Çocuk Yaş Grubu Hastalarda Uygulanan Rektus Kılıf Bloğunda Yayılım Mesafesinin Retrospektif Olarak Değerlendirilmesi
Özet
Objective: Regional anesthesia techniques are gaining importance in
pediatric surgery. However, clear information about the distribution of the injected
local anesthetic is not available yet. In this study, we aim to provide a prediction
about the distribution of local anesthetic in the pediatric age group by choosing a
certain volume according to weight and the injection site over the surgical incision to
be made.
Materials and Methods: Patients age 0-8 years who underwent elective
surgery (umbilical hernia, laparoscopic appendectomy, laparoscopic ovarian cyst
excision or laparoscopic orchiopexy) involving midline incision between January 01
and July 01, 2022 by Pediatric Surgery were included. A rectus sheath block was
applied to all patients included in the study, under general anesthesia, before the
surgical incision. Injections were applied under ultrasound guidance from lateral to
medial, targeting the lateral edge of the rectus sheath, and ultrasound imaging
confirmed whether the extension completely covered the planned surgical incision,
and the cranial and caudal spread distances on the left and right sides were recorded
in the anesthesia report. The anesthesia follow-up form and the preoperative
anesthesia evaluation form in the files of the patients who were taken into surgery
within a 6-month period were examined. Patient demographic data, type of surgery,
type, dose and concentration of local anesthetic applied for rectus sheath block, as
well as cranial and caudal distances obtained were recorded in the case report form
as study parameters. Considering the differences that may be caused by the
anthropometric measurements of the patients, the 0-8 age group; They were divided
into two groups, 0<x≤2 and 2<x≤8 years, and evaluated in terms of total spread, and
the correlation of distances with age, body weight and the volume of local anesthetic
administered was evaluated.
Results: Total extensions, regardless of caudal or cranial; When examined in
two age groups, 0<x≤2 years and 2<x≤8 years, the mean distances on the left and
right were 5.55±0.95 and 5.72±1.27 years for 0<x≤2 years, respectively; For 2<x≤8
years, it was observed as 7.25±1.91 and 7.42±1.77 cm. Cranial and caudal extensions
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on the right side were 3.28±1.04 and 3.74±1.35 cm, respectively, in all age groups,
and 3.44±1.02 and 3.44±1.33 cm on the left side, respectively. The increase in the
diffusion distance of the local anesthetic showed a statistically significant correlation
with the increase in patient age and the increase in the volume of the local anesthetic
used. Patient gender was not found to be significant in terms of spread.
Conclusion: In the rectus sheath block applied with a single injection in a
volume of 0.5 ml/kg, it has been observed that an equal distribution can be achieved
in the cranio-caudal direction from the injection point, and it has been shown that a
total spread of approximately 5 cm in children aged 0-2 and approximately 7 cm in
children aged 2-8 years. These distances may enable the need for a single or two
separate injections to be decided according to the length of the planned surgical
incision.
