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

Yıl 2021, Cilt: 46 Sayı: 4, 1433 - 1440, 30.12.2021

Zeynep Gümüşkanat Tabur Canan Yılmaz Derya Karasu Çağdaş Baytar

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

Cited By: 1

Öz

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.

Anahtar Kelimeler

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

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

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

Öz

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.

Anahtar Kelimeler

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

Proje Numarası

yok

Kaynakça

• Brandt KD, Dieppe P, Radin EL. Etiopathogenesis of osteoarthritis. Rheum Dis Clin North Am 2008; 3, 531-59.
• Arden N, Nevitt MC. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol 2006; 1, 3-25.
• Grosu I, Lavand’homme P, Thienpont E. Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc 2014; 8, 1744-58.
• Ilfeld BM, Mariano ER, Girard PJ et al. A multicenter, randomized, triple-masked, placebo-controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge-readiness following total knee arthroplasty in patients on general orthopaedic wards. Pain, 2010; 3, 477-84.
• Society KK. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res 2012; 4, 201.
• Güler G, Atıcı Ş, Kurt E, Karaca S, Yılmazlar A. Kalça ve Diz Artroplastisi Anestezisinde Güncel Yaklaşımlar. Turk J Anaesthesiol Reanim 2015; 3.
• Dong CC, Dong SL, He FC. Comparison of adductor canal block and femoral nerve block for postoperative pain in total knee arthroplasty: a systematic review and meta-analysis. Medicine 2016; 12.
• Sotelo VG, Maculé F, Minguell J, Bergé R, Franco C, Sala-Blanch X. Ultrasound-guided genicular nerve block for pain control after total knee replacement: Preliminary case series and technical note. Rev Esp Anestesiol Reanim (English Edition), 2017; 10, 568-76.
• Qudsi-Sinclair S, Borrás-Rubio E, Abellan-Guillén JF, Padilla Del Rey ML, Ruiz-Merino G. A Comparison of Genicular Nerve Treatment Using Either Radiofrequency or Analgesic Block with Corticosteroid for Pain after a Total Knee Arthroplasty: A Double-Blind, Randomized Clinical Study. Pain Pract 2017; 5:578-88.
• Hadžić A, Vloka JD, Kuroda MM, Koorn R, Birnbach DJ. The practice of peripheral nerve blocks in the United States: a national survey. Reg Anesth Pain Med 1998; 3, 241-6.
• Abdallah FW, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review. Reg Anesth Pain Med. 2011; 5:493-8.
• Cook P, Stevens J, Gaudron C. Comparing the effects of femoral nerve block versus femoral and sciatic nerve block on pain and opiate consumption after total knee arthroplasty. J Arthroplasty 2003; 5, 583-6.
• Weihrauch JO, Jehmlich M, Leischik M, Hopf HB. Are peripheral nerve blocks of the leg (femoralis in combination with anterior sciatic blockade) as sole anaesthetic technique an alternative to epidural anaesthesia. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 2005; 1, 18-24.
• Pandin P, Vancutsem N, Salengros JC, Huybrechts I, Vandesteene A. The anterior combined approach via a single skin injection site allows lower limb anesthesia in supine patients. Can J Anaesth 2003; 8, 801.
• Eltohamy SA. Ultrasound guided two-in-one technique for sciatic and femoral nerve block in below knee surgery: Comparison between two entry points. Egyptian Journal of Anaesthesia, 2012; 4, 261-7.
• Yasar E, Kesikburun S, Kılıç C, Güzelküçük Ü, Yazar F, Tan AK. Accuracy of Ultrasound-Guided Genicular Nerve Block: A Cadaveric Study. Pain Physician. 2015; 5: E899-904.
• Tran J, Peng PWH, Lam K, Baig E, Agur AMR, Gofeld M. Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med 2018; 4:407-14.
• Choi WJ, Hwang SJ, Song JG et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain 2011; 3:481-7.
• Franco CD, Buvanendran A, Petersohn JD, Menzies RD, Menzies LP. Innervation of the Anterior Capsule of the Human Knee: Implications for Radiofrequency Ablation. Reg Anesth Pain Med 2015; 4: 363-8.
• Santana Pineda MM, Vanlinthout LE, Moreno Martín A, van Zundert J, Rodriguez Huertas F, Novalbos Ruiz JP. Analgesic Effect and Functional Improvement Caused by Radiofrequency Treatment of Genicular Nerves in Patients With Advanced Osteoarthritis of the Knee Until 1 Year Following Treatment. Reg Anesth Pain Med. 2017; 1:62-8.
• Mudumbai SC, Kim TE, Howard SK et al. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res. 2014; 5:1377-83.
• Memtsoudis SG, Yoo D, Stundner O et al. Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement. Int Orthop. 2015; 4:673-80.
• Vaishya R, Agarwal AK, Vijay V, Tiwari MK. Short term outcomes of long duration versus short duration tourniquet in primary total knee arthroplasty: A randomized controlled trial. J Clin Orthop Trauma. 2018; 1:46-50.
• Hakkalamani S, Carroll AF, Ford C, Parkinson RW. Femoral versus combined femoral and sciatic nerve block in total knee replacement: A prospective comparative study. J Bone Joint Surg Br 2019; 91: 141.