Total Diz Artroplastisi Sonrası Ağrı Yönetimi: Kısa-Orta Dönem Sonuçlarımız

Yıl 2022, , 137 - 142, 01.03.2022

Zafer Şen , Alper Kurtoğlu

https://doi.org/10.26453/otjhs.1057623

Öz

Amaç: Total diz artroplasti sonrası diz ağrısı ciddi morbidite oluşturduğu için ağrı yönetiminde farklı teknikler uygulanmaktadır. Bu çalışmada intraoperatif uyguladığımız Ranawat kokteyli ile hastaların klinik olarak opioid ihtiyaçları, fonksiyonel sonuçları ve hasta memnuniyetinin değerlendirilmesi amaçlanmıştır.
Materyal ve Metot: Çalışmaya total diz artroplastisi uygulanan 310 hasta dahil edildi. Tüm hastalara derin ve yüzeyel olmak üzere iki kısım içeren Ranawat kokteyl enjeksiyonu uygulandı. Hastaların VAS skorları (preoperatif, postoperatif 12, 24, 48. saat), opioid ihtiyaçları ve hasta memnuniyet ölçeği ile memnuniyet değerlendirilmesi yapıldı.
Bulgular: Ortalama yaş 64,4±16,4 olarak bulundu. Preoperatif preop VAS değer ortalaması 7,1±1,9, postoperatif 12. saatteki ortalaması 5,2±2,8, postoperatif 24. saatteki ortalaması 3,7±2,3 ve postoperatif 48. saatteki ortalaması 2,4±1,4 olarak bulundu. Olguların %68,3’ü (212 hasta) çok memnun, %31,62’si (98 hasta) az memnun idi. Ameliyat sonrası opioid ihtiyacı %23,5 olarak bulundu.
Sonuç: Multiodak kokteyl enjeksiyonu total diz artroplastisi uygulanmış olan hastalarda rehabilitasyonu kolaylaştırmak açısından basit, güvenli ve etkili bir postoperatif analjezi kontrol disiplinidir.  

Anahtar Kelimeler

Periartiküler enjeksiyon, ranawat kokteyl, total diz artroplastisi

Teşekkür

Yazımızda emeği geçen herkese ve derginize teşekkürlerimizi sunarız

Pain Management after Total Knee Arthroplasty: Our Short-Medium Term Results

Öz

Objective: Since knee pain causes serious morbidity after total knee arthroplasty, different techniques are applied in pain management. In this study, it was aimed to evaluate the clinical opioid needs, functional results and patient satisfaction of the patients with the Ranawat cocktail that we applied intraoperatively.
Materials and Methods: 310 patients who underwent total knee arthroplasty were included in the study. Ranawat cocktail injection containing two parts, deep and superficial, was applied to all patients. The patients' VAS scores (preoperative, postoperative 12, 24, 48th hours), opioid needs, and patient satisfaction scale were evaluated for satisfaction.
Results: The mean age was found to be 64.4±16.4 years. The mean preoperative VAS value was 7.1±1.9 the mean at the postoperative 12th hour was 5.2±2.8 the mean at the postoperative 24th hour was 3.7±2.3 and the mean at the postoperative 48th hour was 2.4±1.4. 68.3% (212 patients) of the cases were very satisfied, 31.62% (98 patients) were less satisfied. The postoperative opioid requirement was found to be 23.5%.
Conclusion: Multifocal cocktail injection is a simple, safe and effective postoperative analgesia control discipline to facilitate rehabilitation in patients who have undergone total knee arthroplasty.

