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Üst Ekstremite Cerrahisi Geçiren ve Periferik Sinir Bloğu Uygulanan Hastalarda Parestezi İnsidansının Değerlendirilmesi

Yıl 2022, Cilt: 75 Sayı: 3, 335 - 341, 18.10.2022

Süheyla Karadağ Erkoç

Öz

Amaç: Ultrasonografi kullanımının yaygınlaşması ile periferik sinir blokları çoğu cerrahi prosedürde etkin bir anestezi tekniği olarak kullanılmaktadır. Bu çalışmada farklı seviyelerde gerçekleştirilen brakiyal pleksus blokajı uygulamalarındaki (supraklaviküler, aksiller ve interskalen) parestezi insidansının değerlendirilmesi amaçlandı.

Gereç ve Yöntem: İbni Sina Hastanesi Ortopedi Ameliyathanesi’nde üst ekstremite cerrahisi için periferik sinir bloğu yapılan hastalar çalışmaya dahil edildi. Hastaların demografik verileri, operasyon tipi ve süresi, brakiyal pleksus bloğu tipi, lokal anestezik dozu, sedasyon ve ek anestezi gereksinimleri hasta kayıtlarından kaydedildi. Postoperatif dönemde 6 aydan uzun süren duyusal veya motor defisit varlığı uzamış parestezi olarak tanımlandı.

Bulgular: Çalışmamıza üst ekstremite cerrahisi geçiren 205 hasta dahil edildi. Bu hastaların %50’si (n=102) el cerrahisi, %25’i (n=51) ön kol ve %25’i (n=51) omuz cerrahisi geçirmişlerdi. Hastaların %44,4’üne (n=91) supraklaviküler blokaj, %29,8’ine (n=61) aksiller blokaj ve %25,6’sına (n=53) interskalen blokaj uygulanmıştı. Hastaların yaş ortalaması 44,44±16,73 idi. %52,2’si (n=107) erkek, %47,8’i (n=98) kadındı. Parestezi insidansı %36,1 (n=74) idi. Hastaların %30,2’si (n=62) uyuşukluk, %25,4’ü (n=52) karıncalanma, %4,4’ü (n=9) normal olmayan his, %16,6’sı (n=34) ağrı ve %23,9’u güçsüzlük bildirdi. Parestezi görülen ve görülmeyen hastalar arasında demografik veriler, uygulanan blokaj türü, sedasyon uygulanması, ameliyat süresi, lokal anestezi miktarları yönünden istatistiksel olarak anlamlı farklılık yoktu (p>0,05). Parestezisi olan hastaların %52,7’sinde (n=39) 6 ay veya daha kısa süre parestezi, %47,3’ünde (n=35) 6 aydan uzun süre parestezi vardı. İstatistiksel olarak anlamlı olmasa da 6 aydan uzun süren parestezi supraklaviküler blok grubunda daha sıktı (p>0,05).

Sonuç: Üst ekstremite periferik sinir bloğunda parestezi insidansı yüksektir ve belirlenmemiş birçok risk faktörü etkili olabilir. Bu nedenle hasta seçimi yapılırken detaylı bir preoperatif değerlendirme yapılmalıdır.

Anahtar Kelimeler

Parestezi Üst Ekstremite Brakiyal Pleksus Sinir Blokajı

Etik Beyan

Çalışmamız için, 18.06.2020 tarihli ve i6- 327-20 karar numarası ile Ankara Üniversitesi Tıp Fakültesi Etik Kurulu’ndan etik onay alınmıştır.

