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FAST TRACK DİZ ARTROPLASTİSİ: İKİ FARKLI MULTİMODAL ANALJEZİ YÖNTEMİNİN KARŞILAŞTIRILMASI

Year 2021, Volume: 28 Issue: 4, 543 - 549, 30.12.2021
https://doi.org/10.17343/sdutfd.897132

Abstract

Amaç
Bu çalışmanın amacı, Fast track Total Diz Artroplasti
(TDA) ameliyatlarında multimodal protokolün, femoral
sinir blokajı (FSB) ile lokal infiltrasyon analjezi (LIA)
yöntemleri kullanarak pre-emptif analjezideki etkilerini
hızlı bir şekilde değerlendirmektir.
Gereç ve Yöntem
Bu çalışma tek merkezli, randomize, tek kör kontrollü
bir çalışma olarak planlandı. Çalışmaya, birincil veya
ikincil osteoartrit nedeniyle TDA uygulanan, her iki
cinsiyetten 40-80 yaş arası toplam 72 gönüllü hasta
dahil edildi. Hastalar bir bilgisayar randomizasyon
programı kullanılarak iki gruba ayrıldı. Grup I: FSB
yöntemi uygulanan hastalar ve Grup II: LIA yöntemi
uygulanan hastalar. Gruplar fonksiyonel puanlar açısından
karşılaştırıldı.
Bulgular
Gruplar arasında yaş, cinsiyet, boy, kilo, vücut kitle indeksi,
ASA, ameliyat edilen taraf, protez tipi ve ameliyat
süresi açısından istatistiksel olarak anlamlı fark
saptanmadı (p> 0,05). Her iki grupta da ölçüm zamanları
arasında fonksiyon skor değerlerinde istatistiksel
olarak anlamlı farklılık belirlendi (p <0.05). Hangi zamanda
veya zamanlarda bir fark olduğunu belirlemek
için çoklu karşılaştırma testleri (post-hoc) uygulandı.
Her iki grupta da fonksiyon skor değerleri tüm ölçüm
zamanlarında farklıydı, preoperatif ölçüm en düşük,
postoperatif 3 aylık değerler en yüksek bulundu.
Sonuç
Çalışmamız femoral sinir bloğu veya lokal infiltrasyon
analjezisi ile multimodal analjezinin kullanılmasının
Fast-track TDA ameliyatlarında etkili analjezi yöntemleri
olarak uygulanabileceğini ve birbirlerine alternatif
olabileceğini göstermektedir.

References

  • 1. Raeder JC. Local infiltration analgesia for pain after total knee replacement surgery: a winner or just a strong runner-up? Anesth Analg. 2011;113(4), 684–686.
  • 2. Berg U, Berg M, Rolfson O, Erichsen-Andersson A. Fast-track program of elective joint replacement in hip and knee-patients' experiences of the clinical pathway and care process. J Orthop Surg Res. 2019;21;14(1):186.
  • 3. Horlocker TT, Kopp SL, Pagnano MW, Hebl J. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J Am Acad Orthop Surg. 2006;14(3), 126– 135
  • 4. Fischer HBJ, Simanski CJP, Sharp C, Bonnet F., Camu F, Neugebauer EAM, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 2008;63(10), 1105–23.
  • 5. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 2011;93(11), 1075–84.
  • 6. Sites BD, Beach M, Gallagher JD, Jarrett RA, Sparks MB, Lundberg CJF. A single injection ultrasound-assisted femoral nerve block provides side effect-sparing analgesia when compared with intrathecal morphine in patients undergoing total knee arthroplasty. Anesth Analg 2004;99(5), 1539–43.
  • 7. 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(2), 282–9.
  • 8. Dillon JP, Brennan L, Mitchell D. Local infiltration analgesia in hip and knee arthroplasty: an emerging technique. Acta Orthop Belg 2012;78(2), 158–63.
  • 9. Parvataneni HK, Ranawat AS, Ranawat CS. The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect. 2007;56:125–131.
  • 10. Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticularinjections: a prospective randomized study. J Arthroplasty 2007;22(6), 33–38.
  • 11. Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty: a randomized trial. J Bone Joint Surg Am. 2006;88(5), 959–963.
  • 12. Kehlet H, Andersen LO. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand. 2011;55(7), 778–784.
  • 13. 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(6), 1552–4
  • 14. Affas F, Nygards EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthopaedica 2011;82(4), 441–7.
  • 15. Carli F, Clemente A, Asenjo JF, Kim DJ, Mistraletti G, Gomarasca M, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 2010;105(2), 185–95
  • 16. Toftdahl K, Kikolajsen L, Haraldsted V, Madsen F, Tønnesen EK, Søballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty. A randomized clinical trial. Acta Orthopaedica 2007;78(2), 172–9.
  • 17. McCartney CJ, McLeod GA. Local infiltration analgesia for total knee arthroplasty, British Journal of Anaesthesia 2011;107 (4), 487–9
  • 18. Tanikawa H, Sato T, Nagafuchi M, Takeda K, Oshida J, Okuma K (2014) Comparison of local infiltration of analgesia and sciatic nerve block in addition to femoral nerve block for total knee arthroplasty. The Journal of arthroplasty 2014;29(12), 2462-2467.
  • 19. Kurosaka K, Tsukada S, Seino D, Morooka T, Nakayama H, Yoshiya S. Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. The Journal of arthroplasty 2016;31(4), 913-917.
  • 20. Tsukada S., Wakui M., Hoshino A. Postoperative Epidural Analgesia Compared with Intraoperative Periarticular Injection for Pain Control Following Total Knee Arthroplasty Under Spinal Anesthesia. J Bone Joint Surg Am. 2014;96(17), 1433-1438.

