Femur fraktürü nedeniyle cerrahi yapılan kritik yetişkin hasta grubunda spinal anestezi ve erektör spina plan bloğunun ağrı yönetimi, perioperatif hemodinamik değişiklikler, morbidite ve mortalite açısından karşılaştırılması
Küçük Resim Yok
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: İleri yaş hastalarda sık görülen kalça kırıkları, tedavisi cerrahi olan, yüksek mortaliteyle seyreden, çoğunlukla postoperatif dönemde yoğun bakımlarda izlenen, sağlık sistemine önemli yük oluşturan bir sağlık sorunudur. Günümüzde rejyonel anestezi teknikleri kalça cerrahilerinde yaygın olarak kullanılmakta olup, spinal anestezi yöntemi uzun süredir güvenle uygulanmaktadır. Güncel çalışmalar ile erektör spina plan bloğu (ESPB) ise etkin rejyonel anestezi ve analjezi yöntemlerinden biri olarak ön plana çıkmıştır. Az sayıdaki hasta serilerinde, temel anestezik yöntem olarak ESPB uygulaması bildirilmiştir. Bu çalışmanın amacı; temel anestezi yöntemi olarak kullanılan spinal anestezi ve ESPB uygulamalarının, kalça kırığı nedeniyle cerrahi geçiren kritik yetişkin hasta grubunda, perioperatif hemodinami, ağrı ve mortalite üzerine etkilerini karşılaştırmaktır. Gereç ve Yöntem: Bu prospektif, randomize ve kör gözlemcili klinik çalışmada, kalça kırığı mevcut, 65 yaş ve üzeri, ASA skoru ≥ III, kırılganlık indeksi ≥ 5 olan toplam 40 hasta dahil edilmiştir. Katılımcılar, iki gruba (Grup 1: ESPB uygulananlar; Grup 2: spinal anestezi uygulananlar) randomize edilmiştir. Preoperatif dönemde demografik veriler, vital bulgular ve ağrı skorları kaydedilmiştir. İntraoperatif ve postoperatif takipte hemodinamik parametreler, sedasyon düzeyleri, komplikasyonlar, ağrı skorları ve analjezik gereksinimleri belirli zaman dilimlerinde sistematik olarak izlenmiştir. Hastalar taburculuk sonrası 30. ve 90. günlerde mortalite açısından değerlendirilmiştir. Elde edilen veriler SPSS 18.0 programında analiz edilmiş; uygun istatistiksel testlerle gruplar arası farklar %95 güven aralığında ve p<0.05 anlamlılık düzeyinde değerlendirilmiştir. Bulgular: Hastaların 20'si ESPB, 20'si ise spinal anestezi altında opere edildi. Demografik veriler açısından gruplar benzerdi. İntraoperatif izlemde, spinal anestezi uygulanan hastaların 0. ve 45. dakikada ölçülen diyastolik kan basınçları ile 45. dakikadaki ortalama kan basıncı ESPB grubuna göre istatistiksel olarak daha düşük bulundu (sırasıyla p=0,007, p=0,026, p<0,05). Spinal anestezi grubunda intraoperatif dönemde hipotansiyon görülme oranı (p=0,025), efedrin ihtiyacı (p=0,018) ESPB grubuna göre anlamlı düzeyde yüksekti. ESPB grubunda ise propofol gereksinimi, spinal anestezi grubuna göre anlamlı düzeyde yüksek olarak gözlendi (p<0,001). Postoperatif yoğun bakım izleminde spinal anestezi uygulanan hastaların 6. saatteki diyastolik ve ortalama, 12. saatteki sistolik ve 18. saatteki diyastolik ve ortalama kan basıncı ölçümleri ESPB grubuna kıyasla anlamlı şekilde daha düşüktü (sırasıyla p=0,032, p=0,032, p=0,028, p=0,027, p=0,020). Postoperatif ilk 30 gün içindeki ve 30-90 gün arasındaki mortalite oranları gruplar arasında benzerdi (sırasıyla p=0,605, p=0,999). Ortalama mortalite günü açısından da istatistiksel anlamlılık gözlenmedi (p=0,174). Sonuç: ESPB, intraoperatif dönemde sedasyon (propofol) ihtiyacını arttırmakta olsa da intraoperatif ve postoperatif süreçte hemodinamik bulgularda stabilite sağlaması, daha az hipotansiyon komplikasyonu göstermesi, postoperatif analjezi ve mortalite üzerinde etkisinin spinal anestezi ile benzer düzeyde olması nedenleriyle, kırılganlık indeksi 5 ve üzerinde olan yaşlı yetişkin hasta grubunda, femur fraktürü cerrahisinde spinal anesteziye iyi bir alternatif olarak tercih edilebilir.
