57
F. S O N U Ç
Çalışmamızda supraklavikular teknikle ve periferik sinir stimülatörü kullanılarak, brakiyal
pleksus blokajı uygulandı. Serum fizyolojikli 30 ml %0.5 lik levobupivakainle 1ml: 50mcg
fentanil eklenmiş levobupivakain karşılaştırıldı.
Olgular peroperatif ek analjezik ihtiyacı, postoperatif VRS, postoperatif hasta
memnuniyeti ve blok geri dönüş süreleri yönünden değerlendirildiğinde; levobupivakain
grubuyla fentanil eklenmiş levobupivakain grubu arasında anlamlı bir farka rastlanmadı. Vital
bulgular ve motor blok açısından bazı veriler istatistiksel olarak anlamlı çıksa da, klinik
olarak özellik göstermedi. Ayrıca postoperatif dönemde olguların hiçbirinde nörolojik
komplikasyona görülmedi.
Sonuç olarak; Supraklavikuler brakiyal pleksus blokajında 30 ml %0.5 lik levobupivakaine
eklenen 1ml: 50mcg fentanilin blok başlangıç süresi, duyusal ve motor blok süreleri, postop
analjezi süresi üzerine, her iki gruptada etkili bir blok oluşturulmasına rağmen ilave bir
etkisini saptamadık.
58
G. ÖZET
Çalışmamız, acil ya da elektif amaçlı tek taraflı el, ön kol veya kol cerrahisi uygulanan,
ASA I – II grubuna dahil, 18-65 yaş arasında, 50 – 100 kg ağırlığında 40 vaka üzerinde
gerçekleştirildi.
Bütün olgulara supraklavikular teknikle ve periferik sinir stimülatörü kullanılarak, brakiyal
pleksus blokajı uygulandı. Birinci gruba 30ml %0,5’lik Levobupivakain+ 1ml serum
fizyolojik solüsyonu, ikinci gruba 30 ml %0,5’lik Levobupivakain+ 1ml: 50 mcg fentanil
solüsyonu verildi.
Çalışmamızda demografik özellikler olarak yaş, kilo ve boy değerleri ölçüldü ve her iki
grup arasında anlamlı farklılık saptanmadı.
Çalışmamızda hemodinamik parametrelerde ve periferik oksijen satürasyon değerlerinde
her iki grup arasında anlamlı farklılık saptanmadı.
Vakaların duyusal blok dereceleri, pinprick ve dokunma testleriyle; motor blok dereceleri,
Bromage skalası ile başlangıç, 5- 10- 15- 20- 30- 60. dakikalarında kaydedilmek üzere radial,
median, ulnar ve muskülokutanöz sinirlerin duyu sahalarında değerlendirildi.
Motor blok oluşma sürelerine seviyeler (omuz, dirsek, bilek, parmaklar) açısından
bakıldığında dirsekte 10. dk da tam blok varlığı fentanil eklenen grupta %65 hastada
oluşmuşken diğer grupta %30 hastada tam blok tespit edildi. Ancak klinik açıdan anlamlı
olarak değerlendirilmedi. Bilek-parmaklarda da 20.dk da tam blok varlığı fentanil eklenen
grupta %30 hastada oluşmuşken diğer grupta %5 hastada tam blok tespit edildi. 30. dk tam
blok varlığı fentanil eklenen grupta %50 hastada oluşmuşken diğer grupta %20 hastada tam
blok tespit edildi. Ancak klinik açıdan anlamlı olarak değerlendirilmedi.
Ayrıca postoperatif dönemde, VRS kullanılarak vakaların ağrı düzeyleri, analjezi ihtiyaç
zamanları, motor bloğun ortadan kalktığı süreler ve hasta memnuniyetleri kaydedildi.
Çalışmamız neticesinde, postoperatif dönemde, VRS kullanılarak vakaların ağrı düzeyleri,
analjezi ihtiyaç zamanları, motor bloğun ortadan kalktığı süreler ve hasta memnuniyetleri
değerlendirildiğinde her iki grupta da benzer sonuçlara rastlandı. Postoperatif dönemde
vakaların hiçbirinde nörolojik komplikasyon gelişmedi.
59
Çalışmamız sonucunda; Supraklavikuler brakiyal pleksus blokajında levobupivakaine
eklenen fentanilin blok karakteristiğini etkilemediği ve postop analjezi süresi üzerinde etkili
olmadığı sonucuna vardık. %0.5 lik 30 ml Levobuivakainin adjuvan ilaç eklenmeden etkili bir
blok oluşturduğu kanaatine vardık.
60
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