EFFECTIVENESS OF POPLITEAL NEVRE BLOCK AND ANKLE NEVRE BLOCK IN HALLUX VALGUS SURGERY

HALLUKS VALGUS AMELİYATINDA POPLİTEAL SİYATİK SİNİR BLOĞU İLE AYAK BİLEĞİ SİNİR BLOĞUNUN ETKİNLİĞİ

Özet

Objective: Regional anesthesia methods have been widely used in hallux valgus (HV) surgery in recent years. General anesthesia, spinal anesthesia and peripheral nerve blocks are frequently applied. The aim of this study was to investigate the effectiveness of ultrasound- guided popliteal sciatic nerve block (UPSNB) and ultrasound-guided ankle nerve block (UANB) in HV surgery. Method: This study was conducted with 40 patients with ASA I-II physical conditioning after having obtained the ethics committee approval from Gaziantep University ethics committee (No:2016/186). Patients were divided into two equal groups; UPSNB was applied with 20 mL of 0.5% bupivacaine in Group S (n=20). In Group P (n=20), UANB (5 mL to the posterior tibial nerve, 5 mL to the superficial peroneal nerve, 4 mL to the deep peroneal nerve, 3 mL to the saphenous nerve, 3 mL to the sural nerve) was applied with 20 mL of 0.5% bupivacaine. The tourniquet time, time of onset of motor block and duration of motor block, time of onset of sensory block and duration of sensory block were recorded for each patient. The time when the visual analogue scale (VAS) was 4 was recorded for each group. Results: The sensory block onset time was shorter in Group P (21.85± 1.53; 9.4± 1.31 min) (p<0.001). The duration of sensory block was also shorter in Group P (14.65± 1.46; 7.35± 0.93 hr) (p<0.001). The motor block onset time was shorter in Group P (25.2± 2.45; 11.8± 2.33 min) (p<0.001). The duration of motor block was also shorter in Group P (12.15± 1.18; 5.5± 0.68 hr) (p<0.001). The time to VAS 4 was shorter in Group P (16.2±1.41; 9.25± 0.44 hr) (p<0.001). Conclusion: While UANB yielded earlier sensory and motor block in HV surgery, the block effect terminated in a shorter time. The post-operative pain onset time was also observed to be shorter in UANB. UANB may be suggested as an alternative to UPSNB in HV surgery.

Abstract

Amaç: Son y›llarda halluks valgus (HV) operasyonlar›nda rejyonel anestezi yöntemleri s›kça kullan›lmaktad›r. Genel anestezi, spinal anestezi ve periferik sinir bloklar› s›kça kullan›lmaktad›r. Bu çal›flman›n amac› HV cerrahinde ultrasound eflli¤inde popliteal siyatik sinir blo¤u (UPSNB) ile ultrasound eflli¤inde ayak bilek sinir blo¤unun (UABSB) etkinli¤ini gözlemlemektir. Yöntem: Çal›flmam›z yerel etik kurul onay› (Gaziantep Üniversitesi Etik kurulu No: 2016/ 186) ile ASA I-II fiziksel durumda olan toplam 40 hasta ile yap›ld›. Çal›flmam›zda iki eflit gruba ayr›lan hastalar›m›zda grup S de (n=20) 20 mL %0.5 lik bupivakain ile UPSNB uyguland›. grup P de (n=20) toplam 20 mL %0.5 lik bupivakain ile UABSB (5 mL posterior tibial sinir, 5 mL yüzeyel peroneal sinir, 4 mL derin peroneal sinir, 3 mL safen sinir, 3 mL sural sinir bloklar›) uyguland›. Hastalar›m›z›n turnike süresi, motor blok bafllama zaman› ve süresi ile sensoryal blok bafllama zaman› ve süresi kayda al›nd›. Ayr›ca her iki grup için vizüel analog skalan›n (VAS) 4 oldu¤u zaman kayda al›nd›. Bulgular: Sensoryal blok bafllama zaman› grup P'de daha k›sa idi (21.85± 1.53; 9,4± 1.31 dk) (p<0.001). Sensoryal blok süresi grup P'de daha k›sa idi (14.65± 1.46; 7.35± 0.93 saat) (p<0.001). Motor blok bafllama zaman› grup P'de daha k›sa idi (25.2± 2.45; 11.8± 2.33 dk) (p<0.001). Motor blok süresi grup P' de daha k›sa idi (12.15± 1.18; 5.5± 0.68 saat) (p<0.001). VAS 4 olma süresi grup P'de daha k›sa idi (16.2±1.41; 9.25± 0.44 saat) (p<0.001). Sonuç: HV cerrahisinde UABSB daha erken sensoryal ve motor blok oluflumu gözlenirken, blok etkisinin daha k›sa sürede sonland›¤› gözlenmifltir. Postoperatif a¤r› oluflum süreside UABSB da daha k›sa olarak gözlenmifltir. HV cerrahisinde daha erken derlenme istenen vakalarda ABSB PSNB' ye alternatif olarak düflünülebilir.