Tıpta Uzmanlık Tezleri
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12645/18341
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Browsing Tıpta Uzmanlık Tezleri by Subject "Anestezi ve Reanimasyon"
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Publication Bel cerrahisi uygulanmış ve uygulanmamış kronik bel ağrılı hastalarda epiduroskopik adezyolizis-nöroplasti etkinliğinin karşılaştırılması(2016) ÖLÇÜLÜ, İbrahim HakkıIntroduction and Aim: Chronic lumbar pain is an important and common problem that effects life quality, social and psychological situation of many people. There are a lot of treatment modailities although it is important to choose appropriate modality to each patient. Epiduroscopic minimally invasive procedures are one of these modalities that's prevalent is raising rapidly at recent times. With technological progress, goal-directed drug enjections in company with direct epidural endoscopic visualisation to narrow nerve roots and affected nerves, also breaking down adhesions with both chemical and mechanical impact of these drugs had became one of the most interesting treatment modalities for protecting patient's comfort with minimalizing surgical technics' complications at patients who were non-response to conservative treatments at chronical lumbar pain patients who were diagnosed radiologically and clinically lumbar spinal stenosis and failed back surgery syndrome. We aimed at our study to compare effectivity of this procedure named Epiduroscopic Adhesiolysis-Neuroplasty at patients who have failed back surgery syndrome that seems frequent ethiological factor of this stenozis against patients who have not lumbar surgery before. Material and Method: 41 patients aged 18-80, ASA I-II-III who have chronic lumbar back pain complain, clinically and radiologically confirmed lumbar spinal stenosis diagnose or failed back surgery syndrome (postoperatif lumbar laminectomy-hemilaminectomy, lumbar disk herniation, posterior spinal stabilization) diagnose (FBSS) that Epiduroscopic Adhesiolysis-Neuroplasty procedure planned involved to our study. Patients spitted two groups, have lumbar surgery before (group 0) and no lumbar surgery history (group N). All patients' VAS values before procedure examined by an independent researcher. Patients that enteral intake has stop an appropriate time ago, are given midazolam and premedication before positioned prone at surgery table, been routine monitorisation then. Operation field is sterilised with appropriate methods, patients are applied conscious anestesia with fentanile and propofole, local anestesia applied to sacral hiatus area with lidocaine. Entered at Sacral Hiatus, epiduroscop settled with Seldinger technique after confirming that needle is epidural space with scopy. 20-60 cc %0,9 NaCl is appiled to epidural space as slow infusons. Affected nerve roots are detected with camera screening and 40 mg metiilprednisolone and 60 mg lidocaine combination injected to the targetted nerve root region, at the same time mechanical adhesiolisis is made to adhesion areas by catheter with slow manipulations. After epiduroscope is removed, medical dressing is made to surgical area and procedure is terminated. Patients are called for control at 1.-2.-3. months, asked and recorded VAS values. Results: In our study, there isn't significant difference at demorafical datas (age-sex) between patients. There is significant decrease at 1.-2.-3. months VAS values comparing before procedure at both groups. At comparing two groups, there is no significant difference at decrease in 1.-2.-3. months VAS values between groups that have lumbar surgery operation nor have not. Conclusion: In our study, 'Epiduroscopic Adhesiolysis-Neuroplasty' procedure resulted significant relief in cronic lumbar back pain at patients who had diagnosed as LSS and FBSS. However, there is no superiority to reduce patient's pain who have lumbar surgery operation compairing patients have no operation history.Publication Kalça protezlerinde postoperatif analjezi için kullanılan epidural infüzyon ve bolus tekniklerinin karşılaştırılması(2015) Güler, Emine YılmazObjective: Our objective is to compare the effectiveness of epidural bolus administration to continuous EI in posoperative pain treatment after total hip arthroplasty. Material and Methods: 60 patients, who are planned to have hip arthroplasty operation, in ASA 1-3 category, aged between 40 and 70, receiving combined spinal epidural anlgesia, are included in the study The patients in both groups are administered spinal anesthesia with 3 mL heavy bupivakain (Marcain®) through L3-L4 or L4-L5 space. Later a catheter is placed into the epidural space. The catheter is shown not to be placed in the intravenenous space by administering 10 μg adrenalin and 10 mg lidokain. The pulse value, systolic and diastolic blood pressure values, oxygen, stauration values, Bromage Scores are recoded before and after spinal anasthesia and 20, 25, 30, 40, 50, 60, 70, 80, 90, 110, 130 minutes after administering the spinal anesthesia. 330 ml solution with %0.125 bupivacain is prepared for analgesia after operation. Patient controlled analgesia (PCA) devices are prepared. The patients are randomly divided into two groups. For Group B, PCA device is adjusted to administer 6 ml/hour bolus with 30 minutes lockout time through epidural catheter for 48 hours. For Group İ, PCA device is adjusted to administer 6 ml infusion and 6 ml bolus with 30 minutes lockout time through epidural catheter for 48 hours. The KAH, OAB and SpO2 values at hours 12, 24 and 48, and at the time first sit and walker are compared between two groups. Moreover patient and surgeon satisfaction scores, VAS and VAS-H, motor block levels, the attempted, administered and total consumed drug levels through PCA device, the extra analgesia administered and the side effects are compared between two groups. Results: The values of VAS at hours 24 and 48 was significantly lower in Group B (p<0.05). Total consumed analgesia levels were significantly higher in Group İ at first sit, walker use, and at postop 12, 24 and 48 hours (p<0.0001). Surgeon and patient satisfaction scores were significantly higher in Group B at all time invervales (p<0.05). Extra analgesia consumption was significantly higher in Group İ at 24 and 48 hours. Motor block levels which is observed postoperatively were higher in Group İ at hours 12 and 24 (p<0.05). There were no side effects in both groups. Conclusion: We concluded that in arthoplasty operations, administration of intermittent bolus doses with PCA devices without an epidural infusion provides better postoperative analgesia high surgeon and patient satisfaction scores, with lower analgesic usage and without any motor block or side effects.