Benign Paroksismal Pozisyonel Vertigo
Özet
Periferik sinir bloklarında adjuvanlar, tek enjeksiyon tekniklerinin analjezi süresini uzatmak, postoperatif opioid ihtiyacını azaltmak ve multimodal analjezi hedeflerini güçlendirmek amacıyla yoğun biçimde araştırılmıştır. Ultrason rehberliğinin yaygınlaşmasıyla periferik bloklarda kullanılan lokal anesteziklerin hacim ve konsantrasyonları azalmış; ancak süre sınırlılığını aşmak için farmakolojik adjuvan kullanımı önem kazanmıştır. Deksametazon, deksmedetomidin ve klonidin en güçlü kanıta sahip ajanlar olup etki mekanizmaları, uygulama yolları ile doz aralıkları bakımından farklı profiller sergilerler. Adrenalin vazokonstriktör etkisiyle lokal anesteziğin etkinliğini destekleyebilir. Ketamin ve magnezyum gibi NMDA reseptörü üzerinden etki gösteren ajanların perinöral kullanımı sınırlıdır ve güvenlik açısından temkinli yaklaşım gerektirir. Periferik bloklarda kullanılan adjuvanlar perinöral ya da intravenöz olarak uygulanmakta olup hangi stratejinin üstün olduğu tartışmalıdır. Adjuvan kullanımı açısından üst ekstremite, alt ekstremite ve gövde blokları ayrı ayrı değerlendirilmelidir. Her blok tipi için adjuvan seçimi ve beklenen kazanım farklılık gösterir ve bu farklılıklar klinik kararı doğrudan etkiler. Güvenlik açısından nörotoksisite riski ve sistemik yan etkiler göz önünde bulundurularak düşük doz stratejileri, intranöral enjeksiyondan kaçınma gibi ilkeler önerilmektedir. Cerrahi tipi, beklenen ağrı şiddeti ve süresi, beklenen fonksiyonel iyileşme süresi, hasta özellikleri gibi birçok değişken; adjuvan kullanma kararı ve ajan seçiminde belirleyici rol oynar. Bu nedenle periferik bloklarda adjuvan kullanımında rutin uygulamalar yerine hasta özelinde bireyselleştirilmiş uygulamalar önerilmektedir.
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