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Total diz artroplastisi sonrası ağrı kontrolünde epidural analjezi ve lokal infiltratif analjezi yöntemlerinin karşılaştırılması

Year 2014, Volume: 48 Issue: 1, 73 - 79, 17.03.2014

Abstract

Amaç: Bu çalışmada total diz protezi uygulanmış hastalarda, ameliyat sonrası ağrı kontrolü için epidural analjezi ile infiltratif analjezinin etkinliklerinin karşılaştırılması amaçlandı.
Çalışma planı: Mayıs 2011 ila Eylül 2011 tarihleri arasında total diz protezi uygulanan 30 hasta (28 kadın, 2 erkek; ortalama yaş: 69.37±5.11, dağılım: 61-80) rastgele 2 gruba ayrıldı. Bupivakainle spinal anestezi yapılan hastalardan, ameliyat sonrası 24 saat boyunca Grup 1’e (n=15) epidural kateterden, Grup 2’ye (n=15) ON-Q infiltrasyon pompasıyla 72 ml %0.9 NaCl + 48 ml bupivakain (1 ml = 5 mg, toplam 120 ml) uygulandı. Gruplar, Bromage skoru ve görsel analog skala (GAS) kullanılarak, kan basıncı, ameliyat sonrası analjezi ihtiyaçları ve yan etkileri yönünden karşılaştırıldı.
Bulgular: Gruplar arasında demografik veriler açısından fark yoktu. Grup 2’nin 60. dakika ve 2. saatteki ek analjezi ihtiyacı Grup 1’den anlamlı olarak yüksek bulundu (p<0.05). Altmışıncı dakika ve 2. saatteki bulantı-kusma oranları Grup 1’de Grup 2’ye kıyasla daha yüksekti (sırasıyla, p<0.05 ve p<0.01). Altmışıncı dakika ve 2. saatteki Bromage skoru yine Grup 1’de anlamlı düzeyde yüksek olarak saptandı (p<0.01). Grup 2’nin 60. dakika ve 2. saat GAS skoru ortalaması Grup 1’den istatistiksel anlamda yüksek olarak bulundu (p<0.05). Olguların 60. dakika SAB ölçümleri arasında istatistiksel olarak anlamlı farklılık varken (p<0.05), DAB ve kalp tepe atımı oranları arasında anlamlı bir fark saptanmadı.
Çıkarımlar: Lokal infiltrasyon yöntemiyle sağlanan analjezi, epidural analjeziden daha geç olsa da, başlangıçta ek analjezi desteğiyle aynı etkinlikte ağrı kontrolü sağlanabilir. Yan etkisinin az olması ve erkan mobiliteye izin vermesi nedeniyle lokal infiltrasyon, epidural analjeziye göre daha üstün bir yöntemdir.

