Total diz artroplastisi sonrası erken dönemde gelişenağrının kontrolünde periartiküler lokal infitrasyon analjezisi ile devamlı femoral sinir blokajının karşılaştırılması

Year 2015, Volume: 49 Issue: 3, 260 - 266, 17.07.2015

Emrah Kovalak , Alper Dogan Onat Uzumcugil Abdullah Obut Asli Yildiz Enes Kanay

https://doi.org/10.3944/AOTT.2015.14.0263

Abstract

Amaç: 24 saat devamlı femoral sinir bloğu (DFSB) ve periartiküler infiltrasyon analjezisinin (PİA) total diz artroplastisi (TDA) sonrası ağrı ve ameliyat sonrası erken dönem (6 hafta) fonksiyonel sonuçlara olan etkisinin karşılaştırılmasıdır.

Çalışma planı: Tek taraflı TDA yapılan 60 hasta çalışmaya alınarak, iki farklı çalışma grubu oluşturuldu. Grup A, DFSB uygulanan hastalardan, grup B, PİA uygulanan hastalardan oluşmakta idi. Tüm hastaların diz eklemi arka kapsülüne, %0.25 levobupivakain ve 1:100,000 epinefrin içeren solüsyon uygulandı. Tüm hastalara hasta-kontrollü analjezi (PCA) cihazı takıldı ve 24 saatlik tramadol kullanımı kaydedildi. Maksimum hareket açıklığı (ROM), ağrı ve fonksiyonel durum, görsel ağrı skalası (VAS), iki dakika yürüme testi, Western Ontario ve McMaster Üniversiteleri Osteoartrit İndeksi (WOMAC) ve Diz Cemiyeti Değerlendirme (KSS) testleri ile değerlendirildi.

Bulgular: B grubu ile karşılaştırıldığında, A grubundaki hastaların opioid kullanımı daha az (p<0.05), ameliyat sonrası istirahatte ağrı kontrolü daha iyi idi (p<0.05). Aktif ve pasif hareket ile daha az ağrı (p<0.05) oluşurken, aktif ve pasif hareket ile daha iyi hareket açıklığı var idi (p<0.05). Grup A’nın ameliyat sonrası iki dakika yürüme testi sonuçları daha iyi (p<0.05), WOMAC ve KSS sonuçları da ameliyat sonrası altıncı haftada daha üstün idi.

Çıkarımlar: DFSB diz eklemi arka kapsülüne infiltrasyon analjezisi ile uygulandığı takdirde, düşük yan etki profili ile ameliyat sonrası daha iyi hasta konforu ve daha fazla hareket açıklığı sağlayan etkili ve güvenilir bir analjezi metodur.

 

DOI: 10.3944/AOTT.2015.14.0263

Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Keywords

Femoral sinir bloğu; diz artroplastisi; multimodal analjezi; periartiküler infiltrasyon.

A comparison of continuous femoral nerve block and periarticular local infiltration analgesia in the management of early period pain developing after total knee arthroplasty

Abstract

Objective: This study aimed to compare the effects of 24-h continuous femoral nerve block (CFNB) and periarticular infiltration analgesia (PIA) on postoperative pain and functional results in the first 6 weeks after total knee arthroplasty (TKA).
Methods: Sixty patients who underwent unilateral TKA were included in this study. The patients were divided into two groups: Group A received CFNB and Group B received PIA. Each patient received 0.25% levobupivacaine and 1:100,000 epinephrine as infiltration to the posterior capsule. A patient-controlled analgesia (PCA) device was used for all patients, and 24-h tramadol usage by patients was recorded. We measured maximum range of motion (ROM), pain using a visual analog scale (VAS), 2-min walk test (2MWT), and the scores of Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Knee Society Score (KSS).
Results: Compared with Group B, Group A had lower postoperative opioid usage (p<0.05), less pain at rest (p<0.05), less pain with passive motion (p<0.05), less pain with movement and after active movement (p<0.05), and superior passive and active ROM (p<0.05). Group A also had better 2MWT results at 24 and 48 h after surgery (p<0.05), and superior WOMAC and KSS results at 6 weeks after surgery.
Conclusion: As long as it is applied with infiltration analgesia to the posterior capsule, CFNB is an effective and safe analgesia method resulting in better postoperative patient comfort and greater ROM. Furthermore, it produces better results in the early postoperative period with a favorable side effect profile.

