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COMPARISON OF AXILLARY BLOCK, INHALER ANAESTHESIA AND TOTAL INTRAVENOUS ANAESTHESIA IN UPPER EXTREMITY SURGERY IN TERMS OF ISCHEMIA REPERFUSION INJURY RELATED WITH TOURNIQUET USE
ESRA Academy. KUTANİS D. Sep 8, 2016; 138481
Topic: REGIONAL ANAESTHESIA (RA) TECHNIQUES - CLINICAL IMPLICATIONS
Dilek KUTANİS
Dilek KUTANİS

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Abstract
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Background and Aims:

Tourniquet use in extremity surgery may cause ischemia reperfusion injury (IRI). The aim of this study is to investigate the effect of brachial plexus block, total intravenous anesthesia(TIVA) and inhalation anesthesia on IRI in upper extremity surgery.


Methods:

After the ethic committe approval, 87 male patients aged between 18-45 years with ASA I-II score were classified in three groups; Group-A(n=31): Axillary block with bupivacaine, Group-I(n=31): Inhalation anesthesia with sevofluorane, Group-T(n=25): TIVA with propofol and remifentanil administration. The blood samples were taken for measuring glucose, lactate, total antioxidant status(TAS), total oxidant status(TOS), oxidative stress index(OSI), ischemia modified albumin(IMA), before anesthesia(t1), 1 minute before tourniquet releases(t2), 20 minute after tourniquet releases(t3) and 4 hours after tourniquet releases(t4).



Results:



In Group-I, lactate level at t3 and glucose levels at t2 and t3 were higher than the other groups. IMA levels at t2, t3 and t4 were lower in Group-A than the other groups. Also; TAS levels at t2, t3 and t4 were higher in Group-I than the other groups. TOS levels at t2 and t3 were lower in Group-A than Group-I. OSI level at t3 was lower in Group-A than Group-I.


Conclusions:

Reperfusion after the ischemic period causes oxidative stress and rise on oxidative markers. Preventive strategies and antioxidant agents may minimize the IRI. Axillary anesthesia leads to sympathetic block and enable better perfusion of upper extremity. Thus,  oxidative stress markers (IMA,TOS,OSI) and biochemical stress markers (glucose, lactate) were lower in Group-A in our study.  Therefore; we concluded that IRI may be prevented by axillary block.

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