Bilateral diz protezi yapılan hastalarda postoperatif analjezi için standart intravenöz hasta kontrollü analjezi dozu yeterli olur mu?

Yıl 2023, Cilt: 37 Sayı: 1, 25 - 35, 03.04.2023

Gözde Gürsoy Çirkinoğlu , Fikret Maltepe , Vasfi Karatosun , Şule Özbilgin , Bayram Ünver , Ayten Deniz

https://doi.org/10.18614/deutip.1142863

Öz

Total diz protezi (TDP) hem unilateral prosedür hem de aynı seferde bilateral prosedür şeklinde uygulanabilir. Operasyon sonrası etkin postoperatif analjezi, komplikasyonları azaltır ve fonksiyonel iyileşmeyi kolaylaştırır. Çalışmamızın amacı, aynı seferde bilateral TDP yapılan hastaların unilateral TDP yapılan hastalara göre kliniğimizin standart intravenöz hasta kontrollü analjezi (İV-HKA) protokolüne verdiği yanıtların farklı olup olmadığını araştırmaktır. Gereç ve Yöntem: Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesinde 01.01.2014- 31.12.2017 tarihleri arasında, ASA (American Society of Anesthesiologists-Amerikan Anestezistler Cemiyeti) fiziksel durum sınıflandırmasına göre ASA I-III risk grubundan, 18-99 yaş arasında, spinal anestezi altında tek seferde bilateral ya da unilateral TDP operasyonu yapılmış ve postoperatif dönemde morfin bazlı İV-HKA kullanan hastaların verileri retrospektif olarak incelenmiştir. Bulgular: Tek seferde bilateral TDP yapılan 68, unilateral TDP yapılan 124 hastanın kayıtlarına ulaşılmıştır. Kadın cinsiyet her iki grupta da daha yüksek bulunmuştur. Operasyon öncesi ve toplam hastanede yatış süresi unilateral TDP grubunda daha yüksektir. Bilateral TDP grubunda postoperatif 0-24 ve 24-48 saatleri arasında hastaların analjezik talepleri, teslim miktarları ve kullandıkları ortalama morfin miktarı unilateral gruptan anlamlı olarak yüksek bulunmuştur. İki grup arasında morfin yan etkileri benzerdir. 24-48 saatleri arasında visuel analog skala (VAS) skorları unilateral TDP grubunda daha yüksek bulunmuştur. Sonuç: Çalışmamızın sonucunda, bilateral TDP hastalarının postoperatif dönemde daha yüksek morfin kullanımı olsa da opioide bağlı yan etkilerin anlamlı farklılık göstermediği ve kullanmakta olduğumuz standart doz İV-HKA protokolümüzün iki grup için de güvenli ve etkin sınırlarda olduğu gösterilmiştir.

Anahtar Kelimeler

total diz protezi, ağrı yönetimi, anesteziyoloji

Is a standard intravenous patient-controlled analgesia protocol sufficient for patients with bilateral knee arthroplasty?

Öz

The aim of this study is to investigate whether patients undergoing one-stage bilateral total knee arthroplasty and those undergoing unilateral total knee arthroplasty differed in their responses to a standard intravenous patient-controlled analgesia protocol. Data from patients with the physiological status I-III according to American Society of Anesthesiologists, aged 18-99 years, undergoing one-stage bilateral or unilateral total knee arthroplasty under spinal anesthesia between January 2014 and December 2017 and offered a standard intravenous patient-controlled analgesia with morphine were retrospectively reviewed. Demographic data, Visual Analogue Scale scores and postoperative complications were examined. The total dose of analgesics consumed, analgesia demands, doses delivered and the ratio of delivered doses to demands in 0- 24 hours and 24-48 hours after surgery available in the patient-controlled analgesia pump monitoring forms were recorded.
Records about 68 patients who had one-stage bilateral total knee arthroplasty and 124 patients who had unilateral total knee arthroplasty were accessed. The analgesia demands and analgesic doses delivered and utilized by the patients with one-stage bilateral total knee arthroplasty were significantly higher in 0-24 hours and 24-48 hours after surgery. Side-effects of the analgesia were similar in both groups. Visual Analogue Scale scores in 24-48 hours after surgery were higher in the patients with unilateral total knee arthroplasty.
Although the patients with one-stage total knee arthroplasty received significantly higher doses of morphine, side-effects due to this opioid did not differ significantly. This showed that the standard intravenous patient-controlled analgesia protocol utilized was reliable and effective in both patient groups.

