sdü tıp fak derg Medical Journal of Süleyman Demirel University 2602-2109 Süleyman Demirel Üniversitesi 10.17343/sdutfd.897132 Surgery Cerrahi FAST TRACK DİZ ARTROPLASTİSİ: İKİ FARKLI MULTİMODAL ANALJEZİ YÖNTEMİNİN KARŞILAŞTIRILMASI FAST TRACK KNEE ARTHROPLASTY: COMPARISON OF TWO DIFFERENT MULTIMODAL ANALGESIA METHODS https://orcid.org/0000-0002-5287-7934 Yavuz İbrahim Alper Ankara Bilkent Şehir Hastanesi https://orcid.org/0000-0002-3091-9697 Öken Fuad Ankara Bilkent Şehir Hastanesi https://orcid.org/0000-0003-0096-7097 Başkan Semih Ankara Bilkent Şehir Hastanesi https://orcid.org/0000-0003-2940-268X Tırın Hakan Bilecik Devlet Hastanesi https://orcid.org/0000-0002-2384-4201 Dilek Andıç Kevser Bilecik Devlet Hastanesi https://orcid.org/0000-0003-2082-2127 Kılcı Oya Ankara Bilkent Şehir Hastanesi https://orcid.org/0000-0002-4107-4853 Yildirim Ahmet Özgür Ankara Bilkent Şehir Hastanesi 12 30 2021 28 4 543 549 03 15 2021 08 09 2021 Copyright © 1994, Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi 1994 Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi

AmaçBu çalışmanın amacı, Fast track Total Diz Artroplasti(TDA) ameliyatlarında multimodal protokolün, femoralsinir blokajı (FSB) ile lokal infiltrasyon analjezi (LIA)yöntemleri kullanarak pre-emptif analjezideki etkilerinihızlı bir şekilde değerlendirmektir.Gereç ve YöntemBu çalışma tek merkezli, randomize, tek kör kontrollübir çalışma olarak planlandı. Çalışmaya, birincil veyaikincil osteoartrit nedeniyle TDA uygulanan, her ikicinsiyetten 40-80 yaş arası toplam 72 gönüllü hastadahil edildi. Hastalar bir bilgisayar randomizasyonprogramı kullanılarak iki gruba ayrıldı. Grup I: FSByöntemi uygulanan hastalar ve Grup II: LIA yöntemiuygulanan hastalar. Gruplar fonksiyonel puanlar açısındankarşılaştırıldı.BulgularGruplar arasında yaş, cinsiyet, boy, kilo, vücut kitle indeksi,ASA, ameliyat edilen taraf, protez tipi ve ameliyatsüresi açısından istatistiksel olarak anlamlı farksaptanmadı (p> 0,05). Her iki grupta da ölçüm zamanlarıarasında fonksiyon skor değerlerinde istatistikselolarak anlamlı farklılık belirlendi (p <0.05). Hangi zamandaveya zamanlarda bir fark olduğunu belirlemekiçin çoklu karşılaştırma testleri (post-hoc) uygulandı.Her iki grupta da fonksiyon skor değerleri tüm ölçümzamanlarında farklıydı, preoperatif ölçüm en düşük,postoperatif 3 aylık değerler en yüksek bulundu.SonuçÇalışmamız femoral sinir bloğu veya lokal infiltrasyonanaljezisi ile multimodal analjezinin kullanılmasınınFast-track TDA ameliyatlarında etkili analjezi yöntemleriolarak uygulanabileceğini ve birbirlerine alternatifolabileceğini göstermektedir.