Anahtar Kelimeler

Periarticular injection, ranawat cocktail, total knee arthroplasty

Kaynakça

• Ekşioğlu E, Gürçay E. Total diz artroplastisi sonrasi rehabilitasyon. İstanbul Tıp Fakültesi Dergisi. 2014;76(1):16-21.
• Güney G. Total Diz Artroplastili Bireylerde Aktivite Öz Algısının Kinezyofobi ve Fonksiyonel İyileşmeye Etkisi. Hacettepepe Üniversitesi, Sağlık Bilimleri Enstitüsü, Yüksek Lisans Tezi. Ankara, Türkiye. 2019.
• Park KK, Shin KS, Chang CB, Kim SJ, Kim TK. Functional disabilities and issues of concern in female Asian patients before TKA. Clinical Orthopaedics and Related Research. 2007;461:143-152. doi:10.1097/BLO.0b013e31804ea0bc
• Strassels SA, Chen C, Carr DB. Postoperative analgesia: Economics, resource use, and patient satisfaction in an urban teaching hospital. Anesth Analg. 2002;94(1):130-137. doi:10.1213/00000539-2002010000-00025
• Jayakumar T, Suhas B, Avinash P. Post-operative Pain Management Using Local İnfiltration Analgesia (LIA) in Total Knee Arthroplasty (TKA): A Prospective Study. International Journal of Orthopaedics. 2019;5(3):670-676. doi:10.22271.ortho.2019.v5.i3I.1611
• Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan Jr JA, Wu CL. Efficacy of Postoperative Epidural Analgesia: A Meta-Analysis. JAMA. 2003;290(18):2455-2463. doi:10.1001/jama.290.18.2455
• Barrington MJ, Olive D, Low K, Scott DA, Brittain J, Choong P. Continuous Femoral Nerve Blockade or Epidural Enalgesia Aafter Total Knee Replacement: A Prospective Randomized Controlled Trial. Anesth Analg. 2005;101(6):1824-1829. doi:10.1213/01ANE.0000184113.57416.DD
• Dalury DF. A State-of-the-art Pain Protocol for Total Knee Replacement. Arthroplasty Today. 2016;2(1):23-25. doi:10.1016/j.artd.2016.01004
• Busch CA, Shore BJ, Bhandari R, et al. Efficacy of Periarticular Multimodal Drug İnjection in Total Knee Arthroplasty: A randomized Trial. J Bone Joint Surgary Am. 2006;88(5):959-963. doi:10.2106/JBJS.E.00344
• Kellgren J, Lawrence J. Radiological Assessment of Osteo-Arthrosis. Annals of the Rheumatic Diseases. 1957;16(4):494. doi:10.1136/ard.16.4.494.
• Keblish PA, Varma AK, Greenwald AS. Patellar Resurfacing or Retention in Total Knee Arthroplasty. A prospective Study of Patients with Bilateral Replacements. The J Bone Joint Surgary Am. 1994;76(6):930-937. doi:10.1302/0301-620X.76B6.7983122
• Okcu G, Yercan HS, Vatansever A, Öziç U. The effectiveness of cold application made on plaster and bandages. Clinical Research. 2004;15(1):155-160
• Bolognese JA, Schnitzer TJ, Ehrich E. Response relationship of VAS and Likert Scales in Osteoarthritis Efficacy Measurement. Osteoarthritis and Cartilage. 2003;11(7):499-507. doi:10.1016/S1063-4584(03)00082-7
• Steiger RN, Graves SE. Orthopaedic Registries: The Australian Experience. EFORT Open Rev. 2019;(4):409–15.
• Cheng BLY, So EHK, Hui GKM, et al. Pre-operative İntravenous Steroid İmproves Pain and Joint Mobility After Total Knee Arthroplasty in Chinese Population: A Double-Blind Randomized Controlled Trial. Eur J Orthop Surg Traumatol. 2019;29(1):1473–1479.
• Li D, Zhao J, Yang Z, Kang P, Shen B, Pei F. Multiple Low Doses of İntravenous Corticosteroids to İmprove Early Rehabilitation in Total Knee Arthroplasty: A Randomized Clinical Trial. J Knee Surg. 2019;32(2):171–179. doi:10.1055/s-0038-1636506