Introduction and Aim: Hip fractures are commonly encountered in the elderly population and require surgical treatment. They are associated with high mortality rates and often require postoperative intensive care follow-up, placing a significant burden on the healthcare system. Currently, regional anesthesia techniques are widely used in hip surgeries, with spinal anesthesia being a well-established and reliable method. Recently, erector spinae plane block (ESPB) has emerged as an effective regional anesthesia and analgesia technique. Some case series with fewer patient populations have reported the use of ESPB as the primary anesthetic method. This study aims to compare the effects of spinal anesthesia and ESPB, used as primary anesthesia methods, on perioperative hemodynamics, pain control, and mortality in critically ill adult patients undergoing surgery for hip fractures. Materials and Methods: This prospective, randomized clinical study included 40 patients aged ≥ 65 years with hip fractures, ASA score ≥ III, and frailty index ≥5. Participants were randomly assigned to two groups (Group 1: patients who received ESPB; Group 2: patients who received spinal anesthesia). The demographic data, vital signs, and pain scores were recorded preoperatively. Intraoperative and postoperative hemodynamic parameters, sedation levels, complications, pain scores, and analgesic requirements were recorded at specified intervals. Patients were followed-up for mortality on postoperative days 30 and 90. Data were analyzed using SPSS 18.0, and intergroup differences were evaluated using appropriate statistical tests with a 95% confidence interval and significance level of p<0.05. Results: Of the patients, 20 underwent surgery under ESPB and 20 under spinal anesthesia. The demographic variables were similar between the groups. Intraoperatively, diastolic blood pressure at minutes 0 and 45 and mean arterial pressure at minute 45 were significantly lower in the spinal anesthesia group than in the ESPB group (p=0.007, p=0.026, and p<0.05, respectively). The incidence of intraoperative hypotension (p=0.025) and ephedrine requirement (p=0.018) were significantly higher in the spinal anesthesia group, while the requirement for propofol was significantly higher in the ESPB group (p<0.001). In the postoperative intensive care follow-up, the spinal anesthesia group exhibited significantly lower diastolic and mean blood pressure at 6 h, systolic blood pressure at 12 h, and diastolic and mean blood pressure at 18 h than the ESPB group (p=0.032, p=0.032, p=0.028, p=0.027, p=0.020, respectively). The mortality rates within the first 30 days postoperatively and between days 30 and 90 were similar between the groups (p=0.605 and p=0.999, respectively), with no significant difference in the mean day of mortality (p=0.174). Conclusion: Although ESPB was associated with a higher need for sedation (propofol) during the intraoperative period, it provided better hemodynamic stability, demonstrated fewer hypotension-related complications, and showed similar outcomes in terms of postoperative analgesia and mortality compared with spinal anesthesia. Therefore, ESPB can be considered a viable alternative to spinal anesthesia in elderly adult patients with a frailty index of ≥5 undergoing femur fracture surgery.
Introduction and Aim: Hip fractures are commonly encountered in the elderly population and require surgical treatment. They are associated with high mortality rates and often require postoperative intensive care follow-up, placing a significant burden on the healthcare system. Currently, regional anesthesia techniques are widely used in hip surgeries, with spinal anesthesia being a well-established and reliable method. Recently, erector spinae plane block (ESPB) has emerged as an effective regional anesthesia and analgesia technique. Some case series with fewer patient populations have reported the use of ESPB as the primary anesthetic method. This study aims to compare the effects of spinal anesthesia and ESPB, used as primary anesthesia methods, on perioperative hemodynamics, pain control, and mortality in critically ill adult patients undergoing surgery for hip fractures. Materials and Methods: This prospective, randomized clinical study included 40 patients aged ≥ 65 years with hip fractures, ASA score ≥ III, and frailty index ≥5. Participants were randomly assigned to two groups (Group 1: patients who received ESPB; Group 2: patients who received spinal anesthesia). The demographic data, vital signs, and pain scores were recorded preoperatively. Intraoperative and postoperative hemodynamic parameters, sedation levels, complications, pain scores, and analgesic requirements were recorded at specified intervals. Patients were followed-up for mortality on postoperative days 30 and 90. Data were analyzed using SPSS 18.0, and intergroup differences were evaluated using appropriate statistical tests with a 95% confidence interval and significance level of p<0.05. Results: Of the patients, 20 underwent surgery under ESPB and 20 under spinal anesthesia. The demographic variables were similar between the groups. Intraoperatively, diastolic blood pressure at minutes 0 and 45 and mean arterial pressure at minute 45 were significantly lower in the spinal anesthesia group than in the ESPB group (p=0.007, p=0.026, and p<0.05, respectively). The incidence of intraoperative hypotension (p=0.025) and ephedrine requirement (p=0.018) were significantly higher in the spinal anesthesia group, while the requirement for propofol was significantly higher in the ESPB group (p<0.001). In the postoperative intensive care follow-up, the spinal anesthesia group exhibited significantly lower diastolic and mean blood pressure at 6 h, systolic blood pressure at 12 h, and diastolic and mean blood pressure at 18 h than the ESPB group (p=0.032, p=0.032, p=0.028, p=0.027, p=0.020, respectively). The mortality rates within the first 30 days postoperatively and between days 30 and 90 were similar between the groups (p=0.605 and p=0.999, respectively), with no significant difference in the mean day of mortality (p=0.174). Conclusion: Although ESPB was associated with a higher need for sedation (propofol) during the intraoperative period, it provided better hemodynamic stability, demonstrated fewer hypotension-related complications, and showed similar outcomes in terms of postoperative analgesia and mortality compared with spinal anesthesia. Therefore, ESPB can be considered a viable alternative to spinal anesthesia in elderly adult patients with a frailty index of ≥5 undergoing femur fracture surgery.
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
