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

Öz

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.

Anahtar Kelimeler

• 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

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