Askarnezhad Faragheh, Aliakbar

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      داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ و ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﻲ درﻣﺎﻧﻲ ﻛﺮﻣﺎن  داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ ﻣﻬﻨﺪس اﻓﻀﻠﻲ ﭘﻮر    ﭘﺎﻳﺎن ﻧﺎﻣﻪ  ﺟﻬﺖ اﺧﺬ درﺟﻪ دﻛﺘﺮاي ﺗﺨﺼﺼﻲ ﻃﺐ اوژاﻧﺲ    ﻋﻨﻮانﻣﻘﺎﻳﺴﻪ ﺑﻠﻮك ارﻛﺘﻮر اﺳﭙﺎﻳﻦ ﺗﺤﺖ ﻫﺪاﻳﺖ ﺳﻮﻧﻮﮔﺮاﻓﻲ ﺑﺎ ﻓﻨﺘﺎﻧﻴﻞ ورﻳﺪي در   ﻗﻔﺴﻪ ﺳﻴﻨﻪﻛﺎﻫﺶ درد ﻧﺎﺷﻲ از ﺗﺮوﻣﺎي     اﺳﺘﺎد راﻫﻨﻤﺎ   دﻛﺘﺮ ﻣﻴﺘﺮا ﻣﻮﺣﺪي    اﺳﺘﺎد ﻣﺸﺎور  دﻛﺘﺮ اﻣﻴﺮﺣﺴﻴﻦ ﻣﻴﺮاﻓﻀﻞ    ﻧﮕﺎرش  اد ﻓﺮاﻏﻪﮋدﻛﺘﺮ ﻋﻠﻲ اﻛﺒﺮ ﻋﺴﻜﺮﻧ    7931-89ﺳﺎل ﺗﺤﺼﻴﻠﻲ     ﭼﻜﻴﺪه:ﺗﺤﺖ ﻫﺪاﻳﺖ ﺳﻮﻧﻮﮔﺮاﻓﻲ ﺑﺎ ﻓﻨﺘﺎﻧﻴﻞ ورﻳﺪي در ﺗﺮوﻣﺎي ﻗﻔﺴﻪ ﺳﻴﻨﻪ   BPSEﻋﻨﻮان:ﻣﻘﺎﻳﺴﻪ اﺛﺮ ﺿﺪ درد روش   ﺳﺒﺐ ﺗﺠﻮﻳﺰ ﻛﻤﺘﺮ ﻓﻨﺘﺎﻧﻴﻞ ﻣﻲ ﺷﻮد. BPSEﺟﻬﺖ ارزﻳﺎﺑﻲ اﻳﻦ ﻣﻮﺿﻮع ﻛﻪ آﻳﺎ ﺗﺮوﻣﺎ  2در ﻳﻚ ﻣﺮﻛﺰ ﺳﻄﺢ  DEروش:اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﺑﺎﻟﻴﻨﻲ ﻛﻨﺘﺮل ﺷﺪه ﺗﺼﺎدﻓﻲ ﺑﻮد ﻛﻪ در ﺑﺨﺶ وارد ﻣﻄﺎﻟﻌﻪ  5ﺑﻴﺸﺘﺮ از    (0-SRNاﻧﺠﺎم ﮔﺮﻓﺖ.ﺑﻴﻤﺎران ﺑﺎﻟﻎ ﺑﺎ ﺗﺮوﻣﺎي ﻗﻔﺴﻪ ﺳﻴﻨﻪ ﺑﺎ ﻧﻤﺮه درد ﺑﺪو ﻣﺮاﺟﻌﻪ)ﺑﻪ ﻫﻤﺮاه  ﻓﻨﺘﺎﻧﻴﻞ ورﻳﺪي   BPSE ﺷﺪﻧﺪ. ﺑﻴﻤﺎران ﺑﺼﻮرت ﺗﺼﺎدﻓﻲ ﻳﺎ ﻓﻨﺘﺎﻧﻴﻞ ورﻳﺪي درﻳﺎﻓﺖ ﻛﺮدﻧﺪ و ﻳﺎ از روش  اﺳﺘﻔﺎده ﺷﺪ.ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﻣﻴﺎﻧﮕﻴﻦ  BPSEﻧﻔﺮدر ﮔﺮوه  63ﻧﻔﺮ در روش ﻓﻨﺘﺎﻧﻴﻞ و  03ﺑﻴﻤﺎر واررد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ  66ﻧﺘﺎﻳﺞ:در  3ﺑﻴﺸﺘﺮ از ﮔﺮوه ﻓﻨﺘﺎﻧﻴﻞ ﺑﻮد) BPSEدﻗﻴﻘﻪ ﺑﻄﻮر واﺿﺢ در ﮔﺮوه  06و  02در دﻗﺎﻳﻖ   SRNﻛﺎﻫﺶ درد در .( دوز ﻣﻴﺎﻧﮕﻴﻦ ﺗﺠﻮﻳﺰي ﻓﻨﺘﺎﻧﻴﻞ در ﻃﻮل ﻣﺪت ﺑﺴﺘﺮي در 300. و10ﻫﺎي  eulaV Pﺑﺎ  2در ﻣﻘﺎﺑﻞ 3,3و 2ﻣﻘﺎﺑﻞ .( ﻧﻤﺮات رﺿﺎﻳﺘﻤﻨﺪي 100ﻛﻤﺘﺮ از Pﺑﻮد.) BPSEﻣﻴﻜﺮوﮔﺮم در ﮔﺮوه ﻓﻨﺘﺎﻧﻴﻞ و  9,32و 4,141ﺑﻪ ﺗﺮﺗﻴﺐ  DE  .(100ﻛﻤﺘﺮ از Pﺑﺎﻻﺗﺮ ﺑﻮد. ) BPSEﺑﻴﻤﺎران ﺑﻄﻮر واﺿﺢ در ﮔﺮوه ﺑﻴﺸﺘﺮ درد وﻣﺼﺮف ﻛﻤﺘﺮ ﻓﻨﺘﺎﻧﻴﻞ و رﺿﺎﻳﺘﻤﻨﺪي ﺑﻴﺸﺘﺮ ﺑﻴﻤﺎران  ﺳﺒﺐ ﻛﻨﺘﺮل BPSEﺑﺤﺚ و ﻧﺘﻴﺠﻪ ﮔﻴﺮي:ﺑﻪ ﺳﺎدﮔﻲ ﺗﻮﺳﻂ ﭘﺰﺷﻜﺎن اورژاﻧﺲ ﻗﺎﺑﻞ اﻧﺠﺎم   BPSEﻧﺴﺒﺖ ﺑﻪ ﻓﻨﺘﺎﻧﻴﻞ ورﻳﺪي ﺷﺪ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦ ﻛﻪ روش اﺳﺖ و ﻋﻮارض ﻛﻤﻲ دارد و ﻧﺴﺒﺖ ﺑﻪ روش ﺑﻲ دردي اﭘﻴﺪورال زﻣﺎن ﻛﻤﺘﺮي ﻧﻴﺎز دارد ﺑﻪ ﺷﺪت ﺗﻮﺻﻴﻪ ﻣﻲ ﺷﻮد   ژاﻧﺲ از اﻳﻦ روش ﺑﻪ ﻋﻨﻮان اﻧﺘﺨﺎب ﻧﺨﺴﺖ در ﺑﻴﻤﺎران دﭼﺎر ﺗﺮوﻣﺎي ﻗﻔﺴﻪ ﺳﻴﻨﻪ اﺳﺘﻔﺎده ﻛﻨﻨﺪ.