Artroskopik diz cerrahisinde eklem içi lokal anestezinin ameliyat sonrası ağrıya etkisi

Öz

Amaç: Bu çalışmada amacımız artroskopik diz cerrahisi uygulanan hastalarda eklem içi lokal anestezik uygulamasının ameliyat sonrası ağrıya ve hasta memnuniyetine etkisini araştırmaktır. Gereç ve yöntem: Çalışmaya artroskopik diz cerrahisi yapılan 18-45 yaş arası 64 hasta dahil edildi. Operasyon sonunda diz eklemi içine Grup B hastalarında %0.5 bupivakain (20 ml, 100 mg) ve Grup K hastalarında serum fizyolojik (20 ml) uygulandıktan 10 dk sonra her 2 grupta da eklem içi serum fizyolojik ile yıkanarak aspire edildi. Hastaların ameliyat sonrası VAS değerleri ve ek analjezik ihtiyaçları kaydedildi. Bulgular: Grupların ameliyat sonrası VAS değerleri karşılaştırıldığında ilk 8 saatte anlamlı fark görülürken 12. ve 24. saatlerde anlamlı fark bulunmadı. Ek analjezik ihtiyacı ise Grup B\'de anlamlı derecede az bulundu. Sonuç: Artroskopik diz cerrahi sonrası eklem içi bupivakain uygulamasının ameliyat sonrası ağrı kontrolünde ilk 8 saatte erken dönemde etkili ve güvenilir bir yöntem olduğu ve hasta memnuniyetini artırdığı görüşündeyiz.

Anahtar Kelimeler

• Artroskopi, eklem içi lokal anestezi, bupivakain, ameliyat sonrası analjezi.

The effect of intraarticular local anaesthesia on postoperative pain in arthroscopic knee surgery

Abstract

Objectives: The aim of this study was to evaluate the effect of intraarticular local anaesthesia on postoperative pain and patients satisfaction in arthroscopic knee surgery. Methods: A total of 64 patients (18–45 years) who underwent arthroscopic knee surgery were included in this study. At the end of surgery %0.5 bupivacaine (20 ml, 100 mg) in group B and saline solution (20 ml) in group K were admitted to the knee joint. Ten minutes after application, knee joint was washed with saline solution in both groups. Postoperative visual analog scores (VAS) values of patients and additional analgesic requirements were recorded. Results: Postoperative VAS values of groups were compared, on the first 8 hours there was a significant difference but on the 12th and 24th th hours significant difference was not found. Conclusions: Intraarticular bupivacaine administiration was found as a reliable and effective method for pain control in arthroscopic knee surgery and can ameliorate patient satisfaction.

Keywords

• Arthroscopic, intraarticular local anaesthesia, bupivacaine, postoperative analgesia.

References

1. Eroglu A, Saracoglu S, Erturk E, Kosucu M, Kerimoglu S. A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia. Knee Surg Sports Traumatol Arthrosc 2010: DOI 10.1007/s00167–010 –1061–0 Ulaşılabileceği adres: http://www.springerlink. com/content/6244755qq13l0655/
2. Ng HP, Nordström U, Axelsson K, et al. Efficacy of intra-ar- ticular bupivacaine, ropivacaine, or a combination of ropiv- acaine, morphine, and ketorolac on postoperative pain relief after ambulatory arthroscopic knee surgery: a randomized double-blind study. Reg Anesth Pain Med 2006;31.26–33.
3. Alagöl A, Calpur OU, Kaya G, Pamukçu Z, Turan FN. The use of intraarticular tramadol for postoperative analgesia after arthroscopic knee surgery: a comparison of differ- ent intraarticular and intravenous doses. Knee Surg Sports Traumatol Arthrosc 2004;12.184–8.
4. Talu GK, Ozyalçin S, Koltka K, et al. Comparison of effi- cacy of intraarticular application of tenoxicam, bupivacaine and tenoxicam: bupivacaine combination in arthroscop- ic knee surgery. Knee Surg Sports Traumatol Arthrosc 2002;10:355–60.
5. Lokal Anestezikler. In Morgan GE, Mikhail MS, Murray MJ, editör. Clinical Anesthesiology. Çeviri editörü: Tulunay M, Cuhruk H. 3. basım Türkçe baskı. Ankara: Güneş Kitabevi, 2004: 233–52.
6. Gürkan Y, Canatay H, Ozdamar D, Solak M, Toker K. Spinal anesthesia for arthroscopic knee surgery. Acta Anaesthesiol Scand 2004;48:513–7.
7. Raj N, Sehgal A, Hall JE, Sharma A, Murrin KR, Groves ND. Comparison of analgesic efficacy and plasma concentrations of high-dose intra-articular and intramuscular morphine for knee arthroscopy. Eur J Anaesthesiol 2004;21:932–7.
8. Santanen U, Raitoma P, Luurila H, Erkola O. Intra-articular ropivacaine injection does not alleviate pain after day-case knee arthroscopy performed under spinal anaesthesia. Ann Chir Gynaecol 2001;90:.47–50.

9. Al-Metwalli RR, Mowafi HA, Ismail SA, et al. Effect of intra- articular dexmedetomidine on postoperative analgesia after arthroscopic knee surgery. Br J Anaesth 2008;101:395–9.
10. Dogan N, Erdem AF, Erman Z, Kizilkaya M. The ef- fects of bupivacaine and neostigmine on articular carti- lage and synovium in the rabbit knee joint. J Int Med Res 2004;32:513–9.
11. Gomoll AH, Kang RW, Williams JM, Bach BR, Cole BJ. Chondrolysis after continuous intra-articular bupivacaine infusion: an experimental model investigating chondrotox- icity in the rabbit shoulder. Arthroscopy 2006;22:813–9.
12. Dragoo JL, Korotkova T, Kanwar R, Wood B. The effect of local anesthetics administered via pain pump on chondro- cyte viability. Am J Sports Med 2008;36:1484–8.
13. Webb ST, Ghosh S. Intra-articular bupivacaine: potentially chondrotoxic? Br J Anaesth 2009;102:439–41.
14. Cepeda MS, Uribe C, Betancourt J, Rugeles J, Carr DB. Pain relief after knee rthroscopy- intraarticular morphine, intraarticular bupivacaine, or subcutaneous morphine? Reg Anesth 1997;22:233–8.
15. Tuncer C, Babacan CA, Arslan M. The pre-emptive analge- sic effect of intra-articular bupivacaine in arthroscopic knee surgery. Acta Anaesthesiol Scand 2005;49:1373–7.
16. Smith I, Shively RA, White PF. Effects of ketorolac and bupivacaine on recovery after outpatient arthroscopy. Anesth Analg 1992;75:208–12.
17. Henderson RC, Campion AR, DeMasi RA, Taft TN. Po- starthroscopy analgesia with bupivacaine: A prospec- tive, randomized, blinded evaluation. Am J Sports Med 1990;18:614–7.
18. Milligan KA, Mowbray MJ, Mulrooney L, Standen PJ. In- traarticular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patients. Anaesthesia 1988;43:563–4.
19. Reuben SS, Sklar J.Pain management in patients who un- dergo outpatient arthroscopic surgery of the knee. J Bone Joint Surg Am 2000;12:1754–66.