Publication: Sünnet sonrası analjezi amacı ile kaudal blok, dorsal penil bloğu, topikal analjezi ve sistemik analjezinin karşılaştırılması
Abstract
Çalışmamızın amacı; sünnet operasyonu geçirecek çocuklarda postoperatif analjezi amacı ile kaudal blok, dorsal penil bloğu, topikal ve sistemik analjezinin etkinlik, yan etkiler ve ebeveyn memnuniyeti açısından karşılaştırılmasıdır. Etik kurul ve ebeveyn onayı sonrası, 3-12 yaş arasında, sünnet operasyonu geçirecek 80 çocuk randomize olarak dört gruba (n=20) ayrıldı. İndüksiyon sonrasında Grup KA‟de %0,25 bupivakain 1ml/ kg ile kaudal blok, Grup DP‟de 0.3ml/ kg %0,25 bupivakain ile dorsal penil blok uygulandı. Grup TA‟de girişimden 1s önce 3gr %2,5 lidokain-%2,5 prilokain karışımı içeren krem ile topikal analjezi, Grup SA‟da indüksiyon sonrası 40 mg/ kg rektal parasetamol, postoperatif dönemde 4x20 mg/ kg rektal/ oral parasetamol, 3x1 mg/ kg meperidin iv ile sistemik analjezi uygulandı. Anestezi indüksiyonu %8 sevofluran ve %30 O2 içinde N2O inhalasyonu veya tiyopental 5-7 mg/ kg iv, anestezi idamesi 1 MAC sevofluran, %30 O2 içinde N2O ile sağlandı. Ağrı şiddeti; NRS ve sözel iletişim kurulamayan hastalarda CHEOPS ile postoperatif 0,2,4,6,12,24. saatlerde değerlendirildi. Ek analjezik gerektiğinde meperidin 1mg/ kg IV uygulandı. Hastaların uyanma zamanı, ilk analjezik gereksinim, ilk idrar yapma, ilk mobilizasyon ve taburculuk zamanı, yan etkiler, 4-puanlı skala ile ebeveyn memnuniyeti kaydedildi. Veriler istatistiksel olarak iki-yönlü ANOVA, Tukey-Kramer, Mann-Whitney U ve ki-kare testleri ile karşılaştırıldı (p<0.05). Peroperatif sevofluran konsantrasyonu 15. dakikada Grup KA‟da diğer gruplardan düşük bulundu (p<0,05). Postoperatif ilk saat CHEOPS değerleri Grup KA ve Grup DP‟de diğer gruplardan, ilk 2 saat NRS değerleri Grup KA‟da Grup TA ve Grup SA‟dan düşük bulundu (p<0,05). Ek analjezik gereken hasta oranı Grup KA ve Grup DP‟de diğer gruplardan düşük bulundu (p<0,05). Gruplar arasında uyanma, ilk analjezik gereksinim, ilk mobilizasyon, ilk idrar yapma zamanı ve motor blok açısından belirgin farklılık saptanmadı (p>0,05). Ebeveyn memnuniyeti ilk 2s Grup KA‟da diğer gruplardan, Grup DP‟de ise Grup TA ve Grup SA‟dan belirgin yüksek bulundu (p<0,05). Sünnet sonrası analjezi sağlamak açısından, kaudal ve dorsal penil bloğun topikal ve sistemik analjeziden daha etkin olduğu ve daha yüksek ebeveyn memnuniyeti sağladığı saptandı.