References

  • Bonica J. Postoperative pain. In: Bonica J, editor. The management of pain. 2nd ed. Philadelphia, PA: Lea & Febiger; 19 p. 461-80. Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg 1998;87:93-7. CrossRef
  • Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anaesth 1989;63:189-95. CrossRef
  • Ryu J, Saito S, Yamamoto K, Sano S. Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp Jt Dis 1993;53:35-40.
  • Shoji H, Solomonow M, Yoshino S, D’Ambrosia R, Dabezies E. Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics 1990;13:643-9.
  • Wiebalck A, Brodner G, Van Aken H. The effects of adding sufentanil to bupivacaine for postoperative patient-controlled epidural analgesia. Anesth Analg 1997;85:124-9.
  • Keskin A. Role of pain in operative strategy. [Article in Turkish] Ağrı 2004;6:42-3.
  • Erdine S. Postoperative analgesia. Pain syndromes and management. [Article in Turkish] Istanbul; 2003. p. 33
  • Elder JB, Hoh DJ, Wang MY. Postoperative continuous paravertebral anesthetic infusion for pain control in lumbar spinal fusion surgery. Spine (Phila Pa 1976) 2008;33:210-8. CrossRef
  • American Society of Anesthesiologists. New classification of physical status. Anesthesiology 1963;24:111.
  • Morgan GE, Mikhail MS, Murray MJ, editors. Clinical anesthesiology. New York, NY: Lange Medical Books/ McGraw-Hill; 2002. p. 309-58.
  • Katz J, Melzack R. Measurement of pain. Surg Clin North Am 1999;79:231-52. CrossRef
  • 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. CrossRef
  • Starks I, Frost A, Wall P, Lim J. Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability? J Bone Joint Surg Br 2011;93:967-9. CrossRef
  • Hoenecke HR Jr, Pulido PA, Morris BA, Fronek J. The efficacy of continuous bupivacaine infiltration following anterior cruciate ligament reconstruction. Arthroscopy 2002;18:854-8. CrossRef
  • Gottschalk A, Burmeister MA, Radtke P, Krieg M, Farokhzad F, Kreissl S, et al. Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery. Anesth Analg 2003;97:1086 CrossRef
  • Bianconi M, Ferraro L, Ricci R, Zanoli G, Antonelli T, Giulia B, et al. The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery. Anesth Analg 2004;98:166-72. CrossRef
  • Singh K, Samartzis D, Strom J, Manning D, CampbellHupp M, Wetzel FT, et al. A prospective, randomized, double-blind study evaluating the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after spinal arthrodesis. Spine (Phila Pa 1976) 2005;30:2477-83. CrossRef
  • Argintar E, Armstrong B, Zawadsky M, Evans B, Romness D. Pain control infusion pumps: a prospective randomized evaluation in bilateral total knee arthroplasty. Orthopedics 2011;34:188.
  • Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth 2008;101:841-7. CrossRef
  • LeBlanc KA, Bellanger D, Rhynes VK, Hausmann M. Evaluation of continuous infusion of 0.5% bupivacaine by elastomeric pump for postoperative pain management after open inguinal hernia repair. J Am Coll Surg 2005;200:198-202. CrossRef
  • Givens VA, Lipscomb GH, Meyer NL. A randomized trial of postoperative wound irrigation with local anesthetic for pain after cesarean delivery. Am J Obstet Gynecol 2002;186:1188-91. CrossRef
  • Wheatley GH 3rd, Rosenbaum DH, Paul MC, Dine AP, Wait MA, Meyer DM, et al. Improved pain management outcomes with continuous infusion of a local anesthetic after thoracotomy. J Thorac Cardiovasc Surg. 2005;130:464-8. CrossRef
  • Baig MK, Zmora O, Derdemezi J, Weiss EG, Nogueras JJ, Wexner SD. Use of the ON-Q pain management system is associated with decreased postoperative analgesic requirement: double blind randomized placebo pilot study. J Am Coll Surg 2006;202:297-305. CrossRef
  • Charous S. Use of the ON-Q pain pump management system in the head and neck: preliminary report. Otolaryngol Head Neck Surg 2008;138:110-2. CrossRef
  • Shen-Gunther J. ON-Q anesthetic pump in gynecologic oncology: feasibility study of a novel placement technique at an army hospital. Mil Med 2008;173:918-23.
  • Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 2008;79:174-83. CrossRef
  • Whiteman A, Bajaj S, Hasan M. Novel techniques of local anaesthetic infiltration. Cont Educ Anaesth Crit Care Pain 2011;11:167-71. CrossRef
  • Spreng UJ, Dahl V, Hjall A, Fagerland MW, Ræder J. High-volume local infiltration analgesia combined with intravenous or local ketorolac+morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth 2010;105:675-82. CrossRef
  • Andersen LØ, Kristensen BB, Husted H, Otte KS, Kehlet H. Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study. Acta Orthop 2008;79:800-5. CrossRef
  • Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006;88:282-9. CrossRef
  • Choi PT, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev 2003;3:CD003071.
  • Thorsell M, Holst P, Hyldahl HC, Weidenhielm L. Pain control after total knee arthroplasty: a prospective study comparing local infiltration anesthesia and epidural anesthesia. Orthopedics 2010;33:75-80. CrossRef
  • Hynes D, McCarroll M, Hiesse-Provost O. Analgesic efficacy of parenteral paracetamol (propacetamol) and diclofenac in post-operative orthopaedic pain. Acta Anaesthesiol Scand 2006;50:374-81. CrossRef