• Tan Z, Kang P, Pei F, Shen B, Zhou Z, Yang J. A Comparison of Adductor Canal Block and Femoral Nerve Block After Total Knee Arthroplasty Regarding Analgesic Effect, Effectiveness of Early Rehabilitation, and Lateral Knee Pain Relief in the Early Stage. Medicine. 2018;97(48):13391-13398. doi:10.1097/MD.0000000000013391
• Canovas F, agneaux L. Quality of Life After Total Knee Arthroplasty. Orthopaedics Traumatology: Surgery Research. 2018;104(1):41-46. doi: 10.1177/15394492211038293
• Zhang Lk, Zhu Fb, Gao Hh, Zhang L, Quan Rf. Is İntraoperative Corticosteroid a Good Choice for Postoperative Pain Relief in Total Joint Arthroplasty? A Meta-Analysis of 11 Randomized Controlled Trials. Medicine. 2021;100(40);27468-27477
• Blendon RJ, Benson JM. The Public and the Opioid-Abuse Epidemic. N Engl J Med. 2018;378(5):407–11
• Zhang Y, Mi F, Zhao H, Xie D, Shi X. Effect of Morphine Added to Multimodal Cocktail on İnfiltration Analgesia in Total Knee Arthroplasty. Medicine. 2019;98(4):17503-17602. doi:10.1097/MD.000000000017503
• Sogbein OA, Sondekoppam RV, Bryant D, et al. Ultrasound-Guided Motor-Sparing Knee Blocks for Postoperative Analgesia Following Total Knee Arthroplasty: A Randomized Blinded Study. J Bone Joint Surg Am. 2017;99(15):1274–1281
• Wang Y, Zhou A. A New İmprovement: Subperiosteal Cocktail Application to Effectively Reduce Pain and Blood Loss After Total Knee Arthroplasty. J Orthop Surge Res. 2020;15(1):1-6. doi:10.1186/s13018-020-1563-5
• Meier M, Sommer S, Huth J, Benignus C, Thienpont E, Beckmann J, et al. Local İnfiltration Analgesia with Additional İntraarticular Catheter Provide Better Pain Relief Compared to Single-Shot Local İnfiltration Analgesia in TKA. Arch Orthop Trauma Surg. 2021;141(1):105–111
• Iseki T, Tsukada S, Wakui M, Kurosaka K, Yoshiya S, Tachibana T. Percutaneous Periarticular Analgesic İnjection at One Day After Simultaneous Bilateral Total Knee Arthroplasty: An Open Label Randomized Control Trial. J Orthop Surg Res. 2021;16(1):357-368. doi:10/1186/s13180-021-02507-1
• Chan VWK, Chan PK, Yan CH, Henry CH, Chan CW, Chiu KY. Effect of Steroid in Local İnfiltration Analgesia in One-Stage Bilateral Total Knee Arthroplasty: A Paired-Randomized Controlled Study. J Knee Surg. 2020. doi:10.1055/s-0040-1713811
• Laoruengthana A, Rattanaprichavej P, Mahatthanatrakul A, Tantimethanon T, Lohitnavy M, Pongpirul K. Periarticular İnjection of Ketorolac Augmenting İntravenous Administration of Ketorolac for Postoperative Pain Control: Randomized Controlled Trial in Simultaneous Bilateral Total Knee Arthroplasty. J Knee Surg. 2020. doi:10.1055/s-0040-1721088
• Seangleulur A, Vanasbodeekul P, Prapaitrakool S, et al. The Efficacy of Local İnfiltration Analgesia in the Early Postoperative Period After Total Knee Arthroplasty: A systematic Review and Meta-Analysis. European Journal of Anaesthesiology (EJA). 2016;33(11):816-831. doi:10.1097/EJA.0000000000000516
• Li C, Qu J, Pan S, Qu Y. Local İnfiltration Anesthesia Versus Epidural Analgesia for Postoperative Pain Control in Total Knee Arthroplasty: A systematic Review and Meta-Analysis. J Bone Joint Surgary Am. 2018;13(1):112. doi: 10.1189/s13018-018-0770-9
• Shah V, Upadhyay S, Shah K, Sheth A, Kshatriya A, Saini D. Multimodal Cocktail İnjection Relieves Postoperative Pain and İmproves Early Rehabilitation Following Total Knee Replacement: A prospective, Blinded and Randomized Study. J Recent Adv Pain. 2017;3(1):14-24. doi:10.5005/jp-dergiler-10046-0060