FAST TRACK KNEE ARTHROPLASTY: COMPARISON OF TWO DIFFERENT MULTIMODAL ANALGESIA METHODS

Year 2021, Volume: 28 Issue: 4, 543 - 549, 30.12.2021
https://doi.org/10.17343/sdutfd.897132

Abstract

Objective
The aim of this study was to evaluate the effects
of a multimodal protocol in pre-emptive analgesia
following Total Knee Arthroplasty (TKA), using
epidural anesthesia with femoral nerve blockage
(FNB) or local infiltration analgesia (LIA) methods in
fast-track TKA.
Material and Methods
This study was planned as a single-centre,
randomized, single-blind, controlled study. The study
included 72 voluntary patients, aged 40-80 years,
of both genders, who underwent TKA for primary or
secondary osteoarthritis. The patients were divided
into two groups using a computer randomization
program. Group I: FNB application and Group II:
LIA methods. Groups were compared in terms of
functional scores.
Results
No statistically significant difference was determined
between the groups in respect of age, gender, height,
weight, BMI, ASA, operated side, prosthesis type,
and operating time (p>0.05). A statistically significant
difference was determined in the function score values
between the measurement times in both groups
(p<0.05). Multiple comparison tests (post-hoc) were
applied to determine at which time or times there was
a difference. In both groups, the function score values
were different at all the measurement times, with the
preoperative measurement found to be the lowest
and the postoperative 3-month values the highest.
Conclusions
Our study show that used multimodal analgesia with
femoral nerve block or local infiltration analgesia can
be applied as effective analgesia methods in fasttrack
TKA and can be considered as alternatives for
each other.

References

  • 1. Raeder JC. Local infiltration analgesia for pain after total knee replacement surgery: a winner or just a strong runner-up? Anesth Analg. 2011;113(4), 684–686.
  • 2. Berg U, Berg M, Rolfson O, Erichsen-Andersson A. Fast-track program of elective joint replacement in hip and knee-patients' experiences of the clinical pathway and care process. J Orthop Surg Res. 2019;21;14(1):186.
  • 3. Horlocker TT, Kopp SL, Pagnano MW, Hebl J. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J Am Acad Orthop Surg. 2006;14(3), 126– 135
  • 4. Fischer HBJ, Simanski CJP, Sharp C, Bonnet F., Camu F, Neugebauer EAM, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 2008;63(10), 1105–23.
  • 5. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 2011;93(11), 1075–84.
  • 6. Sites BD, Beach M, Gallagher JD, Jarrett RA, Sparks MB, Lundberg CJF. A single injection ultrasound-assisted femoral nerve block provides side effect-sparing analgesia when compared with intrathecal morphine in patients undergoing total knee arthroplasty. Anesth Analg 2004;99(5), 1539–43.
  • 7. 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(2), 282–9.
  • 8. Dillon JP, Brennan L, Mitchell D. Local infiltration analgesia in hip and knee arthroplasty: an emerging technique. Acta Orthop Belg 2012;78(2), 158–63.
  • 9. Parvataneni HK, Ranawat AS, Ranawat CS. The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect. 2007;56:125–131.
  • 10. Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticularinjections: a prospective randomized study. J Arthroplasty 2007;22(6), 33–38.
  • 11. Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty: a randomized trial. J Bone Joint Surg Am. 2006;88(5), 959–963.
  • 12. Kehlet H, Andersen LO. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand. 2011;55(7), 778–784.
  • 13. 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(6), 1552–4
  • 14. Affas F, Nygards EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthopaedica 2011;82(4), 441–7.
  • 15. Carli F, Clemente A, Asenjo JF, Kim DJ, Mistraletti G, Gomarasca M, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 2010;105(2), 185–95
  • 16. Toftdahl K, Kikolajsen L, Haraldsted V, Madsen F, Tønnesen EK, Søballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty. A randomized clinical trial. Acta Orthopaedica 2007;78(2), 172–9.
  • 17. McCartney CJ, McLeod GA. Local infiltration analgesia for total knee arthroplasty, British Journal of Anaesthesia 2011;107 (4), 487–9
  • 18. Tanikawa H, Sato T, Nagafuchi M, Takeda K, Oshida J, Okuma K (2014) Comparison of local infiltration of analgesia and sciatic nerve block in addition to femoral nerve block for total knee arthroplasty. The Journal of arthroplasty 2014;29(12), 2462-2467.
  • 19. Kurosaka K, Tsukada S, Seino D, Morooka T, Nakayama H, Yoshiya S. Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. The Journal of arthroplasty 2016;31(4), 913-917.
  • 20. Tsukada S., Wakui M., Hoshino A. Postoperative Epidural Analgesia Compared with Intraoperative Periarticular Injection for Pain Control Following Total Knee Arthroplasty Under Spinal Anesthesia. J Bone Joint Surg Am. 2014;96(17), 1433-1438.
There are 20 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Articles
Authors

İbrahim Alper Yavuz 0000-0002-5287-7934

Fuad Öken 0000-0002-3091-9697

Semih Başkan 0000-0003-0096-7097

Hakan Tırın 0000-0003-2940-268X

Kevser Dilek Andıç 0000-0002-2384-4201

Oya Kılcı 0000-0003-2082-2127

Ahmet Özgür Yildirim 0000-0002-4107-4853

Publication Date December 30, 2021
Submission Date March 15, 2021
Acceptance Date August 9, 2021
Published in Issue Year 2021 Volume: 28 Issue: 4

Cite

Vancouver Yavuz İA, Öken F, Başkan S, Tırın H, Dilek Andıç K, Kılcı O, Yildirim AÖ. FAST TRACK KNEE ARTHROPLASTY: COMPARISON OF TWO DIFFERENT MULTIMODAL ANALGESIA METHODS. Med J SDU. 2021;28(4):543-9.

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