Kasık Fıtığı Cerrahisinde Anestezi
Özet
Kasık fıtığı cerrahisinde anestezi seçimi; hastanın durumu, komorbiditeleri, cerrahi teknik (açık veya laparoskopik), hekim ve hasta tercihleri ile maliyete göre belirlenir. Preoperatif dönemde hastaların geçmişi, hava yolu durumları ve risk faktörleri detaylıca değerlendirilmeli, cerrah ile iş birliği yapılmalıdır. Açık onarımlarda rejyonel yöntemler ön plandayken, laparoskopik cerrahide tam hava yolu kontrolü gerekliliği nedeniyle genel anestezi uygulanır. Genel anestezi indüksiyonu intravenöz ajanlarla başlar ve inhalasyon gazlarıyla sürdürülür; endotrakeal tüp veya laringeal maske kullanılabilir. Nöroaksiyel anestezi teknikleri arasında en sık spinal anestezi tercih edilirken, epidural, kombine spinal-epidural ve çocuklarda genel anesteziye ek olarak kaudal anestezi de uygulanmaktadır. Son yıllarda, hastanın operasyon esnasında öksürebilmesi gibi cerrahi avantajlar sağlayan, genel ve spinal anestezinin yan etkilerinden kaçınmayı mümkün kılan lokal anestezi uygulamalarına ilgi yeniden artmıştır. Postoperatif dönemde ise ağrı yönetimini optimize etmek, opioid ihtiyacını ve kronik ağrı riskini azaltmak amacıyla multimodal analjezi yaklaşımları benimsenmektedir. Bu kapsamda transversus abdominis plan (TAP), ilioinguinal/iliohipogastrik sinir (İİSB), transversalis fasya plan (TFP), paravertebral (PVB) ve quadratus lumborum plan (QLB) gibi trunkal sinir blokları ultrasonografi eşliğinde güvenle uygulanmaktadır.
The choice of anesthesia in inguinal hernia surgery is determined based on the patient's condition, medical comorbidities, surgical technique (open or laparoscopic), physician and patient preferences, and costs. During the preoperative period, patients' medical history, airway status, and risk factors must be thoroughly evaluated in collaboration with the surgeon. Regional methods are preferred in open repairs, whereas general anesthesia is mandated in laparoscopic surgeries due to the necessity of complete airway control. General anesthesia induction begins with intravenous agents and is maintained with inhalation gases, utilizing either an endotracheal tube or a laryngeal mask. Among neuraxial anesthesia techniques, spinal anesthesia is most frequently preferred, while epidural, combined spinal-epidural, and caudal anesthesia—the latter commonly combined with general anesthesia in pediatric patients—are also utilized. In recent years, there has been a renewed interest in local anesthesia, which offers surgical advantages such as allowing the patient to cough during the operation and avoiding the adverse effects of general and spinal anesthesia. In the postoperative period, multimodal analgesia approaches are adopted to optimize pain management, reduce opioid requirements, and prevent chronic pain. Within this scope, ultrasound-guided trunk nerve blocks, including transversus abdominis plane (TAP), ilioinguinal/iliohypogastric nerve, transversalis fascia plane (TFP), paravertebral (PVB), and quadratus lumborum (QLB) blocks, are safely performed.
Referanslar
Butterworth JF, Mackey DC, Wasnick JD. Neuromuscular blocking agents. In: Morgan & Mikhail Clinical Anesthesiology. 6th ed. NY: McGraw-Hill; 2021. p. 324-362.
O’Dwyer PJ, Serpell MG, Millar K, et al. Local or general anesthesia for open hernia repair: A randomised trial. Annals of Surgery. 2003;237(4): 574-579. doi: 10.1097/01.sla.0000059992.76731.64
Nordin P, Staffan H, Willem V, Erik N. Choice of anesthesia and risk of reoperation for recurrence in groin hernia repair. Annals of Surgery. 2004;240(1): 187-92. doi: 10.1097/01.sla.0000130726.03886.93
Burney R, Prabhu M, Greenfield M, Amy S, Michael O. Comparison of spinal vs general anesthesia via laryngeal mask airway in inguinal hernia repair. Archives of Surgery. 2004;139(2): 183–187. doi: 10.1001/archsurg.139.2.183
Butterworth JF, Mackey DC, Wasnick JD. Inhalation anesthetics. In: Butterworth JF, Mackey DC, Wasnick JD (eds.) Morgan & Mikhail Clinical Anesthesiology. 6th ed. NY: McGraw-Hill; 2021. p. 244-279.
Butterworth JF, Mackey DC, Wasnick JD. Intravenous anesthetics. In: Morgan & Mikhail Clinical Anesthesiology. 6th ed. NY: McGraw-Hill; 2021. p. 280-305.