Anahtar Kelimeler

total knee arthroplasty, pain management, anaesthesiology

Kaynakça

• (1) Jankiewicz JJ, Sculco TP, Ranawat CS, Behr C Tarrentino S. One-stage versus 2-stage bilateral total knee arthroplasty. Clin Orthop Relat Res 1994;309:94-101.
• (2) Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement safer approach in older patients. Knee;2001;8:207-11.
• (3) Singelyn FJ, Ferrant T, Malisse MF, Joris D. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total hip arthroplasty. Reg Anesthesia and pain medicine 2005;30(5):452-457.
• (4) Terkawi AS, Mavridis D, Sessler DI, Nunemaker MS, Doais KS, Terkawi RS et al. Pain management modalities after total knee arthroplasty a network meta-analysis of 170 randomized controlled trials. Anesthesiology: The Journal of American Society of Anesthesiologists 2017;126(5):923-937.
• (5) Maung CN, Nazemzadeh M. Spinal or General Anesthesia? Book Chapter Install Scott Surgery of the Knee 2018;83:1058-1061.
• (6) Shetty GM, Mullaji A, Bhayde S, Chandra Vadapalli R, Desai D. Simultaneous bilateral versus unilateral computer-assisted total knee arthroplasty: a prospective comparison of early postoperative pain and functional recovery. Knee 2010;17:191-5.
• (7) Wang YC, Teng WN, Kuo IT, Chang KY, Bhang WK, Tsou MY et al. Patient-machine interactions of intravenous patient-controlled analgesia in bilateral versus unilateral total knee arthroplasty: A retrospective study. J. Chinese Med. Assoc 2013;76(6):330-334
• (8) Uysal HY, Acar V, Kaya A, Ceyhan A. Postoperatif ağrı tedavisinde uygulanan hasta-kontrollü analjezi yöntemlerinin retrospektif incelemesi. Journal of Clinical Experimental Investigations 2013;4(2):159-165.
• (9) SchaibleHG, Richter F. Pathophysiology of pain. Langenbecks Arch Surg.2004;389:237-243.
• (10) Momeni M, Crucitti M, De Kock M. Patient-controlled analgesia in the management of postoperative pain. 2006;66(18):2321-37.
• (11) Katz J, Buis T, Cohen L. Locked out and still knocking: predictors of excessive demands for postoperative intravenous patient-controlled analgesia. Can J Anaesth 2008;55:88-99.
• (12) McCoy EP, Furness G, Wright PM. Patient-controlled analgesia with and without background infusion. Analgesia assessed using the demand: delivery ratio. Anaesthesia 1993;48:256-60.
• (13) Uchiyama K, Kawai M, Tani M, Ueno M, Hama T, Yamaue H. Gender differences in postoperative pain after laparoscopic cholecystectomy. Surgical Endoscopy and Other Interventional Techniques 2006;20(3):448-451.
• (14) Pereira MP, Esther PZ. Gender aspects in postoperative pain. Current opinion in anaesthesiology 2015;28(5):546-558.
• (15) Theodoraki K, Staikou C, Fassoulaki A. Postoperative pain after major abdominal surgery: is it gender related? An observational prospective study. Pain Practice 2014;14(7):613-619.
• (16) Urban MK, Chisholm M, Wukovits B. Are postoperative complications more common with single-stage bilateral ( SBTKR ) than with unilateral knee arthroplasty : Guidelines for patients scheduled for SBTKR. HSS Journal 2006;2(1):78–82.
• (17) Teng WN, Su YP, Kuo IT, Lin SM. Patient controlled epidural analgesia for bilateral versus unilateral total knee arthroplasty: A retrospective study of pain control. J. Chinese Med. Assoc. 2012;75(3):114-20.
• (18) Bohm ER, Molodianovitsh K, Dragan A, Zhu N,Webster G, Masri B et al. Outcomes of unilateral and bilateral total knee arthroplasty in 238.373 patient. Acta Orthopedica 2016;87:24-30.
• (19) Respetro C, Parvizi J, Dietrich T, Einhorn TA, Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. Journal of Bone and Joint Surgery 2007;89(6):1220-6.
• (20) Powell RS, Pulido P, Tuason MS, Colwell CW, Ezzet KA. Bilateral vs Unilateral Total Knee Arthroplasty: A Patient-Based Comparison of Pain Levels and Recovery of Ambulatory Skills. J. Arthroplasty 2006;21(5):642-49.
• (21) Huang Y, Lin C, Yang JH, Lin LC, Mou JY, Chiang KT et al. No difference in the functional improvements between unilateral and bilateral total knee replacements.BMC Musculoskeletal Disorders 2018;19:87.
• (22) Na YG, Gwi Y, Ms K. Must bilaterality be considered in statistical analyses of total knee arthroplasty ?. Clin Orthop Relat Res 2013;471:1970–81.
• (23) George JA, Lin EE, Hanna MN, Murphy JD, Kumar K, Ko PS et al. The effect of intravenous opioid patient-controlled analgesia with and without background infusion on respiratory depression: a meta-analysis. J. Opioid Manag. 2010;6(1):47-54.
• (24) Chen WH, Liu K, Tan PH, Chia YY. Effects of postoperative background PCA morphine infusion on pain management and related side effects in patients undergoing abdominal hysterectomy. Journal of clinical Anesthesia 2011;23(2):124-129.
• (25) Van Beers EJ, Van Tuijn CFJ, Nieuwkerk PT, Friederich P Wranken JH, Biemond BJ. Patient-controlled analgesia versus continuous infusion of morphine during vaso-occlusive crisis in sickle cell disease, a randomized controlled trial. American Journal of Hematology 2007;82:955-60.
• (26) Todd T, Huntman J, Sparks GW, Hulbert ML. Lower continuous infusion, higher bolus dose patient-controlled analgesia results in shorter hospitalization in children with sickle cell vaso-occlusive pain crisis. Blood 2015;126:523.
• (27) Zhang X, Yu Q, Lv D.The single-incision versus multiple-incision video-assisted thoracoscopic surgery in the treatment of lung cancer: A systematic review and meta-analysis. Indian Journal of Cancer 2017;54(1):291.
• (28) Kliethermes C, Blazek K, Ali K, Nijjar JB, Kliethermes S, Guan X. Postoperative pain after single-site versus multiport hysterectomy. Journal of the Society of Laparoendoscopic Surgeons 2017;21(4).
• (29) Evers L, Bouvy N, Branje D, Peeters A. Single-incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy : a systematic review and meta-analysis. Surg. Endosc. 2017;31(9):3437-48.