ﻛﻪ ﭘﺰﺷﻜﺎن اور     Comparison of ultrasound guided erector spinae fascial plain block with intra-venous fentanyl to achieve analgesia in chest trauma Abstract  Objectives: To compare the analgesic efficacy of ultrasound guided erector spinae plain block (ESPB) with intravenous fentanyl in chest trauma and to assess if ESPB results in lower doses of fentanyl administration. Methods: This was a randomized controlled trial which was performed in the emergency department (ED) of a level 2 referral trauma center. Adult patients with chest trauma and initial numerical rating scale (NRS-0) score of more than 5 were included. Patients were randomized to receive intravenous fentanyl or ESPB (with supplemental intravenous fentanyl if necassary). Results: A total of 66 patients were enrolled, 30 in the fentanyl and 36 in the ESPB group. The mean value of reduction in NRS after 20 and 60 minutes were significantly higher in the ESPB than in the fentanyl group (3.0 vs. 2.0 and 3.3 vs. 2.0, respectively, p values: 0.01 and 0.003, respectively). The average dose of administered fentanyl during the ED stay were 141.4 and 23.9 µg in fentanyl and ESPB groups, respectively (p<0.001). Satisfaction scores reported by the patients were significantly higher in the ESPB group (p<0.001). Conclusion: ESPB results in significantly superior pain control, lower fentanyl consumption and higher patient satisfaction than systemic analgesia with fentanyl. Since it is simple to perform by the emergency physicians (EPs), has low complication rates and is not time consuming in relation to procedures such as epidural analgesia, it is highly recommended for the EPs to use this modality as a first line analgesic therapy for chest trauma related pain         

مقایسه بلوک ارکتور اسپاین تحت هدایت سونوگرافی با فنتانیل وریدی در کاهش درد ناشی از ترومای قفسه سینه

http://eprints.kmu.ac.ir/31874/1/7384.pdf

مقایسه بلوک ارکتور اسپاین تحت هدایت سونوگرافی با فنتانیل وریدی در کاهش درد ناشی از ترومای قفسه سینه

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