Total diz protezi hastalarında hızlandırılmış iyileşme protokolü: adduktor kanal bloğu ile ağrı ve opioid tüketiminin azaltılması

Abstract

Giriş Bu çalışma, Enhanced Recovery After Surgery (ERAS) protokollerine uygun olarak gerçekleştirilen total diz artroplastisi (TKA) operasyonlarında ultrason eşliğinde uygulanan adduktör kanal bloğunun (AKB) ameliyat sonrası ağrı kontrolü, opiyat tüketimi ve taburculuk süresi üzerindeki etkilerini değerlendirmeyi amaçlamaktadır. Yöntem Bu prospektif gözlemsel kohort çalışma, Pamukkale Üniversitesi Hastanesi Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesinde, Pamukkale Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan alınan etik onay (08.01.2020-E.1710) ile yürütülmüştür. Birincil çıktı, ameliyat sonrası ilk 24 saat içinde istirahat hâlinde ve ilk ambulasyon sırasında ölçülen Visual Analog Skala (VAS) skorlarıydı. İkincil çıktılar arasında ameliyat sonrası tramadol kullanımı, dozu, opioide bağlı yan etkiler, ilk ambulasyon süresi, ambulasyon mesafesi, hasta memnuniyeti, 24. saatteki kuadriseps kas gücü ve taburculuğa hazır olma zamanı yer almaktadır. Veriler SPSS 25.0 yazılımı kullanılarak analiz edilmiştir. Sürekli değişkenler ortalama ± standart sapma, kategorik değişkenler ise sayı ve yüzde biçiminde ifade edilmiştir. Gruplar arası karşılaştırmalarda Independent T testi ve Mann-Whitney U testi, grup içi değişikliklerin değerlendirilmesinde Friedman testi uygulanmıştır. Kategorik veriler Pearson Ki-kare testiyle analiz edilmiştir. İstatistiksel anlamlılık düzeyi p<0.05 olarak kabul edilmiştir. Bulgular Çalışmaya TKA uygulanan 60 hasta dâhil edilmiştir. Hastalar iki gruba ayrılmıştır: Grup I yalnızca LIA almış, Grup II ise hem LIA hem de AKB (20 mL içinde 15 mL %0,5 bupivakain, 4 mL serum fizyolojik ve 1 mL epinefrin) almıştır. Ağrı, ilk 24 saat içinde istirahat hâlinde, yürüme sırasında ve VAS yöntemiyle ölçülmüştür. Grup II, istirahat, yürüme ve uyku dâhil tüm zaman noktalarında Grup I’e göre sürekli olarak daha düşük VAS skorlarına sahip olmuştur (p<0,05). Opioid tüketimi Grup I’de anlamlı derecede daha yüksek bulunmuştur (p<0,027) ve taburculuğa hazır olma süresi Grup I’de Grup II’ye kıyasla daha geç gerçekleşmiştir (p<0,05). Sonuç AKB alan hastalarda, ameliyat sonrasındaki ilk 24 saat boyunca istirahat, ambulasyon ve uyku esnasında ölçülen VAS skorlarının anlamlı derecede daha düşük olduğu görülmüştür. Ayrıca opioid tüketimi daha düşük, yan etki insidansı daha az, hasta memnuniyeti daha yüksek ve taburculuğa hazır olma süresi AKB grubunda daha kısa bulunmuştur.bölgesel anestezi.

Keywords

• adduktor kanal bloğu
• fonksiyonel iyileşme
• diz artroplastisi
• opioid tüketimi
• postoperatif ağrı

Project Number

Evrak Tarih ve Sayısı: 08.01.2020-E.1710

Accelerated recovery protocol in total knee replacement patients: reducing pain and opioid consumption with adductor canal block

Abstract

Aims: This study aims to evaluate the effects of ultrasound-guided adductor canal block (ACB) on postoperative pain control, opioid consumption, and discharge time in total knee arthroplasty (TKA) operations performed in accordance with enhanced recovery after surgery (ERAS) protocols. Methods: This prospective randomized controlled trial was conducted at Pamukkale University Hospital after obtaining ethical approval. A total of 60 patients who underwent TKA under spinal anesthesia were randomly assigned into two groups. Group I received only local infiltration analgesia (LIA), while group II received both LIA and an ACB. The groups were compared in terms of postoperative Visual Analog Scale (VAS) score at rest and during first ambulation, comparison of tramadol use, dosage, and side effects, time to first ambulation, ambulation distance, quadriceps muscle strength scores, and patient satisfaction and hospital discharge times. Results: Group II showed consistently lower VAS scores compared with group I at all time points, including rest, walking, and sleep (p<0.05). Opioid consumption was significantly higher in group I (p=0.027), and readiness for discharge was delayed in group I compared with group II (p<0.05). Conclusion: In patients undergoing TKA, the combination of LIA and ACB appears to be an effective option in multimodal analgesia practices during the postoperative period and may provide potential benefits in accelerating recovery and reducing opioid-related side effects.

Keywords

• Adductor canal block
• functional recovery
• knee arthroplasty
• opioid consumption
• postoperative pain
• regional anesthesia

Supporting Institution

Pamukkale University

Project Number

Evrak Tarih ve Sayısı: 08.01.2020-E.1710

Ethical Statement

Statements and Declarations Funding There were no external funding sources for this research. Conflict of Interest The authors declare that they have no conflict of interest. EthicalApproval It was approved by the Pamukkale University Ethics Committee (08.01.2020-E.1710). Acknowledgments None.

Thanks

None

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