were divided into 2 groups as non-TPVB:Group 1 (n:10) and TPVB:Group 2 (n:9). There was no difference between the groups in terms of the average age of the patients and the duration of the operation. All patients in Group 1 needed opioids. 2 patients needed Remifentanil infusion, 4 patients needed Fentanil 100 mg and 4 patients needed 150 mg Fentanil. The group 2 did not need any opioids. This was also statistically meaningful (p<0.005). In the postoperative period, all patients in Group 1 had an analgesic need. 5 patients needed Contramal 60 mg 3*1, 5 patients needed Contramal 60 mg 4*1. Patients in group 2 did not need any analgesics. This was also statistically meaningful (p<0.005). Modified radical mastectomy in cases accompanied by ultrasound with the cervical paravertebral block in the intraoperative period does not require opioids while the postoperative does not require analgesics in the first 24 hours.
Total paravertebral block is a common analgesic and anesthetic technique that used in mastectomy procedures. In this study we aim to show the effects of ultrasound guided paravertebral block administiration on introperative opioid consumption and postoperative pain in modified radical mastectomy procedures. Nineteen patients that underwent thoracal paravertebral block with a diagnosis of modified radical mastectomy between 2017-2018 years were analysed retrospectively. Demographical parameters, procedure duration, intraoperative and postoperative 24 hours analgesic consumption were analysed. Statistical evaluation were performed with SPSS for Windows 21.0 programme. P<0.05 value was identified as statistical significance. Patients ages were between the range of 20-79 years and age avarage was 50,89 (±15,74). Three patients were ASA I, 6 patients were ASA II and 10 patients were ASA III. Body Mass Index avarage was 29,92(±3,99). Procedure duration avarage was 129,05(±66,04) minutes. Patients were divided into two goups; Group 1 (n=10): TPVB was not applied, Group 2 (n=9): TPVB was applied. There were no significant difference between groups in means of age and procedure duration. All patients in group 1 required opioid medication. Two patients required remifentanyl infusion, 4 patients required 100 µg and 4 patients required 150 µg intravenous fentanyl. None of the patients in Group 2 required opioid medication and this condition found statistically significant (p<0.005). All patients in Group 1 required postoperative analgesic treatment. Five patients had given contramal 60 µg 3*1, 5 patients had given contramal 60 µg 4*1. There were no postoperative analgesic requirement in Group 2 and it was statistically significant (p<0.005). Ultrasound guided thoracal paravertebral block in modified radical mastectomy provides an opioid free intraoperative period and obtain analgesia for postoperative 24 hours.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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