Our anesthesia experiences with geriatric patients at high risk group undergoing hip surgery under combined psoas compartment-sciatic nerve block
Öz
Abstract
Aim. The effect of psoas compartment and sciatic nerve block combination on hemodynamic parameters in high risk geriatric patients with hip fracture surgeries was evaluated. Methods. In this study, high risk old patients who underwent psoas compartment block and sciatic nerve block for hip surgery anesthesia were evaluated retrospectively. In Group 1 there were 14 patients with levobupivacaine and lidocaine combination and in Group 2 there were 10 patients with levobupivacaine and prilocaine combination. In our study we evaluated the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure levels and sedation need between groups, between age over and below 85 years and in all patients. Results. There were no statistically significant difference in heart rate and mean arterial blood pressure levels between groups and age groups (p˃0.05). There were a 6.18% and 16.52% decrease in mean arterial blood pressure in Group 1 and 2 respectively. When we evaluated the whole patients there was a 10.06% decrease in mean arterial blood pressure. Conclusion. We consider that the combination of psoas and sciatic block as an anesthetic method may be a proper option especially in the elderly and high-risk patients who were underwent the hip surgery.
Keywords: Psoas compartment block, geriatrics, hip surgery
Özet
Amaç. Kalça kırığı cerrahisi geçiren yüksek risk grubu yaşlı hastalarda psoas kompartman bloğu ve siyatik sinir blok kombinasyonunun hemodinamik parametrelere etkisi araştırıldı. Yöntem. Bu çalışmada kalça cerrahisi anestezisi için psoas kompartman bloğu ve siyatik sinir bloğu ikilisi yapılan yüksek risk grubu, yaşlı hastalar retrospektif olarak değerlendirildi. Lokal anestezik olarak levobupivakain ve lidokain kombinasyonu verilen 14 yaşlı hasta Grup 1 olarak, levobupivakain ve prilokain kombinasyonu verilen 10 yaşlı hasta Grup 2 olarak adlandırıldı. Çalışmamızda hastaların tümünde, gruplar arasında ve 85 yaşın üstünde olanlarla altında olanların kalp atım hızı, ortalama kan basıncı değerleri ve sedasyon ihtiyacı incelendi. Bulgular. Gruplar arasında ve yaş grupları arasında ortalama kan basıncı değerleri ve kalp atım hızları karşılaştırıldığında istatiksel olarak anlamlı bir fark saptanmadı (p˃0,05). Grup 1’de ortalama kan basıncında %6,18 düşüş olurken Grup 2’de %16,52 düşüş oldu. Tüm hastalar değerlendirildiğinde ortalama kan basıncında %10,06 oranında düşüş gözlendi. Sonuç. Kalça cerrahisi uygulanan yaşlı ve yüksek risk grubu hastalarda anestezik yöntem olarak psoas ve siyatik blok kombinasyonunun uygun bir seçenek olabileceğini düşünüyoruz.
Anahtar sözcükler: Psoas kompartman bloğu, geriatri, kalça cerrahisiAnahtar Kelimeler
Kaynakça
- Buckenmaier CC 3rd, Xenos JS, Nilsen SM. Lumbar plexus block with perineural catheter and sciatic nerve block for total hip arthroplasty. J Arthroplasty 2002; 17: 499-502.
- Touray ST, de Leeuw MA, Zuurmond WW, Perez RS. Psoas compartment block for lower extremity surgery: a meta-analysis. Br J Anaesth 2008; 101: 750-60. de Visme V, Picart F, Le Jouan R, Legrand A, Savry C, Morin V. Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly. Reg Anesth Pain Med 2000; 25: 158
- Chudinov A, Berkenstadt H, Salai M, Cahana A, Perel A. Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures. Reg Anesth Pain Med 1999; 24: 563-8.
- Moreno M, Casalia AG. Lumbar plexus anesthesia: psoas compartment block. Techniques in Reg Anesth and Pain Management 2006; 10: 145-9.
- Mannion S. Psoas compartment block. Continuing Education in Anaesthesia, Critical Care & Pain 2007; 7: 162-6. de Leeuw MA, Slagt C, Hoeksema M, Zuurmond WW, Perez RS. Hemodynamic changes during a combined psoas compartment-sciatic nerve block for elective orthopedic surgery. Anesth Analg 2011; 112: 719-24.
- Rooke GA, Robinson BJ. Cardiovascular and autonomic nervous system aging. Problems in Anesthesia 1997; 9: 482-97.
- Eyrolle L, Zetlaoui P, Belbachir A, Rosencher N, Conseiller C. Regional anaesthesia for femoral neck fracture surgery: comparison of lumbar plexus block and spinal anaesthesia. Br J Anaesth 1998; 80: 383.
- Gaillat F, Thibault S, Scemama F, Joly F, Paladini M, Auffray J. Bloc lombaire et sciatique posterieur pour fracture du col du femur du sujet age: experience clinique. Cah Anesthesiol 2002; 50: 99-104.