A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty

Year 2014, Volume: 48 Issue: 1, 73 - 79, 17.03.2014

Abstract

Objective: The aim of this study was to compare the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty.
Methods: Thirty patients (28 female, 2 male; mean age: 69.37±5.11 years, range: 61 to 80 years) undergoing total knee arthroplasty between May 2011 and September 2011 were randomly divided into 2 groups. All patients received spinal anesthesia with bupivacaine. Postoperative analgesia of 72 ml 0.9% NaCl + 48 ml bupivacaine (1 ml = 5 mg, total 120 ml) was administered throughout 24 hours to Group 1 (n=15) by epidural catheter and to Group 2 (n=15) by ON-Q infiltration pump. Groups were compared based on the Bromage scores and visual analog scale (VAS), blood pressure, postoperative analgesia requirement and side effects.
Results: Demographic data were similar in both groups. Rates of additional analgesia requirement at the postoperative 60th minute and 2nd hour were significantly higher in Group 2 than Group 1 (p<0.05). Rates of nausea-vomiting at the postoperative 60th minute and 2nd hour were significantly higher in Group 1 than Group 2 (p<0.05 and p<0.01, respectively). Bromage scores at 60 minutes and 2 hours was significantly higher in Group 1 than in Group 2 (p<0.01). Mean VAS scores at 60 minutes and 2 hours were significantly higher in Group 2 than Group 1 (p<0.05). While a statistically significant difference was found between systolic arterial pressure measurements at 60 minutes (p<0.05), there was no significant difference in diastolic arterial pressure and peak heart rate.
Conclusion: Although the analgesic effect of local infiltration is provided later than by epidural analgesia, the same level of pain control can be achieved with initial additional analgesia. Local infiltration is superior to epidural analgesia in respect of few side effects and early mobilization. 

References

  • Bonica J. Postoperative pain. In: Bonica J, editor. The management of pain. 2nd ed. Philadelphia, PA: Lea & Febiger; 19 p. 461-80. Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg 1998;87:93-7. CrossRef
  • Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anaesth 1989;63:189-95. CrossRef
  • Ryu J, Saito S, Yamamoto K, Sano S. Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp Jt Dis 1993;53:35-40.
  • Shoji H, Solomonow M, Yoshino S, D’Ambrosia R, Dabezies E. Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics 1990;13:643-9.
  • Wiebalck A, Brodner G, Van Aken H. The effects of adding sufentanil to bupivacaine for postoperative patient-controlled epidural analgesia. Anesth Analg 1997;85:124-9.
  • Keskin A. Role of pain in operative strategy. [Article in Turkish] Ağrı 2004;6:42-3.
  • Erdine S. Postoperative analgesia. Pain syndromes and management. [Article in Turkish] Istanbul; 2003. p. 33
  • Elder JB, Hoh DJ, Wang MY. Postoperative continuous paravertebral anesthetic infusion for pain control in lumbar spinal fusion surgery. Spine (Phila Pa 1976) 2008;33:210-8. CrossRef
  • American Society of Anesthesiologists. New classification of physical status. Anesthesiology 1963;24:111.
  • Morgan GE, Mikhail MS, Murray MJ, editors. Clinical anesthesiology. New York, NY: Lange Medical Books/ McGraw-Hill; 2002. p. 309-58.
  • Katz J, Melzack R. Measurement of pain. Surg Clin North Am 1999;79:231-52. CrossRef
  • 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. CrossRef
  • Starks I, Frost A, Wall P, Lim J. Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability? J Bone Joint Surg Br 2011;93:967-9. CrossRef
  • Hoenecke HR Jr, Pulido PA, Morris BA, Fronek J. The efficacy of continuous bupivacaine infiltration following anterior cruciate ligament reconstruction. Arthroscopy 2002;18:854-8. CrossRef
  • Gottschalk A, Burmeister MA, Radtke P, Krieg M, Farokhzad F, Kreissl S, et al. Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery. Anesth Analg 2003;97:1086 CrossRef
  • Bianconi M, Ferraro L, Ricci R, Zanoli G, Antonelli T, Giulia B, et al. The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery. Anesth Analg 2004;98:166-72. CrossRef
  • Singh K, Samartzis D, Strom J, Manning D, CampbellHupp M, Wetzel FT, et al. A prospective, randomized, double-blind study evaluating the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after spinal arthrodesis. Spine (Phila Pa 1976) 2005;30:2477-83. CrossRef
  • Argintar E, Armstrong B, Zawadsky M, Evans B, Romness D. Pain control infusion pumps: a prospective randomized evaluation in bilateral total knee arthroplasty. Orthopedics 2011;34:188.
  • Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth 2008;101:841-7. CrossRef
  • LeBlanc KA, Bellanger D, Rhynes VK, Hausmann M. Evaluation of continuous infusion of 0.5% bupivacaine by elastomeric pump for postoperative pain management after open inguinal hernia repair. J Am Coll Surg 2005;200:198-202. CrossRef
  • Givens VA, Lipscomb GH, Meyer NL. A randomized trial of postoperative wound irrigation with local anesthetic for pain after cesarean delivery. Am J Obstet Gynecol 2002;186:1188-91. CrossRef
  • Wheatley GH 3rd, Rosenbaum DH, Paul MC, Dine AP, Wait MA, Meyer DM, et al. Improved pain management outcomes with continuous infusion of a local anesthetic after thoracotomy. J Thorac Cardiovasc Surg. 2005;130:464-8. CrossRef
  • Baig MK, Zmora O, Derdemezi J, Weiss EG, Nogueras JJ, Wexner SD. Use of the ON-Q pain management system is associated with decreased postoperative analgesic requirement: double blind randomized placebo pilot study. J Am Coll Surg 2006;202:297-305. CrossRef
  • Charous S. Use of the ON-Q pain pump management system in the head and neck: preliminary report. Otolaryngol Head Neck Surg 2008;138:110-2. CrossRef
  • Shen-Gunther J. ON-Q anesthetic pump in gynecologic oncology: feasibility study of a novel placement technique at an army hospital. Mil Med 2008;173:918-23.
  • Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 2008;79:174-83. CrossRef
  • Whiteman A, Bajaj S, Hasan M. Novel techniques of local anaesthetic infiltration. Cont Educ Anaesth Crit Care Pain 2011;11:167-71. CrossRef
  • Spreng UJ, Dahl V, Hjall A, Fagerland MW, Ræder J. High-volume local infiltration analgesia combined with intravenous or local ketorolac+morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth 2010;105:675-82. CrossRef
  • Andersen LØ, Kristensen BB, Husted H, Otte KS, Kehlet H. Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study. Acta Orthop 2008;79:800-5. CrossRef
  • Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006;88:282-9. CrossRef
  • Choi PT, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev 2003;3:CD003071.
  • Thorsell M, Holst P, Hyldahl HC, Weidenhielm L. Pain control after total knee arthroplasty: a prospective study comparing local infiltration anesthesia and epidural anesthesia. Orthopedics 2010;33:75-80. CrossRef
  • Hynes D, McCarroll M, Hiesse-Provost O. Analgesic efficacy of parenteral paracetamol (propacetamol) and diclofenac in post-operative orthopaedic pain. Acta Anaesthesiol Scand 2006;50:374-81. CrossRef
There are 33 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Eylem Bedir This is me

