Ultrasound-Guided Rectus Sheath Block in Gynaecological Surgery with Pfannenstiel Incision [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. 2015; 43(5): 318-322 | DOI: 10.5152/TJAR.2015.79037  

Ultrasound-Guided Rectus Sheath Block in Gynaecological Surgery with Pfannenstiel Incision

Şule Cüneyitoğlu1, Mediha Türktan2, Ebru Biricik2, Dilek Özcengiz2
1Clinic of Anaesthesiology and Reanimation, Aşkım Tüfekçi State Hospital, Adana, Turkey
2Department of Anaesthesiology and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey

INTRODUCTION: This study aimed to evaluate the effects of ultrasound-guided rectus sheath block in gynaecological surgery with Pfannenstiel incision.
METHODS: After the approval of the ethics committee and the patients’ consent, 75 ASA I-II patients who were aged between 20 and 70 years and scheduled for a gynaecological surgery with Pfannenstiel incision were included in this study. After induction of general anaesthesia, patients were randomly divided into three groups. In Group UR patients (n=25), ultrasound-guided rectus sheath block with 0.25% levobupivacaine (0.2 mL kg−1) was performed. In Group SR patients (n=25), surgical rectus sheath block with 0.25% levobupivacaine (0.2 mL kg−1) was applied. In Group T (n=25) patients, tramadol (2 mg kg−1) was intravenously administered 30 min before the end of surgery. Patient-controlled analgesia device was established for postoperative pain relief in all groups. Haemodynamic data and inspired sevoflurane concentration were recorded during the operation. Pain scores, total tramadol consumption, supplemental analgesic requirement and side effects were postoperatively evaluated.
After induction of general anaesthesia, patients were randomly divided into three groups. In Group UR patients (n=25), ultrasound guided rectus sheath block with 0.25% levobupivacaine 0.2 mL kg-1 was performed. In Group SR patients (n=25), surgical rectus sheath block with 0.25% levobupivacaine 0.2 mL kg-1 was applied. In Group T (n=25) patients, tramadol 2 mg kg-1 was given intravenously 30 minutes before the end of surgery. Patient controlled analgesia device was established for postoperative pain relief in all groups.
Haemodynamic data and inspired sevoflurane concentration were recorded during operation. Pain scores, total tramadol consumption, supplemental analgesic requirement and side effects were evaluated postoperatively.
RESULTS: Demographic characteristics, duration of surgery and haemodynamic parameters were similar between the groups. Inspired sevoflurane concentration (%) and VAS scores were significantly lower in Group UR than those in Groups SR and T. Total tramadol consumption was significantly lower in Groups UR and SR than that in Group T. There was no significant difference in the incidence of side effects.
DISCUSSION AND CONCLUSION: This study demonstrates that ultrasound-guided rectus sheath block helps to provide the effective analgesia without any side effects compared with surgical rectus sheath block and intravenous tramadol for gynaecological surgery with Pfannenstiel incision.

Keywords: Gynecologic surgery, regional anaesthesia, postoperative, analgesia, ultrasound


Pfannenstiel İnsizyonla Yapılan Jinekolojik Cerrahide Ultrason Eşliğinde Rektus Kılıf Bloğu

Şule Cüneyitoğlu1, Mediha Türktan2, Ebru Biricik2, Dilek Özcengiz2
1Aşkım Tüfekçi Devlet Hastanesi, Anestezi Ve Reanimasyon Bölümü, Adana, Türkiye
2Çukurova Üniversitesi Tıp Fakültesi, Anestezi Ve Reanimasyon Anabilim Dalı, Adana, Türkiye

GİRİŞ ve AMAÇ: Çalışmamızda, Pfannenstiel insizyonla yapılan jinekolojik cerrahide ultrason eşliğinde uygulanan rektus kılıf bloğunun etkisini araştırmayı amaçladık.
YÖNTEM ve GEREÇLER: Etik kurul onayı ve olguların onamı alındıktan sonra, American Society of Anesthesiologists (ASA) I-II grubu, 20-70 yaş arası, Pfannenstiel insizyonla jinekolojik cerrahi yapılması planlanan 75 hasta çalışmaya dahil edildi. Genel anestezi uygulandıktan sonra olgular randomize olarak üç gruba ayrıldı. Grup UR’ye (n=25) 0,2 mL kg-1 %0,25 levobupivakain ile ultrason eşliğinde rektus kılıf bloğu, Grup SR’ye (n=25) 0,2 mL kg-1 %0,25 levobupivakain ile cerrahi rektus kılıf bloğu uygulandı. Grup T’deki olgulara ise (n=25) cerrahi bitiminden 30 dakika önce intravenöz 2 mg kg-1 tramadol yapıldı. Tüm olgulara postoperatif ağrı kontrolü için hasta kontrollü analjezi cihazı kuruldu. Hemodinamik veriler ve inspire edilen sevofluran konsantrasyonu ameliyat boyunca kaydedildi. Postoperatif dönemde ağrı skorları, toplam tramadol tüketimi, ek analjezik ihtiyacı ve yan etkiler değerlendirildi.
BULGULAR: Demografik özellikler, cerrahi süre ve hemodinamik parametreler gruplar arasında benzer bulundu. Grup UR’de inspire edilen sevofluran konsantrasyonu (%) ve VAS skorları Grup SR ve Grup T’ye göre daha düşük saptandı. Toplam tramadol tüketimi Grup UR ve Grup SR’de Grup T’ye göre belirgin düşük bulundu. Gruplar arasında yan etki profili açısından fark saptanmadı.
TARTIŞMA ve SONUÇ: Bu çalışma, Phannenstiel insizyonla yapılan jinekolojik cerrahide, ultrason eşliğinde uygulanan rektus kılıf bloğunun cerrahi rektus kılıf bloğu ve tramadole kıyasla yan etki sıklığını arttırmadan etkin bir analjezi sağlamaya yardımcı olduğunu göstermiştir.

Anahtar Kelimeler: Jinekolojik cerrahi, rejyonal anestezi, postoperatif, analjezi, ultrason


Şule Cüneyitoğlu, Mediha Türktan, Ebru Biricik, Dilek Özcengiz. Ultrasound-Guided Rectus Sheath Block in Gynaecological Surgery with Pfannenstiel Incision. Turk J Anaesthesiol Reanim. 2015; 43(5): 318-322

Corresponding Author: Mediha Türktan, Türkiye


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