Bilateral Multiple Kot Fraktürü Olan Hastada Fasyal Plan Bloklarının Kritik Hasta Yönetiminde Yaşam Kurtarıcı Rolü
Özet
Künt toraks travmasına bağlı multiple kaburga kırıkları, özellikle ileri yaş hastalarda morbidite ve mortalitenin önemli nedenlerinden biridir. Yetersiz ağrı kontrolü; hipoventilasyon, sekresyon retansiyonu, atelektazi ve pnömoni gelişimine yol açarak solunum yetmezliği riskini artırır ve sıklıkla invaziv mekanik ventilasyon gereksinimine neden olur. Bu nedenle etkin analjezi, tedavinin temel basamaklarından birini oluşturur. Bu olgu sunumunda, bilateral multiple kot fraktürü bulunan 66 yaşındaki kadın hastada bilateral Parasternal İnterkostal Plan Bloğu (PİPB) ve Serratus Anterior Plan Bloğu (SAPB) kombinasyonu uygulanmıştır. Ultrason rehberliğinde gerçekleştirilen fasyal plan blokları sonrasında ağrı skorlarında belirgin azalma sağlanmış, solunum eforu iyileşmiş ve oksijenizasyon parametreleri düzelmiştir. Yüksek akımlı nazal oksijen desteği kademeli olarak sonlandırılmış, invaziv mekanik ventilasyon gereksinimi ortaya çıkmamış ve erken mobilizasyon sağlanmıştır. Hasta bloklara bağlı komplikasyon gelişmeden yoğun bakım ünitesinden servise devredilmiştir. PİPB anterior torasik dermatomları (T2–T6), SAPB ise lateral torasik dermatomları (T2–T9) kapsayarak birlikte geniş segmental analjezi sağlar. Bu multimodal rejyonel analjezi yaklaşımı opioid gereksinimini azaltarak pulmoner fonksiyonların korunmasına katkı sağlar. Yüksek riskli travma hastalarında PİPB ve SAPB kombinasyonu, güvenli ve etkili bir akciğer koruyucu strateji olarak erken iyileşmeyi destekleyebilir ve ventilasyon gereksinimini azaltabilir.
Multiple rib fractures secondary to blunt thoracic trauma represent a significant cause of morbidity and mortality, particularly in elderly patients. Inadequate pain control contributes to hypoventilation, secretion retention, atelectasis, pneumonia, and subsequent respiratory failure, frequently necessitating invasive mechanical ventilation. Effective analgesia is therefore a cornerstone of management. We report the case of a 66-year-old female patient with bilateral multiple rib fractures who was managed using a combination of bilateral Parasternal Intercostal Plane Block (PIPB) and Serratus Anterior Plane Block (SAPB). Ultrasound-guided fascial plane blocks resulted in marked reduction in pain scores, improvement in respiratory effort, and enhanced oxygenation parameters. High-flow nasal oxygen support was gradually discontinued, invasive mechanical ventilation was avoided, and early mobilization was successfully achieved. The patient was transferred from the intensive care unit without block-related complications. PIPB provides anterior thoracic dermatomal coverage (T2–T6), while SAPB offers lateral thoracic analgesia (T2–T9), enabling broad segmental pain control when combined. This multimodal regional analgesic strategy reduces opioid requirements and preserves pulmonary function. In high-risk trauma patients, the combined use of PIPB and SAPB may represent a safe, effective, and lung-protective approach that facilitates early recovery and may decrease ventilatory support requirements.
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