Destekleyen Kurum

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Proje Numarası

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Teşekkür

-

Kaynakça

  • 1. Drasner K. Local anesthetic neurotoxicity: clinical injury and strategies that may minimize risk. Reg Anesth Pain Med. 2002;27:576-580.
  • 2. Pietraszek PM. Regional anaesthesia induced peripheral nerve injury. Anaesthesiol Intensive Ther. 2018;50:367-377.
  • 3. Brull R, McCartney CJ, Chan VW, et al. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104:965-974.
  • 4. Cuvillon P, Ripart J, Lalourcey L, et al. The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg. 2001;93:1045-1049.
  • 5. Watts SA, Sharma DJ. Long-term neurological complications associated with surgery and peripheral nerve blockade: outcomes after 1065 consecutive blocks. Anaesth Intensive Care. 2007;35:24-31.
  • 6. Stan TC, Krantz MA, Solomon DL, et al. The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. A prospective study of 1,000 consecutive patients. Reg Anesth. 1995;20:486-492.
  • 7. Urban MK, Urquhart B. Evaluation of brachial plexus anesthesia for upper extremity surgery. Reg Anesth. 1994;19:175-182.
  • 8. Auroy Y, Benhamou D, Bargues L, et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002;97:1274 1280.
  • 9. Borgeat A, Ekatodramis G, Kalberer F, et al. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology. 2001;95:875-880.
  • 10. Bilbao Ares A, Sabaté A, Porteiro L, et al. Complicaciones neurológicas asociadas a bloqueos interescalénico y supraclavicular guiados con ecografía en cirugía electiva de hombro y extremidad superior. Estudio observacional prospectivo en un hospital universitario [Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital]. Rev Esp Anestesiol Reanim. 2013;60:384-391.
  • 11. Lam KK, Soneji N, Katzberg H, et al. Incidence and etiology of postoperative neurological symptoms after peripheral nerve block: a retrospective cohort study. Reg Anesth Pain Med. 2020;45:495-504.
  • 12. Saba R, Brovman EY, Kang D, et al. A Contemporary Medicolegal Analysis of Injury Related to Peripheral Nerve Blocks. Pain Physician. 2019;22:389- 400.
  • 13. Faryniarz D, Morelli C, Coleman S, et al. Interscalene block anesthesia at an ambulatory surgery center performing predominantly regional anesthesia: a prospective study of one hundred thirty-three patients undergoing shoulder surgery. J Shoulder Elbow Surg. 2006;15:686-690.
  • 14. Barrington MJ, Watts SA, Gledhill SR, et al. Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications. Reg Anesth Pain Med. 2009;34:534-541.
  • 15. Bomberg H, Wetjen L, Wagenpfeil S, et al. Risks and Benefits of Ultrasound, Nerve Stimulation, and Their Combination for Guiding Peripheral Nerve Blocks: A Retrospective Registry Analysis. Anesth Analg. 2018;127:1035- 1043.
  • 16. Neal JM, Barrington MJ, Brull R, et al. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015. Reg Anesth Pain Med. 2015;40:401- 430.
  • 17. Sites BD, Spence BC, Gallagher JD, et al. Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med. 2007;32:107-115.
  • 18. Pham MN, Cunningham-Rundles C. Evaluation of Lymphoproliferative Disease and Increased Risk of Lymphoma in Activated Phosphoinositide 3 Kinase Delta Syndrome: A Case Report With Discussion. Front Pediatr. 2018;6:402.
  • 19. Andersen HL, Andersen SL, Tranum-Jensen J. Injection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis. Reg Anesth Pain Med. 2012;37:410-414.
  • 20. Dhir S, Brown B, Mack P, et al. Infraclavicular and supraclavicular approaches to brachial plexus for ambulatory elbow surgery: A randomized controlled observer-blinded trial. J Clin Anesth. 2018;48:67-72.
  • 21. Maga J, Missair A, Visan A, et al. Comparison of Outside Versus Inside Brachial Plexus Sheath Injection for Ultrasound-Guided Interscalene Nerve Blocks. J Ultrasound Med. 2016;35:279-285.

Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block

Yıl 2022, Cilt: 75 Sayı: 3, 335 - 341, 18.10.2022

Süheyla Karadağ Erkoç

Öz

Objectives: With the widespread use of ultrasonography, peripheral nerve blocks are used as an effective anesthesia technique in most surgical procedures. We aimed to evaluate the incidence of paresthesia in brachial plexus blockade performed at different levels.

Materials and Methods: Patients who underwent peripheral nerve block for upper extremity surgery in Ibni Sina Hospital Orthopedics Operating Room were included in this study. Demographic data of the patients, type and duration of operation, type of brachial plexus block, local anesthetic dose, sedation and additional anesthetic requirement were recorded from patients’ files. The presence of sensory or motor deficits lasting more than 6 months in the postoperative period was defined as prolonged paresthesia.

Results: Our study included 205 patients who underwent upper extremity surgery. Of these patients, 50% (n=102) had hand surgery, 25% (n=51) had forearm surgery, and 25% (n=51) had shoulder surgery. Supraclavicular blockade was performed in 44.4% (n=91), axillary blockade in 29.8% (n=61), and interscalene blockade in 25.6% (n=53). The mean age of the patients was 44.44±16.73 years. 52.2% (n=107) were male and 47.8% (n=98) were female. The incidence of paresthesia was 36.1% (n=74). Among the patients, 30.2% (n=62) reported numbness, 25.4% (n=52) reported tingling, 4.4% (n=9) reported abnormal sensation, 16.6% (n=34) reported pain, and 23.9% reported weakness. There was no statistically significant difference between patients with and without paresthesia in terms of demographic data, type of blockade, sedation, duration of surgery, and amount of local anesthesia (p>0.05). 52.7% (n=39) of patients had paresthesia for 6 months or less, 47.3% (n=35) had paresthesia longer than 6 months. Although not statistically significant, paresthesia lasting longer than 6 months was more common in the supraclavicular blockade group (p>0.05).

Conclusion: The incidence of paresthesia is high in upper extremity peripheral nerve block and many undetermined risk factors may be effective. Therefore, a detailed preoperative evaluation should be performed when selecting patients.