ObjectiveThe aim of this study was to evaluate the effectsof a multimodal protocol in pre-emptive analgesiafollowing Total Knee Arthroplasty (TKA), usingepidural anesthesia with femoral nerve blockage(FNB) or local infiltration analgesia (LIA) methods infast-track TKA.Material and MethodsThis study was planned as a single-centre,randomized, single-blind, controlled study. The studyincluded 72 voluntary patients, aged 40-80 years,of both genders, who underwent TKA for primary orsecondary osteoarthritis. The patients were dividedinto two groups using a computer randomizationprogram. Group I: FNB application and Group II:LIA methods. Groups were compared in terms offunctional scores.ResultsNo statistically significant difference was determinedbetween the groups in respect of age, gender, height,weight, BMI, ASA, operated side, prosthesis type,and operating time (p>0.05). A statistically significantdifference was determined in the function score valuesbetween the measurement times in both groups(p<0.05). Multiple comparison tests (post-hoc) wereapplied to determine at which time or times there wasa difference. In both groups, the function score valueswere different at all the measurement times, with thepreoperative measurement found to be the lowestand the postoperative 3-month values the highest.ConclusionsOur study show that used multimodal analgesia withfemoral nerve block or local infiltration analgesia canbe applied as effective analgesia methods in fasttrackTKA and can be considered as alternatives foreach other.

 Arthroplasty Analgesia Local infiltration analgesia Femoral nerve block Multi-modal analgesia Fast-Track cerrahi Total diz artroplastisi Lokal infiltrasyon analjezi Femoral sinir bloğu Multimodal analjezi 1. Raeder JC. Local infiltration analgesia for pain after total knee replacement surgery: a winner or just a strong runner-up? Anesth Analg. 2011;113(4), 684–686. 2. Berg U, Berg M, Rolfson O, Erichsen-Andersson A. Fast-track program of elective joint replacement in hip and knee-patients' experiences of the clinical pathway and care process. J Orthop Surg Res. 2019;21;14(1):186. 3. Horlocker TT, Kopp SL, Pagnano MW, Hebl J. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J Am Acad Orthop Surg. 2006;14(3), 126– 135 4. Fischer HBJ, Simanski CJP, Sharp C, Bonnet F., Camu F, Neugebauer EAM, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 2008;63(10), 1105–23. 5. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 2011;93(11), 1075–84. 6. Sites BD, Beach M, Gallagher JD, Jarrett RA, Sparks MB, Lundberg CJF. A single injection ultrasound-assisted femoral nerve block provides side effect-sparing analgesia when compared with intrathecal morphine in patients undergoing total knee arthroplasty. Anesth Analg 2004;99(5), 1539–43. 7. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006;88(2), 282–9. 8. Dillon JP, Brennan L, Mitchell D. Local infiltration analgesia in hip and knee arthroplasty: an emerging technique. Acta Orthop Belg 2012;78(2), 158–63. 9. Parvataneni HK, Ranawat AS, Ranawat CS. The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect. 2007;56:125–131. 10. Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticularinjections: a prospective randomized study. J Arthroplasty 2007;22(6), 33–38. 11. Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty: a randomized trial. J Bone Joint Surg Am. 2006;88(5), 959–963. 12. Kehlet H, Andersen LO. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand. 2011;55(7), 778–784. 13. Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg. 2010;111(6), 1552–4 14. Affas F, Nygards EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthopaedica 2011;82(4), 441–7. 15. Carli F, Clemente A, Asenjo JF, Kim DJ, Mistraletti G, Gomarasca M, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 2010;105(2), 185–95 16. Toftdahl K, Kikolajsen L, Haraldsted V, Madsen F, Tønnesen EK, Søballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty. A randomized clinical trial. Acta Orthopaedica 2007;78(2), 172–9. 17. McCartney CJ, McLeod GA. Local infiltration analgesia for total knee arthroplasty, British Journal of Anaesthesia 2011;107 (4), 487–9 18. Tanikawa H, Sato T, Nagafuchi M, Takeda K, Oshida J, Okuma K (2014) Comparison of local infiltration of analgesia and sciatic nerve block in addition to femoral nerve block for total knee arthroplasty. The Journal of arthroplasty 2014;29(12), 2462-2467. 19. Kurosaka K, Tsukada S, Seino D, Morooka T, Nakayama H, Yoshiya S. Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. The Journal of arthroplasty 2016;31(4), 913-917. 20. Tsukada S., Wakui M., Hoshino A. Postoperative Epidural Analgesia Compared with Intraoperative Periarticular Injection for Pain Control Following Total Knee Arthroplasty Under Spinal Anesthesia. J Bone Joint Surg Am. 2014;96(17), 1433-1438.