The investigation of the effect on consumption of intra-operative anesthetic agents and post-operative analgesic agents by using different volumes of local anesthetic with ultrasonography-guided rectus sheath block applied to major abdominal surgery in children

ABSTRACTThe Investigation of The Effect on Consumption of Intra-Operative Anesthetic Agents and Post-Operative Analgesic Agents by Using Different Volumes of Local Anesthetic With Ultrasonography-Guided Rectus Sheath Block Applied to Major Abdominal Surgery in ChildrenPurpose: In our study, we investigated to reduce on consumption of peroperative anesthetic agents and postoperative analgesic agents of the rectus sheath block by using high volume levobupivacain, compared with low volume levobupivacain.Materials and Method: Our study was carried out in the Anaesthesiology and Reanimation Clinics of Çukurova University, Faculty of Medicine, Balcalı Hospital after the necessary permissions and approvals had been taken from the parents and Turkish Republic Ministry of Health Ethics Committee.40 patients whose ages were between 1-16 and from the group of ASA I-II and who would be implemented major abdominal surgery were included into our study. The patients were randomly classified into two groups.The patients of group I (n=20) were implemented ultrasonography-guided rectus sheath block prepared with preoperative 0.1 ml/kg levobupivakain (0.5%) diluted in 0.1 ml/kg saline. The patients of group II (n=20) were implemented ultrasonography-guided rectus sheath block prepared with preoperative 0.1 ml/kg levobupivakain (0.5%) diluted in 0.4 ml/kg saline after general anesthesia. For the postoperative pain, as needed, 0.1 mg/kg morphine intravenoz injection was decided.Sevoflurane concentration and the amounts those were inspired (%) and total used (ml) during the operation and some hemodynamic data such as intra-operative and post-operative systolic and diastolic blood pressures, heart rates and oxygen saturations of the both groups were measured and recorded. The consumption of analgesic agent, pain scores, the sedation level, nausea, vomiting and the adverse effects were observed and noted.Findings: The demographic characteristics, the operation periods and hemodynamic parameters of the groups were similar. It was found that the sevoflurane concentrations inspired and consumed in the intra-operative period of groups were similar too. The total sevoflurane consumption was 106.85±28.6 ml in the patients of group I and it was 91.50±36.6 ml in the patients of group II (p>0.05).When the post-operative hemodynamic data was compared, between the groups, no statistically significant difference was observed.The post-operative pain scores, the sedation scores and morphine consumption were similar in both groups (p>0.05). Additional analgesia was required 7 patients in group I and 3 patients in group II.No patients, nausea, vomiting and other side-effects were observed. Additional analgesic consumption, between the groups, no statistically significant difference was observed.Results: Consequently, it was seen that intra-operative sevoflurane consumption and the post-operative morphine consumption, no statistically significant difference was observed in the patients who were implemented pre-operative rectus sheath block by using high volume levobupivacain, compared with low volume levobupivacain. In addition, we concluded that the implementation of rectus sheath block accompanied by ultrasound provided an effective and reliable analgesia.Keywords: Pediatric Patients, the Patient-controlled Analgesia, Levobupivakain, Rectus Sheath Block, Sevoflurane, Ultrasonography.