Keywords

Femoral nerve block, knee arthroplasty, multimodal analgesia, periarticular infiltration

References

• Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 2009;467:1418–23.
• Kazak Bengisun Z, Aysu Salviz E, Darcin K, Suer H, Ates Y. Intraarticular levobupivacaine or bupivacaine adminis- tration decreases pain scores and provides a better recovery after total knee arthroplasty. J Anesth 2010;24:694–9.
• Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local peri- articular injections: a prospective randomized study. J Ar- throplasty 2007;22(6 Suppl 2):33,8.
• Ng FY, Ng JK, Chiu KY, Yan CH, Chan CW. Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty: a prospective, crossover, ran- domized clinical trial. J Arthroplasty 2012;27:1234–8.
• Gómez-Cardero P, Rodríguez-Merchán EC. Postoperative analgesia in TKA: ropivacaine continuous intraarticular infusion. Clin Orthop Relat Res 2010;468:1242–7.
• Kadic L, Boonstra MC, DE Waal Malefijt MC, Lako SJ, VAN Egmond J, Driessen JJ. Continuous femoral nerve block after total knee arthroplasty? Acta Anaesthesiol Scand 2009;53:914–20.
• Dobrydnjov I, Anderberg C, Olsson C, Shapurova O, Angel K, Bergman S. Intraarticular vs. extraarticular ropi- vacaine infusion following high-dose local infiltration an- algesia after total knee arthroplasty: a randomized double- blind study. Acta Orthop 2011;82:692–8.
• Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res 2010;468:135–40.
• Meftah M, Wong AC, Nawabi DH, Yun RJ, Ranawat AS, Ranawat CS. Pain management after total knee ar- throplasty using a multimodal approach. Orthopedics 2012;35:660–4.
• Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beyn- non BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)-development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998;28:88–96.
• Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13–4.
• Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tİn- nesen EK, Sİballe K. Comparison of peri- and intraar- ticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 2007;78:172–9.
• Affas F, Nygårds EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop 2011;82:441–7.
• Carli F, Clemente A, Asenjo JF, Kim DJ, Mistraletti G, Go- marasca M, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs contin- uous femoral nerve block. Br J Anaesth 2010;105:185–95.
• Yadeau JT, Goytizolo EA, Padgett DE, Liu SS, Mayman DJ, Ranawat AS, et al. Analgesia after total knee replace- ment: local infiltration versus epidural combined with a femoral nerve blockade: a prospective, randomised prag- matic trial. Bone Joint J 2013;95-B:629–35.
• Krenzel BA, Cook C, Martin GN, Vail TP, Attarian DE, Bolognesi MP. Posterior capsular injections of ropivacaine during total knee arthroplasty: a randomized, double- blind, placebo-controlled study. J Arthroplasty 2009;24(6 Suppl):138–43.
• Mahadevan D, Walter RP, Minto G, Gale TC, McAllen CJ, Oldman M. Combined femoral and sciatic nerve block vs combined femoral and periarticular infiltration in total knee arthroplasty: a randomized controlled trial. J Arthro- plasty 2012;27:1806–11.
• Sakai N, Inoue T, Kunugiza Y, Tomita T, Mashimo T. Continuous femoral versus epidural block for attainment of 120° knee flexion after total knee arthroplasty: a ran- domized controlled trial. J Arthroplasty 2013;28:807-14.
• Jones CA, Cox V, Jhangri GS, Suarez-Almazor ME. De- lineating the impact of obesity and its relationship on re- covery after total joint arthroplasties. Osteoarthritis Carti- lage 2012;20:511–8.
• Bugała-Szpak J, Kusz D, Dyner-Jama I. Early evaluation of quality of life and clinical parameters after total knee ar- throplasty. Ortop Traumatol Rehabil 2010;12:41–9.
• Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL. CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc 2001;33:1126–41.