Tuhan Kurtulmus This is me

Selma Basyigit This is me

Ugur Bakir This is me

Necdet Saglam This is me

Gursel Saka This is me

Publication Date March 17, 2014
Published in Issue Year 2014 Volume: 48 Issue: 1

Cite

APA Bedir, E., Kurtulmus, T., Basyigit, S., Bakir, U., et al. (2014). A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty. Acta Orthopaedica Et Traumatologica Turcica, 48(1), 73-79.
AMA Bedir E, Kurtulmus T, Basyigit S, Bakir U, Saglam N, Saka G. A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty. Acta Orthopaedica et Traumatologica Turcica. March 2014;48(1):73-79.
Chicago Bedir, Eylem, Tuhan Kurtulmus, Selma Basyigit, Ugur Bakir, Necdet Saglam, and Gursel Saka. “A Comparison of Epidural Analgesia and Local Infiltration Analgesia Methods in Pain Control Following Total Knee Arthroplasty”. Acta Orthopaedica Et Traumatologica Turcica 48, no. 1 (March 2014): 73-79.
EndNote Bedir E, Kurtulmus T, Basyigit S, Bakir U, Saglam N, Saka G (March 1, 2014) A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty. Acta Orthopaedica et Traumatologica Turcica 48 1 73–79.
IEEE E. Bedir, T. Kurtulmus, S. Basyigit, U. Bakir, N. Saglam, and G. Saka, “A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty”, Acta Orthopaedica et Traumatologica Turcica, vol. 48, no. 1, pp. 73–79, 2014.
ISNAD Bedir, Eylem et al. “A Comparison of Epidural Analgesia and Local Infiltration Analgesia Methods in Pain Control Following Total Knee Arthroplasty”. Acta Orthopaedica et Traumatologica Turcica 48/1 (March 2014), 73-79.
JAMA Bedir E, Kurtulmus T, Basyigit S, Bakir U, Saglam N, Saka G. A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty. Acta Orthopaedica et Traumatologica Turcica. 2014;48:73–79.
MLA Bedir, Eylem et al. “A Comparison of Epidural Analgesia and Local Infiltration Analgesia Methods in Pain Control Following Total Knee Arthroplasty”. Acta Orthopaedica Et Traumatologica Turcica, vol. 48, no. 1, 2014, pp. 73-79.
Vancouver Bedir E, Kurtulmus T, Basyigit S, Bakir U, Saglam N, Saka G. A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty. Acta Orthopaedica et Traumatologica Turcica. 2014;48(1):73-9.