- Ben-David B, Lee E, Croitoru M. Psoas block for surgical repair of hip fracture: a case report and description of a catheter technique. Anesth Analg 1990; 71: 29830
- Stevens RD, Van Gessel E, Flory N, Fournier R, Gamulin Z. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology 2000; 93: 115-21.
- Twyman R, Kirwan T, Fennelly M. Blood loss reduced during hip arthroplasty by lumbar plexus block. J Bone Joint Surg Br 1990; 72: 770-1.
- Hoek JA, Henny CP, Knipscheer HC, ten Cate H, Nurmohamed MT, ten Cate JW. The effect of different anaesthetic techniques on the incidence of thrombosis following total hip replacement. Thromb Haemost 1991; 65: 122-5.
- Bruelle P, Lefrant JY, de la Coussaye JE, Peray PA, Desch G, Sassine A, Eledjam JJ. Comparative electrophysiologic and hemodynamic effects of several amide local anesthetic drugs in anesthetized dogs. Anesth Analg 1996; 82: 648
- Lefrant JY, de La Coussaye JE, Ripart J, Muller L, Lalourcey L, Peray PA, Mazoit X, Sassine A, Eledjam JJ. The comparative electrophysiologic and hemodynamic effects of a large dose of ropivacaine and bupivacaine in anesthetized and ventilated piglets. Anesth Analg 2001; 93: 1598-605.
- Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol 1998; 46: 245Farny J, Girard M, Drolet P. Posterior approach to the lumbar plexus combined with a sciatic nerve block using lidocaine. Can J Anaesth 1994; 41: 486-91.
- Simon MA, Gielen MJ, Lagerwerf AJ, Vree TB. Plasma concentrations after high doses of mepivacaine with epinephrine in the combined psoas compartment/sciatic nerve block. Reg Anesth 1990; 15: 256-60.
- Vanterpool S, Steele SM, Nielsen KC, Tucker M, Klein SM. Combined lumbarplexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations. Reg Anesth Pain Med 2006; 31: 417-21.
- Cappelleri G, Ghisi D, Fanelli A, Aldegheri G, La Colla L, Albertin A. Posterior psoas vs 3-in-1 approach for lateral femoral cutaneous and obturator nerve block for anterior cruciate ligament repair. Minerva Anestesiol 2009; 75: 568-73.
- Litz RJ, Vicent O, Wiessner D, Heller AR. Misplacement of a psoas compartment catheter in the subarachnoid space. Reg Anesth Pain Med 2004; 29: 61-4.
- Pousman RM, Mansoor Z, Sciard D. Total spinal anesthetic after continuous posterior lumbar plexus block. Anesthesiology 2003; 98: 1281-2.
- Aida S, Takahashi H, Shimoji K. Renal subcapsular hematoma after lumbar plexus block. Anesthesiology 1996; 84: 452-5.
- Weller RS, Gerancher JC, Crews JC, Wade KL. Extensive retroperitoneal hematoma without neurologic deficit in two patients who underwent lumbar plexus block and were later anticoagulated. Anesthesiology 2003; 98: 581-5.
Öz
Amaç. Kalça kırığı cerrahisi geçiren yüksek risk grubu yaşlı hastalarda psoas kompartman bloğu ve siyatik sinir blok kombinasyonunun hemodinamik parametrelere etkisi araştırıldı. Yöntem. Bu çalışmada kalça cerrahisi anestezisi için psoas kompartman bloğu ve siyatik sinir bloğu ikilisi yapılan yüksek risk grubu, yaşlı hastalar retrospektif olarak değerlendirildi. Lokal anestezik olarak levobupivakain ve lidokain kombinasyonu verilen 14 yaşlı hasta Grup 1 olarak, levobupivakain ve prilokain kombinasyonu verilen 10 yaşlı hasta Grup 2 olarak adlandırıldı. Çalışmamızda hastaların tümünde, gruplar arasında ve 85 yaşın üstünde olanlarla altında olanların kalp atım hızı, ortalama kan basıncı değerleri ve sedasyon ihtiyacı incelendi. Bulgular. Gruplar arasında ve yaş grupları arasında ortalama kan basıncı değerleri ve kalp atım hızları karşılaştırıldığında istatiksel olarak anlamlı bir fark saptanmadı (p˃0,05). Grup 1’de ortalama kan basıncında %6,18 düşüş olurken Grup 2’de %16,52 düşüş oldu. Tüm hastalar değerlendirildiğinde ortalama kan basıncında %10,06 oranında düşüş gözlendi. Sonuç. Kalça cerrahisi uygulanan yaşlı ve yüksek risk grubu hastalarda anestezik yöntem olarak psoas ve siyatik blok kombinasyonunun uygun bir seçenek olabileceğini düşünüyoruz.
Anahtar Kelimeler
Kaynakça
- Buckenmaier CC 3rd, Xenos JS, Nilsen SM. Lumbar plexus block with perineural catheter and sciatic nerve block for total hip arthroplasty. J Arthroplasty 2002; 17: 499-502.