Warren D, Neal J, Bernards C. Neuraxial Anesthesia. In: Longnecker DE, Newman MF, Zapol WM, Brown DL (eds.) Anesthesiology. 2nd Ed. NY: McGraw-Hill, 2007; p. 786–807.
Brull R, Macfarlane A, Chan W. Spinal, Epidural, and Caudal Anesthesia. In: Miller RD. Miller’s Anesthesia. 8th ed. Philadelphia: Elseviers. 2015; p. 1684-1720.
Neal JM, Bernards CM, Hadzic A, Hebl JR, Hogan QH, Horlocker TT, et al. ASRA Practice advisory on neurologic complications in regional anesthesia and pain medicine. Regional Anesthesia & Pain Medicine. 2008;33(5): 404–415. doi: 10.1016/j.rapm.2008.07.527
Horlocker TT, Schroeder DR. Neuraxial anesthesia and analgesia in patients with preexisting central nervous system disorders. Regional Anesthesia and Pain Medicine. 2006;103(1): 223–228. doi: 10.1213/01.ane.0000220896.56427.53
Wedel DJ, Horlocker TT. Regional Anesthesia in the Febrile or Infected Patient. Regional Anesthesia and Pain Medicine. 2006;31(4): 324–33. doi:10.1016/j.rapm.2006.04.003
Foster RH, Markham A. Levobupivacaine; A review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59(3): 551-579. doi:10.2165/00003495-200059030-00013
Kehlet H., Nielsen MB. Anaesthetic practice for groin hernia repair- a nation- wide study in Denmark 1998-2003. Acta Anaesthesiologica Scandinavia. 2005;49(2): 143-146. doi: 10.1111/j.1399-6576.2004.00600.x
Visser WA, Lee RA, Gielen MJM. Factors affecting the distribution of neural blockade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracic epidural anesthesia. Anesthesia & Analgesia. 2008;107(2): 708–721. doi: 10.1213/ane.0b013e31817e7065
Butterworth JF, Mackey DC, Wasnick JD. Spinal, epidural, & caudal blocks. In: Morgan & Mikhail Clinical Anesthesiology. 6th ed. NY: McGraw-Hill; 2021. p. 1598-1664.
Butterworth JF, Mackey DC, Wasnick JD. Inhalation anesthetics. In: Morgan & Mikhail Clinical Anesthesiology. 6th ed. NY: McGraw-Hill; 2021. p. 1493-1523.
Gultekin FA, Kurukahvecioglu O, Karamercan A, et al. A prospective comparison of local and spinal anesthesia for inguinal hernia repair. Hernia. 2007;11(2): 153-156. doi.org/10.1007/s10029-006-0166-3
Kulakçıoğlu H. Kasık fıtıklarının cerrahi tedavisinde adım-adım lokal anestezi tekniği “Teknik Not” . Ulusal Cerrahi Dergisi. 2012;28(3): 164-168. doi: 10.5152/UCD.2012.10
Kulakcıoglu H. Current options in inguinal hernia repair in adult patients. Hippokratia. 2011;15(3): 223–231.
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4): 343–403. doi: 10.1007/s10029-009-0529-7
Okur O, Tekgul ZT, Erkan N. Comparison of efficacy of transversus abdominis plane block and iliohypogastric/ilioinguinal nerve block for postoperative pain management in patients undergoing inguinal herniorrhaphy with spinal anesthesia: a prospective randomized controlled open-label study. Journal of Anesthesia. 2017;31(5): 678–685. doi:10.1007/s00540-017-2378-3
Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001;56(10): 1024-1026. doi:10.1046/j.1365-2044.2001.02279-40.x
Demirci AEE, Türker G, Gurbet A, Kaya FN, Anil A, Çimen I. Iliohypogastric/ilioinguinal nerve block in inguinal hernia repair for postoperative pain management: comparison of the anatomical landmark and ultrasound guided techniques. Revista Brasileira de Anestesiologia. 2014;64(5): 350–356. doi:10.1016/j.bjan.2014.01.001
Hebbard PD. Transversalis fascia plane block, a novel ultrasound-guided abdominal wall nerve block. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie. 2009;56(8): 618–620. doi:10.1007/s12630-009-9110-1
Karmakar MK: Thoracic paravertebral block. Anesthesiology.2001;95(3): 771-780. doi:10.1097/00000542-200109000-00033
Blanco R. Tap block under ultrasound guidance: the description of a “no pops” technique. Regional anesthesia and pain medicine. 2007;32(5): 130. doi:10.1016/j.rapm.2007.06.268
Elsharkawy H. Quadratus Lumborum Blocks. Advances in anesthesia. 2017;35(1): 145-57. doi:10.1016/j.aan.2017.07.007
