Total diz protezi yapılan gonratroz hastalarında postoperatif analjezi için adduktör kanal blogu ile lokal infiltrasyon analjezi tekniklerinin karşılaştırılması

Yıl 2020, Cilt: 11 Sayı: 2, 6 - 11, 21.03.2020

Semih Başkan Fuad Oken Oya Kılcı Kevser Dılek Hakan Tırın Ozgur Yıldırım Fatih Incı Dilsen Ornek

https://doi.org/10.18663/tjcl.649648

Öz

Amaç: Total dizartroplastisi(TDA) major bir ortopedik cerrahidir ve hastalar postoperatif dönemde ciddi ağrı çekmektedir. Lokal infiltrasyon analjezisi ve / veya periferik sinir blokları  TDA sonrası analjezi amaçlı sıklıkla kullanılır.

Bu çalışmanın amacı TDA sonrası postoperatif ilk 24 saat içerisinde lokal infiltrasyon analjezisi ve addütör kanal blok tekniğinin etkinliğini karşılaştırmaktır.

Gereç ve Yöntemler : 40-80 yaş arası, ASA I-III grup ve TDA yapılacak 60 hasta lokal etik komite onayı alındıktan sonra bu çalışmaya dahil edildi. Tüm hastalara 15 mg 0.5% heavy bupivacaine ile spinal anestezi uygulandı. I. Gruba sinir blokajı amaçlı ultrasonografi eşliğinde 20 mL 0.25% bupivacaine uygulandı. II. Gruba periartiküler alan ve subkutan dokuya 60 mL kokteyl enjekte edildi. Vizüel analogskalası(VAS) ile postoperatif 0,1,2,8,12 ve 24. saatlerde ağrı skorları değerlendirildi. VAS skoru 4 üzerinde olan ve ağrısının giderilmesine ihtiyacı olduğunu belirten hastalara intravenöz analjezikler uygulandı ve analjezi gereksinim zamanı olarak kaydedildi. İstatistiksel analiz IBM SPSS 23.0 software ile yapıldı. p< 0.05 değeri anlamlı olarak kabule dildi.

Bulgular:Demografik veriler veya gruplar arasında VAS skorlarında anlamlı bir fark bulunamadı (p>0.05). I. Gruptaki hastaların tamamının ortalama 10.0±4.9. saatlerde ve II. Gruptaki hastaların 28’inin ise 8.7±6.02. saatlerde  ek analjezi ihtiyacı olduğu gözlendi. Bu fark istatistiksel olarak anlamlı bulunmadı (p>0.05).

Sonuç: Bu çalışmada; TDA operasyonu sonrasındaki ilk 24 saatte multimodal analjezi methodu olarak her iki yöntemin de yeterli analjezi sağladığı ve kullanılabileceği gösterilmiştir.

Anahtar Kelimeler

Postoperatif analjezi, Total diz artroplastisi, Adduktör kanal bloğu, Lokal infiltrasyon analjezisi

Comparison of adductor canal block and local infiltration analgesia techniques for postoperative analgesia in gonarthrosis patients receiving a total knee prosthesis

Öz

Aim: Total knee arthroplasty (TKA) is a major orthopaedic surgery, and patients experience severe postoperative pain. Local infiltration anaesthesia and/or peripheral nerve blocks are often used for analgesia after TKA. The aim of this study was to compare the analgesic efficacy of the local infiltration anaesthesia and adductor canal block (ACB) techniques in the first postoperative 24 hours after TKA.

Material and Methods: Sixty patients of both sexes who were aged 40-80 years, in the ASA I-III group and undergoing TKA were included in this study after approval of the local ethics committee. Spinal anaesthesia was achieved with 15 mg 0.5% heavy bupivacaine in all patients. In Group I, nerve blocks were applied under ultrasonography with a 20 mL 0.25% bupivacaine. In Group II, a 60 ml cocktail was injected into the periarticular area and subcutaneous tissue. Postoperative pain was evaluated at 0, 1, 2, 8, 12, and 24 hours with a visual analogue scale (VAS). When the VAS score was >4 or the patient reported a need for pain relief, intravenous analgesics were administered, and the analgesia requirement time was recorded. Statistical analysis was performed with IBM SPSS 23.0 software. A value of p<0.05 was accepted as significant.

Results: No statistically significant differences were determined between groups with respect to the demographic data or VAS values (p>0.05). All patients in Group I and 28 patients in Group II required additional analgesia at 10.0±4.9 hours and 8.7±6.02 hours. These differences were not statistically significant (p>0.05).

Conclusion: The study showed that both methods provided effective analgesia and can be used for a multimodal analgesia method postoperatively in the first 24 hours after TKA operations.

Anahtar Kelimeler

Postoperative analgesia, Total knee arthroplasty, Adductor Canal Block, Local infiltration Analgesia.

Kaynakça

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