- Touray ST, de Leeuw MA, Zuurmond WW, Perez RS. Psoas compartment block for lower extremity surgery: a meta-analysis. Br J Anaesth 2008; 101: 750-60. de Visme V, Picart F, Le Jouan R, Legrand A, Savry C, Morin V. Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly. Reg Anesth Pain Med 2000; 25: 158
- Chudinov A, Berkenstadt H, Salai M, Cahana A, Perel A. Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures. Reg Anesth Pain Med 1999; 24: 563-8.
- Moreno M, Casalia AG. Lumbar plexus anesthesia: psoas compartment block. Techniques in Reg Anesth and Pain Management 2006; 10: 145-9.
- Mannion S. Psoas compartment block. Continuing Education in Anaesthesia, Critical Care & Pain 2007; 7: 162-6. de Leeuw MA, Slagt C, Hoeksema M, Zuurmond WW, Perez RS. Hemodynamic changes during a combined psoas compartment-sciatic nerve block for elective orthopedic surgery. Anesth Analg 2011; 112: 719-24.
- Rooke GA, Robinson BJ. Cardiovascular and autonomic nervous system aging. Problems in Anesthesia 1997; 9: 482-97.
- Eyrolle L, Zetlaoui P, Belbachir A, Rosencher N, Conseiller C. Regional anaesthesia for femoral neck fracture surgery: comparison of lumbar plexus block and spinal anaesthesia. Br J Anaesth 1998; 80: 383.
- Gaillat F, Thibault S, Scemama F, Joly F, Paladini M, Auffray J. Bloc lombaire et sciatique posterieur pour fracture du col du femur du sujet age: experience clinique. Cah Anesthesiol 2002; 50: 99-104.
- Ben-David B, Lee E, Croitoru M. Psoas block for surgical repair of hip fracture: a case report and description of a catheter technique. Anesth Analg 1990; 71: 29830
- Stevens RD, Van Gessel E, Flory N, Fournier R, Gamulin Z. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology 2000; 93: 115-21.
- Twyman R, Kirwan T, Fennelly M. Blood loss reduced during hip arthroplasty by lumbar plexus block. J Bone Joint Surg Br 1990; 72: 770-1.
- Hoek JA, Henny CP, Knipscheer HC, ten Cate H, Nurmohamed MT, ten Cate JW. The effect of different anaesthetic techniques on the incidence of thrombosis following total hip replacement. Thromb Haemost 1991; 65: 122-5.
- Bruelle P, Lefrant JY, de la Coussaye JE, Peray PA, Desch G, Sassine A, Eledjam JJ. Comparative electrophysiologic and hemodynamic effects of several amide local anesthetic drugs in anesthetized dogs. Anesth Analg 1996; 82: 648
- Lefrant JY, de La Coussaye JE, Ripart J, Muller L, Lalourcey L, Peray PA, Mazoit X, Sassine A, Eledjam JJ. The comparative electrophysiologic and hemodynamic effects of a large dose of ropivacaine and bupivacaine in anesthetized and ventilated piglets. Anesth Analg 2001; 93: 1598-605.
- Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol 1998; 46: 245Farny J, Girard M, Drolet P. Posterior approach to the lumbar plexus combined with a sciatic nerve block using lidocaine. Can J Anaesth 1994; 41: 486-91.
- Simon MA, Gielen MJ, Lagerwerf AJ, Vree TB. Plasma concentrations after high doses of mepivacaine with epinephrine in the combined psoas compartment/sciatic nerve block. Reg Anesth 1990; 15: 256-60.
- Vanterpool S, Steele SM, Nielsen KC, Tucker M, Klein SM. Combined lumbarplexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations. Reg Anesth Pain Med 2006; 31: 417-21.
- Cappelleri G, Ghisi D, Fanelli A, Aldegheri G, La Colla L, Albertin A. Posterior psoas vs 3-in-1 approach for lateral femoral cutaneous and obturator nerve block for anterior cruciate ligament repair. Minerva Anestesiol 2009; 75: 568-73.
- Litz RJ, Vicent O, Wiessner D, Heller AR. Misplacement of a psoas compartment catheter in the subarachnoid space. Reg Anesth Pain Med 2004; 29: 61-4.
- Pousman RM, Mansoor Z, Sciard D. Total spinal anesthetic after continuous posterior lumbar plexus block. Anesthesiology 2003; 98: 1281-2.
- Aida S, Takahashi H, Shimoji K. Renal subcapsular hematoma after lumbar plexus block. Anesthesiology 1996; 84: 452-5.
- Weller RS, Gerancher JC, Crews JC, Wade KL. Extensive retroperitoneal hematoma without neurologic deficit in two patients who underwent lumbar plexus block and were later anticoagulated. Anesthesiology 2003; 98: 581-5.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 2 Ocak 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 3 |