Total diz protezi yapılan gonratroz hastalarında postoperatif analjezi için adduktör kanal blogu ile lokal infiltrasyon analjezi tekniklerinin karşılaştırılması

Year 2020, , 6 - 11, 21.03.2020

Semih Başkan , Fuad Oken Oya Kılcı Kevser Dılek Hakan Tırın Ozgur Yıldırım Fatih Incı Dilsen Ornek

https://doi.org/10.18663/tjcl.649648

Cited By: 1

Abstract

Amaç: Total dizartroplastisi(TDA) major bir ortopedik cerrahidir ve hastalar postoperatif dönemde ciddi ağrı çekmektedir. Lokal infiltrasyon analjezisi ve / veya periferik sinir blokları  TDA sonrası analjezi amaçlı sıklıkla kullanılır.

Bu çalışmanın amacı TDA sonrası postoperatif ilk 24 saat içerisinde lokal infiltrasyon analjezisi ve addütör kanal blok tekniğinin etkinliğini karşılaştırmaktır.

Gereç ve Yöntemler : 40-80 yaş arası, ASA I-III grup ve TDA yapılacak 60 hasta lokal etik komite onayı alındıktan sonra bu çalışmaya dahil edildi. Tüm hastalara 15 mg 0.5% heavy bupivacaine ile spinal anestezi uygulandı. I. Gruba sinir blokajı amaçlı ultrasonografi eşliğinde 20 mL 0.25% bupivacaine uygulandı. II. Gruba periartiküler alan ve subkutan dokuya 60 mL kokteyl enjekte edildi. Vizüel analogskalası(VAS) ile postoperatif 0,1,2,8,12 ve 24. saatlerde ağrı skorları değerlendirildi. VAS skoru 4 üzerinde olan ve ağrısının giderilmesine ihtiyacı olduğunu belirten hastalara intravenöz analjezikler uygulandı ve analjezi gereksinim zamanı olarak kaydedildi. İstatistiksel analiz IBM SPSS 23.0 software ile yapıldı. p< 0.05 değeri anlamlı olarak kabule dildi.

Bulgular:Demografik veriler veya gruplar arasında VAS skorlarında anlamlı bir fark bulunamadı (p>0.05). I. Gruptaki hastaların tamamının ortalama 10.0±4.9. saatlerde ve II. Gruptaki hastaların 28’inin ise 8.7±6.02. saatlerde  ek analjezi ihtiyacı olduğu gözlendi. Bu fark istatistiksel olarak anlamlı bulunmadı (p>0.05).

Sonuç: Bu çalışmada; TDA operasyonu sonrasındaki ilk 24 saatte multimodal analjezi methodu olarak her iki yöntemin de yeterli analjezi sağladığı ve kullanılabileceği gösterilmiştir.

Keywords

Postoperatif analjezi, Total diz artroplastisi, Adduktör kanal bloğu, Lokal infiltrasyon analjezisi

Comparison of adductor canal block and local infiltration analgesia techniques for postoperative analgesia in gonarthrosis patients receiving a total knee prosthesis

Abstract

Aim: Total knee arthroplasty (TKA) is a major orthopaedic surgery, and patients experience severe postoperative pain. Local infiltration anaesthesia and/or peripheral nerve blocks are often used for analgesia after TKA. The aim of this study was to compare the analgesic efficacy of the local infiltration anaesthesia and adductor canal block (ACB) techniques in the first postoperative 24 hours after TKA.

Material and Methods: Sixty patients of both sexes who were aged 40-80 years, in the ASA I-III group and undergoing TKA were included in this study after approval of the local ethics committee. Spinal anaesthesia was achieved with 15 mg 0.5% heavy bupivacaine in all patients. In Group I, nerve blocks were applied under ultrasonography with a 20 mL 0.25% bupivacaine. In Group II, a 60 ml cocktail was injected into the periarticular area and subcutaneous tissue. Postoperative pain was evaluated at 0, 1, 2, 8, 12, and 24 hours with a visual analogue scale (VAS). When the VAS score was >4 or the patient reported a need for pain relief, intravenous analgesics were administered, and the analgesia requirement time was recorded. Statistical analysis was performed with IBM SPSS 23.0 software. A value of p<0.05 was accepted as significant.

Results: No statistically significant differences were determined between groups with respect to the demographic data or VAS values (p>0.05). All patients in Group I and 28 patients in Group II required additional analgesia at 10.0±4.9 hours and 8.7±6.02 hours. These differences were not statistically significant (p>0.05).

Conclusion: The study showed that both methods provided effective analgesia and can be used for a multimodal analgesia method postoperatively in the first 24 hours after TKA operations.

Keywords

Postoperative analgesia, Total knee arthroplasty, Adductor Canal Block, Local infiltration Analgesia.

References

• 1. Fischer HB, Simanski CJ, Sharp C, Bonnet F, Camu F, Neugebauer EA, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 2008; 63: 1105-23.
• 2. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 2011; 93: 1075-84.
• 3. Grevstad U, Mathiesen O, Lind T, Dahl JB. Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty: a randomized study with individual patient analysis. Br J Anaesth 2014; 112: 912-19.
• 4. Raeder JC. Local infiltration analgesia for pain after total knee replacement surgery: a winner or just a strong runner-up? Anesth Analg 2011; 113: 684-86.
• 5. Hanson NA, Allen CJ, Hostetter LS et al. Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesth Analg. 2014; 118: 1370-77.
• 6. Ranawat AS, Ranawat CS. Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplasty 2007; 22: 12-15.
• 7. McCartney CJL, McLeod GA. Local infiltration analgesia for total knee arthroplasty. Br J Anaesth 2011; 107: 487-89.
• 8. Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med 2015; 40: 3-10.
• 9. Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Borglum J. Defining adductor canal block. Reg Anesth Pain Med. 2014; 39: 253-54.
• 10. Cowlishaw P, Kotze P. Adductor canal block or subsartorial canal block? Reg Anesth Pain Med 2015; 40: 175-76.
• 11. Chen J, Lesser JB, Hadzic A, Reiss W, Resta-Flarer F. Adductor canal block can result in motor block of the quadriceps muscle. Reg Anesth Pain Med 2014; 39: 170-71.
• 12. Gautier PE, Lecoq JP, Vandepitte C, Harstein G, Brichant JF. Impairment of sciatic nerve function during adductor canal block. Reg Anesth Pain Med 2015; 40: 85-89.
• 13. Vora MU, Nicholas TA, Kassel CA, Grant SA. Adductor canal block for knee surgical procedures: review article. J Clin Anesth. 2016; 35: 295-303.
• 14. Bauer M, Wang L, Onibonoje OK et al. Continuous femoral nerve blocks: decreasing local anesthetic concentration to minimize quadriceps femoris weakness. Anesthesiology 2012; 116: 665-72.
• 15. Kwofie MK, Shastri UD, Gadsden JC et al. The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med 2013; 38: 321-25.
• 16. Kim DH, Lin Y, Goytizolo EA et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology 2014; 120: 540-50.
• 17. Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg 2010; 111: 1552-54.