The aim of our study was to compare the postoperative analgesic effect, side effects and parent satisfaction of caudal block, dorsal penile block, topical and systemic analgesia in children undergoing circumcision. After ethics committee approval and parental written concent, eighty children aged between 3-12 years, undergoing circumsicion were randomised into four groups (n=20). After induction, Group KA received caudal block with 0.25% bupivacain 1ml/ kg; Group DP received dorsal penile block with 0.25% bupivacain 0.3ml/ kg; Group TA received topical cream consisting of 3gr 2.5% lidocain and 2.5% prilocain 1 hour before operation and Group SA received 40mg/ kg rectal/ oral paracetamol, 3x1 mg/ kg meperidine iv postoperatively. General anesthesia was induced with 8% sevoflourane and N2O inhalation in 30% O2 or thiopental 5-7 mg/ kg iv and was maintained with 1 MAC sevoflourane and N2O in 30% O2. The severity of pain was measured with NRS and with CHEOPS in children who colud not express pain severity at postoperative 0, 2nd, 4th, 6th, 12th and 24th hours. When additional analgesia was required, meperidine 1mg/ kg IV was administered. Patients' awakening time, first analgesic requirement time, first urination, mobilisation and discharge times, side effects and parental satisfaction according to a 4 point scale was measured. Data was statistically analysed with two-way ANOVA, Tukey-Kramer, Mann-Whitney U and chi-square tests. (p<0.05). The peroperative sevoflourane concentration was found to be lower in group KA at 15th minute (p<0,05). At postoperative first hour, the CHEOPS values were lower in Group KA and Group DP compared to other groups and in the first 2 hours the NRS values were lower in Group KA compared to Groups TA and SA (p<0,05). The need for additional analgesia was lower in Group KA and DP compared to other groups (p<0,05). No significant difference was found in awakening, first analgesic need, mobilisation and urination times (p>0,05). Parental satisfacsatisfaction was higher in Group KA compared to other groups and higher in Group DP compared to Groups TA and SA (p<0,05). With regard to postoperative analgesia after circumcision, caudal and dorsal penile block were found more effective and had higher parental satisfaction compared to topical and systemic analgesia during early postoperative period.
The aim of our study was to compare the postoperative analgesic effect, side effects and parent satisfaction of caudal block, dorsal penile block, topical and systemic analgesia in children undergoing circumcision. After ethics committee approval and parental written concent, eighty children aged between 3-12 years, undergoing circumsicion were randomised into four groups (n=20). After induction, Group KA received caudal block with 0.25% bupivacain 1ml/ kg; Group DP received dorsal penile block with 0.25% bupivacain 0.3ml/ kg; Group TA received topical cream consisting of 3gr 2.5% lidocain and 2.5% prilocain 1 hour before operation and Group SA received 40mg/ kg rectal/ oral paracetamol, 3x1 mg/ kg meperidine iv postoperatively. General anesthesia was induced with 8% sevoflourane and N2O inhalation in 30% O2 or thiopental 5-7 mg/ kg iv and was maintained with 1 MAC sevoflourane and N2O in 30% O2. The severity of pain was measured with NRS and with CHEOPS in children who colud not express pain severity at postoperative 0, 2nd, 4th, 6th, 12th and 24th hours. When additional analgesia was required, meperidine 1mg/ kg IV was administered. Patients' awakening time, first analgesic requirement time, first urination, mobilisation and discharge times, side effects and parental satisfaction according to a 4 point scale was measured. Data was statistically analysed with two-way ANOVA, Tukey-Kramer, Mann-Whitney U and chi-square tests. (p<0.05). The peroperative sevoflourane concentration was found to be lower in group KA at 15th minute (p<0,05). At postoperative first hour, the CHEOPS values were lower in Group KA and Group DP compared to other groups and in the first 2 hours the NRS values were lower in Group KA compared to Groups TA and SA (p<0,05). The need for additional analgesia was lower in Group KA and DP compared to other groups (p<0,05). No significant difference was found in awakening, first analgesic need, mobilisation and urination times (p>0,05). Parental satisfacsatisfaction was higher in Group KA compared to other groups and higher in Group DP compared to Groups TA and SA (p<0,05). With regard to postoperative analgesia after circumcision, caudal and dorsal penile block were found more effective and had higher parental satisfaction compared to topical and systemic analgesia during early postoperative period.