.: ORİJİNAL ARAŞTIRMA
Analgesic Efficacy of Adductor Canal Block After Total Knee Arthroplasty
Total Diz Artroplastisi Sonrası Adduktor Kanal Bloğunun Analjezik Etkisi
Turkiye Klinikleri J Anest Reanim. 2019;17(1):22-8
doi: 10.5336/anesthe.2019-66057
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Total knee arthroplasty (TKA) is a severely painful procedure even with the administration of extensive multimodal analgesics. We aim to assess whether US-guided adductor canal block (ACB) would improve postoperative pain scores and consequently decrease local anesthetic consumption by means of an epidural catheter with patient-controlled anaesthesia (PCA) device after TKA. Material and Methods: This was a retrospective study. Fifty-eight patients WHO underwent TKA between June 2015 and June 2016 and were fitted with either an epidural catheter with PCA (group A, n=30) or an epidural catheter with PCA followed by ACB (group B, n=28) were included in the study. PCA consumption during the postoperative 24 h and visual analogue scale (VAS) pain scores at 0, 4 and 24 h were determined. Motor block ending time and local anaesthetic drug consumption were also determined. Results: Basal bupivacaine and total bupivacaine consumption were reduced in group B 24 h postoperatively compared to that in group A. ACB reduced VAS score at 0 and 4 h post-operatively during movement. There was no statistically significant difference between VAS scores for each group at 24 h postoperatively. Motor block duration in group B patients who underwent ACB was longer than group A. Conclusion: Adductor canal block is effective for patients undergoing TKA. US-guided ACB reduced 24 h PCA requirements and VAS scores after TKA. ACB is a promising technique in producing effective and prolonged postoperative analgesia for patients undergoing TKA.
Keywords: Adductor canal block; epidural anaesthesia; ultrasound; total knee arthroplasty
Objective: Total knee arthroplasty (TKA) is a severely painful procedure even with the administration of extensive multimodal analgesics. We aim to assess whether US-guided adductor canal block (ACB) would improve postoperative pain scores and consequently decrease local anesthetic consumption by means of an epidural catheter with patient-controlled anaesthesia (PCA) device after TKA. Material and Methods: This was a retrospective study. Fifty-eight patients WHO underwent TKA between June 2015 and June 2016 and were fitted with either an epidural catheter with PCA (group A, n=30) or an epidural catheter with PCA followed by ACB (group B, n=28) were included in the study. PCA consumption during the postoperative 24 h and visual analogue scale (VAS) pain scores at 0, 4 and 24 h were determined. Motor block ending time and local anaesthetic drug consumption were also determined. Results: Basal bupivacaine and total bupivacaine consumption were reduced in group B 24 h postoperatively compared to that in group A. ACB reduced VAS score at 0 and 4 h post-operatively during movement. There was no statistically significant difference between VAS scores for each group at 24 h postoperatively. Motor block duration in group B patients who underwent ACB was longer than group A. Conclusion: Adductor canal block is effective for patients undergoing TKA. US-guided ACB reduced 24 h PCA requirements and VAS scores after TKA. ACB is a promising technique in producing effective and prolonged postoperative analgesia for patients undergoing TKA.
Keywords: Adductor canal block; epidural anaesthesia; ultrasound; total knee arthroplasty
ÖZET
Amaç: Total diz artroplastisi (TDA) çoklu analjezik ilaç kullanımına rağmen oldukça ağrılı seyreden işlemdir. Biz ultrasonografi altında adduktor kanal bloğu (AKB) postoperatif ağrı skorunu düşürmeyi ve epidural kateter aracılığı ile hasta kontrollü ağrı (HKA) cihazında lokal analjezik ilaç kullanımını azaltmayı hedefledik. Gereç ve Yöntemler: Geriye dönük 2015-2016 haziran zaman aralığında kombine spinal epidural anestezi altında TDA geçiren hastalar, AKB yapılmayan 30 hasta (A grubu) ve yapılan 28 (B grubu) hasta şeklinde sınıflandırıldı. Hastaların HKA cihazı aracılığı ile ağrı kesici kullanımı ve postoperatif 0, 4 ve 24. saat ağrı skorları incelendi. Ayrıca motor blok sonlanma zamanı karşılaştırıldı. Bulgular: Bupivakainin bazal ve total tüketiminin A grubu ile karşılaştırıldığında B grubunda daha az olduğu saptanmıştır. AKB postoperatif 0 ve 4. saatlerdeki VAS skorunu azaltmıştır ancak her iki grup 24. saat VAS skorunda farklılık gözlenmemiştir. AKB uygulanan B grubunda motor blok süresi daha uzun bulunmuştur. Sonuç: AKB yapılan hastalarda postoperatif 0 ve 4. saatlerde bakılan VAS değeri daha düşük saptanmıştır. Postoperatif 24. saatte bakılan VAS değerleri kıyaslandığında gruplar arası anlamlı fark gözlenmemiştir. Adduktor kanal bloğu TDA geçiren hastalarda etkili bulunmuştur; postoperatif 24 saatlik süreçte HKA ilaç kullanımını ve VAS değerini düşürmüştür. AKB, TDA uygulanan hastalarda etkili ve uzun süreli postoperatif analjezi üretmede umut verici bir tekniktir.
Anahtar Kelimeler: Adduktor kanal bloğu; epidural anestezi; ultrasonografi; total diz artroplastisi
Amaç: Total diz artroplastisi (TDA) çoklu analjezik ilaç kullanımına rağmen oldukça ağrılı seyreden işlemdir. Biz ultrasonografi altında adduktor kanal bloğu (AKB) postoperatif ağrı skorunu düşürmeyi ve epidural kateter aracılığı ile hasta kontrollü ağrı (HKA) cihazında lokal analjezik ilaç kullanımını azaltmayı hedefledik. Gereç ve Yöntemler: Geriye dönük 2015-2016 haziran zaman aralığında kombine spinal epidural anestezi altında TDA geçiren hastalar, AKB yapılmayan 30 hasta (A grubu) ve yapılan 28 (B grubu) hasta şeklinde sınıflandırıldı. Hastaların HKA cihazı aracılığı ile ağrı kesici kullanımı ve postoperatif 0, 4 ve 24. saat ağrı skorları incelendi. Ayrıca motor blok sonlanma zamanı karşılaştırıldı. Bulgular: Bupivakainin bazal ve total tüketiminin A grubu ile karşılaştırıldığında B grubunda daha az olduğu saptanmıştır. AKB postoperatif 0 ve 4. saatlerdeki VAS skorunu azaltmıştır ancak her iki grup 24. saat VAS skorunda farklılık gözlenmemiştir. AKB uygulanan B grubunda motor blok süresi daha uzun bulunmuştur. Sonuç: AKB yapılan hastalarda postoperatif 0 ve 4. saatlerde bakılan VAS değeri daha düşük saptanmıştır. Postoperatif 24. saatte bakılan VAS değerleri kıyaslandığında gruplar arası anlamlı fark gözlenmemiştir. Adduktor kanal bloğu TDA geçiren hastalarda etkili bulunmuştur; postoperatif 24 saatlik süreçte HKA ilaç kullanımını ve VAS değerini düşürmüştür. AKB, TDA uygulanan hastalarda etkili ve uzun süreli postoperatif analjezi üretmede umut verici bir tekniktir.
Anahtar Kelimeler: Adduktor kanal bloğu; epidural anestezi; ultrasonografi; total diz artroplastisi
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