Anahtar Kelimeler

Paresthesia Upper Extremity Brachial Plexus Nerve Blockade

Etik Beyan

-

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Kaynakça

  • 1. Drasner K. Local anesthetic neurotoxicity: clinical injury and strategies that may minimize risk. Reg Anesth Pain Med. 2002;27:576-580.
  • 2. Pietraszek PM. Regional anaesthesia induced peripheral nerve injury. Anaesthesiol Intensive Ther. 2018;50:367-377.
  • 3. Brull R, McCartney CJ, Chan VW, et al. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104:965-974.
  • 4. Cuvillon P, Ripart J, Lalourcey L, et al. The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg. 2001;93:1045-1049.
  • 5. Watts SA, Sharma DJ. Long-term neurological complications associated with surgery and peripheral nerve blockade: outcomes after 1065 consecutive blocks. Anaesth Intensive Care. 2007;35:24-31.
  • 6. Stan TC, Krantz MA, Solomon DL, et al. The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. A prospective study of 1,000 consecutive patients. Reg Anesth. 1995;20:486-492.
  • 7. Urban MK, Urquhart B. Evaluation of brachial plexus anesthesia for upper extremity surgery. Reg Anesth. 1994;19:175-182.
  • 8. Auroy Y, Benhamou D, Bargues L, et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002;97:1274 1280.
  • 9. Borgeat A, Ekatodramis G, Kalberer F, et al. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology. 2001;95:875-880.
  • 10. Bilbao Ares A, Sabaté A, Porteiro L, et al. Complicaciones neurológicas asociadas a bloqueos interescalénico y supraclavicular guiados con ecografía en cirugía electiva de hombro y extremidad superior. Estudio observacional prospectivo en un hospital universitario [Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital]. Rev Esp Anestesiol Reanim. 2013;60:384-391.
  • 11. Lam KK, Soneji N, Katzberg H, et al. Incidence and etiology of postoperative neurological symptoms after peripheral nerve block: a retrospective cohort study. Reg Anesth Pain Med. 2020;45:495-504.
  • 12. Saba R, Brovman EY, Kang D, et al. A Contemporary Medicolegal Analysis of Injury Related to Peripheral Nerve Blocks. Pain Physician. 2019;22:389- 400.
  • 13. Faryniarz D, Morelli C, Coleman S, et al. Interscalene block anesthesia at an ambulatory surgery center performing predominantly regional anesthesia: a prospective study of one hundred thirty-three patients undergoing shoulder surgery. J Shoulder Elbow Surg. 2006;15:686-690.
  • 14. Barrington MJ, Watts SA, Gledhill SR, et al. Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications. Reg Anesth Pain Med. 2009;34:534-541.
  • 15. Bomberg H, Wetjen L, Wagenpfeil S, et al. Risks and Benefits of Ultrasound, Nerve Stimulation, and Their Combination for Guiding Peripheral Nerve Blocks: A Retrospective Registry Analysis. Anesth Analg. 2018;127:1035- 1043.
  • 16. Neal JM, Barrington MJ, Brull R, et al. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015. Reg Anesth Pain Med. 2015;40:401- 430.
  • 17. Sites BD, Spence BC, Gallagher JD, et al. Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med. 2007;32:107-115.
  • 18. Pham MN, Cunningham-Rundles C. Evaluation of Lymphoproliferative Disease and Increased Risk of Lymphoma in Activated Phosphoinositide 3 Kinase Delta Syndrome: A Case Report With Discussion. Front Pediatr. 2018;6:402.
  • 19. Andersen HL, Andersen SL, Tranum-Jensen J. Injection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis. Reg Anesth Pain Med. 2012;37:410-414.
  • 20. Dhir S, Brown B, Mack P, et al. Infraclavicular and supraclavicular approaches to brachial plexus for ambulatory elbow surgery: A randomized controlled observer-blinded trial. J Clin Anesth. 2018;48:67-72.
  • 21. Maga J, Missair A, Visan A, et al. Comparison of Outside Versus Inside Brachial Plexus Sheath Injection for Ultrasound-Guided Interscalene Nerve Blocks. J Ultrasound Med. 2016;35:279-285.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Anesteziyoloji
Bölüm Makaleler
Yazarlar

Süheyla Karadağ Erkoç 0000-0001-5086-5916

Proje Numarası -
Yayımlanma Tarihi 18 Ekim 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 75 Sayı: 3

Kaynak Göster

APA Karadağ Erkoç, S. (2022). Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 75(3), 335-341. https://doi.org/10.4274/atfm.galenos.2022.31932
AMA Karadağ Erkoç S. Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ekim 2022;75(3):335-341. doi:10.4274/atfm.galenos.2022.31932
Chicago Karadağ Erkoç, Süheyla. “Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75, sy. 3 (Ekim 2022): 335-41. https://doi.org/10.4274/atfm.galenos.2022.31932.
EndNote Karadağ Erkoç S (01 Ekim 2022) Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75 3 335–341.
IEEE S. Karadağ Erkoç, “Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 75, sy. 3, ss. 335–341, 2022, doi: 10.4274/atfm.galenos.2022.31932.
ISNAD Karadağ Erkoç, Süheyla. “Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75/3 (Ekim 2022), 335-341. https://doi.org/10.4274/atfm.galenos.2022.31932.
JAMA Karadağ Erkoç S. Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2022;75:335–341.
MLA Karadağ Erkoç, Süheyla. “Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 75, sy. 3, 2022, ss. 335-41, doi:10.4274/atfm.galenos.2022.31932.
Vancouver Karadağ Erkoç S. Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2022;75(3):335-41.
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