Çocuk Yaş Grubu Hastalarda Uygulanan Rektus Kılıf Bloğunda Yayılım Mesafesinin Retrospektif Olarak Değerlendirilmesi

Abstract

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.