Ameliyat Planlanan Multitravmalı Bir Hastada Bilateral İnfraklaviküler Blok Uygulaması
Özet
Araç içi trafik kazası sonrası bilateral el bileği kırığı nedeniyle ameliyat planlanan hastanın preoperatif değerlendirmesinde yüzünde abrazyonlar, rakun göz ve göğüs bölgesinde yer yer ekimoz görüldü. Beyin, toraks ve batın radyolojik görüntülemesinde birkaç kontüzyon alanı dışında patoloji görülmedi. Üst ekstremite cerrahisi yaygın olarak karşılaşılan ve genellikle anestezide genel ya da nöroaksiyel blok tercih edilen bir cerrahi türüdür. Son yıllarda nüfus yaşlanmasına paralel ameliyat olan yaşlı hasta sayısında büyük bir artış gözlenmektedir. Yaşlı hastalar sıklıkla birçok ek hastalık yanında kırılgan bir fizyolojiye sahip olması uygulanacak anestezi yönteminde ciddi zorluklara yol açmaktadır. Özellikle ultrasonagrafi (USG)’in anestezide kullanımı, periferik sinir bloklarının uygulanmasında başarı ve güvenlikte artış sağlayarak bu blokların yaygınlaşmasına katkı sağlamıştır. Bu çalışma yaşlı, ek hastalığı ve multitravmaya bağlı akciğer kontüzyonu olan hastaya USG eşliğinde bilateral infraklavikuler blok yapılarak ameliyatı başarılı şekilde tamamlan olgumuz üzerinden üst eksremite bloklarına güncel bir bakış açısı sunmaktadır.
During the preoperative evaluation of a patient scheduled for surgery due to a bilateral wrist fracture following an in-vehicle traffic accident, facial abrasions, raccoon eyes, and scattered ecchymoses in the chest region were observed. Brain, thorax, and abdominal radiological imaging revealed no pathology other than a few areas of contusion. Upper extremity surgery is a commonly encountered type of surgery, for which general anesthesia or neuroaxial blocks are generally preferred. In recent years, a significant increase has been observed in the number of elderly patients undergoing surgery, in parallel with the aging population. The fact that elderly patients frequently have a fragile physiology alongside multiple comorbidities poses serious challenges in the choice of anesthetic method. In particular, the use of ultrasonography (USG) in anesthesia has contributed to the widespread adoption of peripheral nerve blocks by increasing the success and safety of their application. This study presents a current perspective on upper extremity blocks through our case, an elderly patient with comorbidities and pulmonary contusion due to multi-trauma, whose surgery was successfully completed by performing a USG-guided bilateral infraclavicular block.
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