A comparison of peri-articular injection and femoral block for pain management after total knee arthroplasty: A prospective cohort study

Abstract

Aim: Though Total knee arthroplasty (TKA) is an effective treatment method for osteoarthritis, insufficient postoperative pain control negatively affects patients’ satisfaction and functional results. The aim of this study is to compare the effects of intraoperative peri-articular injection and postoperative single-dose femoral nerve block on functional results, the need for analgesia, and pain in the short-term following total knee arthroplasty (TKA).
Methods: Thirty-one patients who received peri-articular injection (PAI) during TKA and 38 who were administered a single dose of femoral nerve block (FNB) postoperatively were evaluated. In both groups, an intravenous patient-controlled analgesia (PCA) device was utilized for postoperative analgesia. Analgesia demand and the amount administered from the PCA in the first 24 hours were recorded. For the evaluation of the level of postoperative pain, a visual analog scale (VAS) was used at rest at 2nd, 4th, 8th, 12th, and 24th hours, and dynamic VAS was used at the 24th hour to assess pain with mobilization. Range of movement (ROM) was recorded with the measurements of active flexion and extension angles at the first, second and third postoperative days.
Results: The resting VAS scores at the 2nd, 4th, 8th, and 24th hours were significantly lower in the PAI group than in the FNB group (P=0.032, P=0.037, P=0.014, P=0.004, respectively). The number of patients’ demands on the PCA for pain relief and the number of doses administered were higher in the FNB group. The ROM values measured on postoperative days 1, 2, and 3 were insignificantly greater in the PAI patients (P=0.956, P=0.103, P=0.162, respectively).
Conclusion: The peri-articular injection technique, when used appropriately, is easy to apply with a low-side effect profile. Therefore, it can be considered a safe and effective analgesia method providing a higher level of patient comfort and greater range of movement.

Keywords

• Peri-articular injection,Femoral nerve block,Total knee arthroplasty,Pain management

Total diz artroplastisi sonrası periartiküler enjeksiyon ile femoral bloğun ağrı üzerindeki etkinliğinin karşılaştırılması: Prospektif kohort çalışma

Öz

Amaç: Total diz artroplastisi (TDA) diz osteoartriti için etkili bir tedavi yöntemi olmasına rağmen, postoperatif yetersiz ağrı kontrolünün uygulanması hastaların memnuniyetini ve fonksiyonel sonuçları etkiler. Bu çalışmanın amacı intraoperatif periartiküler enjeksiyon ile postoperatif tek doz femoral sinir bloğunun total diz artroplastisi sonrası erken dönemde ağrı, analjezik gereksinimi ve fonksiyonel sonuçlar üzerine olan etkilerini karşılaştırmaktır.
Yöntemler: Total diz artoplastisi sırasında intraoperatif periartiküler enjeksiyon uygulanan (PAG) 31 hasta ve postoperatif tek doz femoral sinir bloğu uygulanan (FBG) 38 hasta çalışmada değerlendirildi. Postoperatif iki gruba da analjezi için intravenöz hasta kontrollü analjezi (PCA) cihazı takıldı. 24 saatlik analjezik talebi ve PCA’dan verilen miktar kaydedildi. Postoperatif ağrı düzeyini değerlendirmek için istirahatte vizüel analog skala (VAS) skoru 2., 4., 8., 12. ve 24. saatlerde, mobilizasyon ile değerlendirmeye başlanan dinamik VAS (DVAS) ise 24. saatte değerlendirildi. 1.gün, 2.gün ve 3.günde aktif fleksiyon ve ekstansiyon dereceleri ölçülerek eklem hareket açıklıkları (EHA) kaydedildi.
Bulgular: Postoperatif sırasıyla 2., 4., 8. ve 24. saatteki istirahat VAS skorları PAG’ta FBG’na göre anlamlı şekilde daha düşük bulundu (sırasıyla P-değerleri: P=0,032, P=0,037, P=0,014,
P=0,004). Ağrı kontrolü için kullanılan PCA’ya basma miktarı ve PCA tarafından verilen doz sayısı PAG’ndaki hastalarda FBG’undaki hastalara göre daha az olduğu görüldü. PAG’ndaki hastaların eklem hareket açıklıklarının 1. 2. ve 3. günlerde daha fazla ölçülmesine rağmen iki grup arasındaki bu fark anlamlı bulunmadı (sırasıyla P-değerleri: P=0,956, P=0,103, P=0,162).
Sonuç: Periartiküler enjeksiyon tekniğine uygun olarak uygulandığı zaman kolay uygulanabilir, düşük yan etki profili ile ameliyat sonrası daha yüksek düzeyde hasta konforu ve daha fazla hareket açıklığı sağlayan etkili ve güvenilir bir analjezi yöntemidir.

Anahtar Kelimeler

• Periartiküler enjeksiyon,Femoral sinir bloğu,Total diz artroplastisi,Ağrı yönetimi

Kaynakça

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