Total diz artroplastisinde postoperatif ağrı için ultrason eşliğinde femoral + anterior siyatik sinir bloğu ve geniküler sinir bloğunun karşılaştırılması

Year 2021, , 1433 - 1440, 30.12.2021

Zeynep Gümüşkanat Tabur , Canan Yılmaz , Derya Karasu , Çağdaş Baytar

https://doi.org/10.17826/cumj.977400

Cited By: 1

Abstract

Amaç: Çalışmamızın amacı; genel anestezi altında yapılan total diz artroplastisinde (TDA) ultrason eşliğinde uygulanan femoral ve anterior siyatik (FAS) sinir bloğu ile geniküler (G) sinir bloğunun postoperatif analjezik etkilerini araştırmaktır.
Gereç ve Yöntem: Ameliyat öncesi 55-80 yaş arası toplam 50 hasta 2 gruba ayrıldı. FAS gruptaki hastalara (n=25) 20 ml solüsyon (10 ml %0.5 Bupivakain+1 ml (4 mg) Deksametazon+ 9 ml serum fizyolojik) ultrason eşliğinde hem femoral hem de siyatik blok uygulamak için uygulandı. G gruptaki hastalara (n=25) her bir geniküler sinire 5 ml solüsyon (2 ml %0.5 Bupivakain+ 1 ml (4 mg) Deksametazon+ 2 ml serum fizyolojik) geniküler blok için ultrason eşliğinde uygulandı. Hastaların postoperatif 24 saat boyunca ağrı skorları, tüketilen opioid miktarları, ilk analjezik gereksinim zamanları, postoperatif komplikasyonları kaydedildi.
Bulgular: Postoperatif 0, 1, ve 6. saatteki VAS skorları ve postoperatif 24 saat boyunca tüketilen tramadol miktarı FAS grubunda G grubuna göre anlamlı olarak daha düşük bulundu. Operasyon sonrası FAS grupta hiç ek analjezik gereksinimi olmazken, G grubunda 9 hastada ek analjezik ihtiyacı oldu.
Sonuç: Ultrason eşliğinde uygulanan femoral ve siyatik sinir blokları TDA'da geniküler sinir bloklarından üstündü. Ayrıca geniküler bloğun motor bloğa neden olmamasıyla TKA'da postoperatif analjezi amacıyla alternatif olarak kullanılabilecektir.

Keywords

Siyatik Sinir Bloğu, Geniküler Sinir Bloğu, Femoral Sinir Bloğu, Total Diz Artroplastisi, Postoperatif Ağrı

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Comparison of ultrasound-guided femoral + anterior sciatic nerve block and genicular nerve block for postoperative pain in total knee arthroplasty

Abstract

Purpose: This study aimed to compare the effectiveness of ultrasound-guided femoral and anterior sciatic (FAS) nerve blocks and genicular (G) nerve blocks as preventive analgesia methods after total knee arthroplasty.
Materials and Methods: Fifty patients, aged 55–80 years were divided into two groups preoperatively. Patients in the FAS group (n=25) received 20 mL solutions (10 mL 0.5% bupivacaine, 1 mL [4 mg] dexamethasone, and 9 mL saline) in both femoral and sciatic blocks. Patients in the G group (n=25) received 5 mL solutions (2 mL 0.5% bupivacaine, 1 mL [4 mg] dexamethasone, and 2 mL saline) for each nerve. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesic requirement, total analgesic dose, and postoperative complications during the first 24 h were recorded.
Results: VAS scores at postoperative 0, 1, and 6 h and the total amount of tramadol consumed 24 h were lower in the FAS group than in the G group. There was no requirement for additional analgesia in the first 24 h in the FAS group; however, 9 patients required additional analgesia in the G group.
Conclusion: USG FAS nerve blocks were superior to the genicular nerve blocks in TKA. Additionally, the genicular block doesn’t cause motor block. A genicular block can be considered as an alternative with this regard.

Keywords

Sciatic Nerve, Genicular Nerve, Femoral Nerve, Total Knee Arthroplasty, Postoperative Pain

Project Number

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