Total Diz Artroplastisi Sonrası Hastalara Adduktor ve IPACK Blok Uygulamasının Ameliyat Sonrası İyileşme ve Uyku Kalitesi Üzerine Etkisi: Randomize, Kontrollü Bir Çalışma

Year 2024, , 609 - 615, 31.10.2024

Tayfun Et , Muhammet Korkusuz , Umman Menendi

https://doi.org/10.54005/geneltip.1404497

Abstract

Amaç: Adduktor kanal bloğu (ACB) ve popliteal arter ile diz kapsülü arasındaki boşluk ( IPACK ) blokları motor koruyucu bloklardır, hızlı ambulasyon ve etkili analjezi sağlar. Bu çalışma total diz artroplastisi (TDA) için ACB ile IPACK uygulanan hastaların postoperatif iyileşme ve uyku kalitesini etkisini araştırmak için tasarlandı.
Gereç ve Yöntemler: Bu prospektif çift kör randomize kontrollü çalışmaya spinal anestezi altında tek taraflı TDA uygulanan 80 hasta dahil edildi. ACB ve IPACK blok uygulanan tüm hastalar (Grup ACB+IPACK n= 40) ve bir kontrol grubuna (Grup C, n=40 ) ayrıldı. Birincil sonuç, postoperatif 1 gün quality of recovery (QoR-15) ölçeğidir. İkincil sonuçlar; postoperatif 1 ve 2 gün Time up Go (TUG) ve range of motion (ROM) , kurtarıcı opioid ilaçların toplam miktarı ve ameliyat sonrası 48 saat içinde farklı zaman noktalarında ağrı skorları, postoperatif gece ve 6 gün uyku değerlendirmesi ve 1 ay uyku kalitesi indeksi degerledirmesi idi ( PSQI).
Results: ACB+ IPACK grubu control grubuna göre postoperatif 1 ve 7 gün iyileşme skorları daha iyiyidi ( sırasıyla; p= 0.001, p= 0.002 ). Postoperratif 1. ve 2. TUG ( sırasıyla p= 0.035, p= 0.019) ve ROM ( sırasıyla; p= 0.003, p= 0.000 ) değerleri ACB+ IPCAK grubunda daha yüksekti. postoperatif opiodi tüketim ACB+IPACK grubunda daha düşüktü ( p= 0.012). Postoperatif 1 ay PSQI degerleri gruplar arası benzerdi ( p =0.095).
Sonuç: TDA postoperatif analjezi için ultrason ile uygulanan ACB+IPACK daha yüksek QoR ve fiziksel performans sağladığı, postoperaitf opioid tüketimini azalttığı ve etkili analjezi sağladığı yönündedir. Ancak postoperaif uyku kalitesi üzerine etkisiz kaldığıdır.

Keywords

Alt ekstremite, Ağrı yönetimi, Postoperative ağrı, Diz artroplastisi

Project Number

02-2022/18

The Effect of the Application of Adductor and Infiltration of Local Anesthetic Between the Popliteal Artery and Capsule of the Knee (IPACK) Block to Patients on Postoperative Recovery and Sleep Quality Following Total Knee Arthroplasty: a Randomized, Controlled Study

Abstract

Aim: The adductor canal block (ACB) and IPACK (Infiltration of local anesthetic between the popliteal artery and capsule of the knee) block are motor protective blocks that provide effective analgesia and allow early ambulation. The aim of this study was to investigate the effect on postoperative recovery and sleep quality of patients applied with ACB and IPACK for total knee arthroplasty (TKA).
Material and Method: This prospective, double-blinded, randomized, controlled study included 80 patients who underwent unilateral TKA under spinal anesthesia. The patients were separated as those applied with ACB+IPACK (Group ACB+IPACK, n=40) and a control group (Group C, n=40). The primary outcome was the postoperative first-day quality of recovery scale (QoR-15). Secondary outcomes were postoperative first and second-day Timed-Up-and-Go (TUG) test and range of motion (ROM), the total amount of rescue opioid drugs required, pain scales at different time points in the first 48 hours postoperatively, sleep evaluation on the postoperative and 6 following nights, and evaluation of sleep quality for 1 month using the Pittsburgh Sleep Quality Index (PSQI).
Results: The QoR on postoperative days 1 and 7 were better in the ACB+ IPACK group than in the control group (p= 0.001, p= 0.002, respectively). On postoperative days 1 and 2, the TUG (p= 0.035, p= 0.019, respectively) and ROM (p=0.003, p=0.000) values were higher in the ACB+ IPCAK group. Postoperative opioid consumption was lower in the ACB+IPACK group (p= 0.012). The PSQI values at 1 month postoperatively were similar in both groups (p =0.095).
Conclusion: The study results demonstrated that ACB+IPACK applied with ultrasound for TKA postoperative analgesia provided effective analgesia, higher QoR and physical performance, and reduced postoperative opioid consumption. However, there was no effect on postoperative sleep quality.

Keywords

Lower extremity, Pain management, Postoperative pain, Knee arthroplasty

Project Number

02-2022/18

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