Siyatik Sinir Bloğunun Postoperatif Ağrı ve İnflamatuar Yanıt Üzerine Etkilerinin İncelenmesi

Öz

Amaç: Postoperatif ağrı, ortopedik ameliyatlardan sonra iyileşme ve hastaneye yatış üzerinde önemli bir etkiye sahiptir. Çalışmanın amacı, tek diz eklemi artroplastilerinde (TDA) femoral sinir bloğu ile birlikte uygulanan siyatik sinir bloğunun inflamatuar yanıt ve ameliyat sonrası ağrı kontrolü üzerindeki etkilerini araştırmaktır. Gereç ve Yöntemler: Çalışma Afyonkarahisar Sağlık Bilimleri Üniversitesi Hastanesi'nde gerçekleştirildi. Elektif TDA geçiren 40-80 yaş aralığındaki ASA I-III hastalar çalışmaya dahil edildi. Katılımcılar rastgele iki gruba ayrıldı: Grup I'e hem femoral hem de siyatik sinir bloğu uygulanırken, Grup II'ye sadece femoral sinir bloğu uygulandı. Ameliyat sonrası ağrı, Görsel Analog Skala (VAS) kullanılarak 2, 4, 8, 12 ve 24. saatlerde değerlendirildi. İnflamatuar belirteçler TNF-alfa, IL-6, IL-8 ve IL-10 ameliyat öncesi ve ameliyattan 24 saat sonra ölçüldü. Sonuçlar gruplar arasında karşılaştırıldı. Sonuçlar: Çalışmaya 45 hasta dahil edildi (Grup-I'de 22 ve Grup-II'de 23). Grup-I, ilk 12 saat içinde dinlenme ve hareket sırasında Grup-II'ye kıyasla önemli ölçüde daha düşük VAS skorları gösterdi (p<0.05). İlk analjezik gereksinimi Grup-I'de daha erken gerçekleşti (p<0.001). Her iki grupta da sitokin seviyeleri artmasına rağmen, artış Grup-I'de daha az belirgindi ve bu da kombine sinir bloğu tekniğiyle ilişkili inflamatuar yanıtta potansiyel bir azalma olduğunu düşündürmektedir (p>0.05). Gruplar arasında opioid ile ilişkili yan etkilerde önemli bir fark görülmedi (p=0.04). Sonuç: Bu çalışma, femoral sinir bloğuna siyatik sinir bloğu eklenmesinin, ameliyat sonrası ağrı yönetimini etkili bir şekilde iyileştirdiğini ve TKA hastalarında inflamatuar yanıtı hafifletebileceğini göstermektedir.

Anahtar Kelimeler

• Siyatik sinir bloğu
• Femoral sinir bloğu
• Postoperatif ağrı
• Postoperatif inflamasyon
• total diz artroplastisi

EVALUATION OF THE EFFECT OF SCIATIC NERVE BLOCK ON POSTOPERATIVE ANALGESIA AND INFLAMMATORY RESPONSE IN KNEE ARTHROPLASTY

Öz

Aim: Postoperative pain significantly impact on the recovery and hospitalization following orthopedic surgeries. The aim of the study was to investigate the effects of sciatic nerve block together with to femoral nerve block on the inflammatory response and postoperative pain control in single knee joint arthroplasties (TKA). Material and Methods: The study was carried out at Afyonkarahisar Health Sciences University Hospital. The patients with ASA I-III patients aged 40-80 years undergoing elective unilateral TKA were enrolled. Participants were randomly assigned into two groups: Group I received both femoral and sciatic nerve blocks, while Group II received only a femoral nerve block. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 2, 4, 8, 12, and 24 hours. Inflammatory markers TNF-alpha, IL-6, IL-8, and IL-10 were measured preoperatively and at 24 hours post-surgery. The results were compared between the groups. Results: 45 patients were enrolled to the study (22 in Group I and 23 in Group II). Group I exhibited significantly lower VAS scores at rest and during movement within the first 12 hours compared to Group II (p<0.05). The first analgesic requirement occurred earlier in Group I (p<0.001). Although cytokine levels increased in both groups, the rise was less pronounced in Group I, suggesting a potential reduction in the inflammatory response associated with the combined nerve block technique (p>0.05). No significant differences in opioid-related side effects were noted between the groups (p=0,04). Conclusion: This study shows that the addition of a sciatic nerve block to a femoral nerve block effectively enhances postoperative pain management and may attenuate the inflammatory response in TKA patients.

Anahtar Kelimeler

• Sciatic nerve block
• Femoral nerve block
• Total knee arthroplasty
• Postoperative pain
• Postoperative inflammation

Destekleyen Kurum

Afyonkarahisar Health Sciences University Scientific Research Projects Commission with project number 19.TIP.007.

Etik Beyan

The study was approved by Afyon Kocatepe University Clinical Research Ethics Committee (decision dated 04.05.2018 and numbered 2018/126)

Kaynakça

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