Usporedba postoperativnog analgetskog učinka UZV-om vođenog FICB (eng. Fascia Iliaca Compartment Block) i intratekalnog morfija nakon operativnog liječenja frakture kuka učinjenog u unilateralnoj hipobaričnoj spinalnoj anesteziji

professional thesis

• Title (english): Comparison of ultrasound-guided FICB (Fascia Iliaca Compartment Block) and intrathecal morphine after hip fracture surgery in unilateral hypobaric spinal anesthesia
• Author: Antonija Vrbanić Šutalo
• Mentor: Tihana Magdić Turković (mentor)
• Mentor: Tomislav Radočaj (komentor)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2024-10-03, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Starenjem populacije raste i broj pacijenata s prijelomom kuka, a kirurški zahvat je standard u liječenju istih. Operativno liječenje uključuje vrstu osteosinteze, tzv. gamma nail (GN), dinamični kompresivni vijak (DHS), parcijalnu (PEP) ili totalnu endoprotezu kuka (TEP). Operativno liječenje prijeloma kuka može se obaviti u općoj ili regionalnoj anesteziji (obuhvaća neuroaksijalnu anesteziju i periferne živčane blokove). Odabir anestezije ovisi o komorbiditetima pacijenta i trajanju zahvata (1). Spinalnom anestezijom se lokalni anestetik, sam ili u kombinaciji s drugim lijekovima, primjenjuje intratekalno s ciljem anestezije ispod mjesta primjene. Ovisno o baricitetu otopine lijeka za intratekalnu primjenu u odnosu na cerebrospinalni likvor, razlikujemo izobaričnu, hiperbaričnu i hipobaričnu otopinu. Adekvatna postoperativna analgezija je vrlo važna jer doprinosi boljoj fizikalnoj terapiji, ranijoj mobilizaciji te smanjenju incidencije postoperativnih komplikacija poput upale pluća, dekubitusa te duboke venske tromboze. Sistemski učinci parenteralno primijenjenih analgetika mogu se izbjeći primjenom perifernih živčanih blokova.
Pacijenti su bili podijeljeni u dvije skupine primjenom generatora nasumičnih brojeva. Prva grupa je kao mješavinu za spinalnu anesteziju dobila 0.5%-tni levobupivakain 1.5 mL, morfij 80 mcg i sterilnu vodu 1 mL, a druga grupa 0.5%-tni levobupivakain 1.5 mL i sterilnu vodu 1 mL uz postoperativno učinjen S-FICB vođen UZV-om kojim je primijenjen 0.2%-tni levobupivakain 30-40 ml ovisno o težini pacijenta. Postoperativno se bilježila primjena analgetika parenteralno i jačina boli koristeći NRS skalu.
Istraživanjem je dokazano da je ultrazvukom vođen S-FICB dobra alternativa intratekalno primijenjenom morfiju za analgeziju pacijenata s prijelomom kuka. Sve više pažnje je posvećeno FICB-u, no nema dovoljno dokaza na kojima bi se temeljile preporuke za idealan pristup kod izvođenja FICB.

Abstract (english)

As the population gets older, incidence of hip fracture increases too and timely surgery is a standard in managing these patients. Operative treatment includes „Gamma nail“ (a type of osteosynthesis), DHS, partial and total hip replacement. Hip surgery can be performed under general or regional anesthesia (includes neuroaxial anesthesia and peripheral nerve blocks). The choice of anesthesia depends on patient comorbidities and the duration of the procedure (1). In performing spinal anesthesia, a local anesthetic, alone or in combination with other drugs, is administered intratechally. Depending on the baricity of the drug solution for intrathecal administration in relation to cerebrospinal fluid, we distinguish isobaric, hyperbaric and hypobaric solution.
Adequate postoperative analgesia is important because it contributes to better physical therapy, earlier mobilization and a reduction in the incidence of postoperative complications such as pneumonia, pressure ulcers and deep vein thrombosis. Systemic effects of parenterally given analgesics can be avoided by performing peripheral nerve blocks.
Patients were divided into two groups using a random number generator. The first group received 0.5% levobupivacaine 1.5 mL, intrathecal morphine 80 mcg and sterile water 1 mL, as a mixture for spinal anesthesia, and the second group received 0.5% levobupivacaine 1.5 mL and sterile water 1 mL with postoperative ultrasound performed suprainguinal FICB using 0.2% levobupivacaine 30-40 ml depending on the weight of the patient. Postoperatively, the use of parenteral analgesics and pain intensity were recorded using the NRS.
Ultrasound-guided S-FICB is a good alternative to intrathecally given morphine in providing postoperative analgesia in patients with hip fracture. There is good evidence that peripheral nerve blocks provide effective analgesia in the hip fracture patients, but there is insufficient evidence to make guidelines regarding the optimal approach.

• Keywords: levobupivakain; hipobarična spinalna anestezija; S-FICB; intratekalni morfij; UZV
• Keywords (english): levobupivacaine; hypobaric spinal anesthesia; S-FICB; intrathecal morphine; US
• Language: croatian
• URN:NBN: urn:nbn:hr:105:969394
• Study programme: Title: Anesthesiology, reanimatology and intensive care medicine; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/magistra anesteziologije, reanimatologije i intenzivne medicine (sveučilišni/a magistar/magistra anesteziologije, reanimatologije i intenzivne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-12-05 08:05:31