Eylem BEDİR, Tuhan KURTULMUS, Selma BASYİGİT, Ugur BAKİR, Necdet SAGLAM, Gursel SAKA

Total diz artroplastisi sonrası ağrı kontrolünde epidural analjezi ve lokal infiltratif analjezi yöntemlerinin karşılaştırılması

Amaç: Bu çalışmada total diz protezi uygulanmış hastalarda, ameliyat sonrası ağrı kontrolü için epidural analjezi ile infiltratif analjezinin etkinliklerinin karşılaştırılması amaçlandı. Çalışma planı: Mayıs 2011 ila Eylül 2011 tarihleri arasında total diz protezi uygulanan 30 hasta (28 kadın, 2 erkek; ortalama yaş: 69.37±5.11, dağılım: 61-80) rastgele 2 gruba ayrıldı. Bupivakainle spinal anestezi yapılan hastalardan, ameliyat sonrası 24 saat boyunca Grup 1’e (n=15) epidural kateterden, Grup 2’ye (n=15) ON-Q infiltrasyon pompasıyla 72 ml %0.9 NaCl + 48 ml bupivakain (1 ml = 5 mg, toplam 120 ml) uygulandı. Gruplar, Bromage skoru ve görsel analog skala (GAS) kullanılarak, kan basıncı, ameliyat sonrası analjezi ihtiyaçları ve yan etkileri yönünden karşılaştırıldı. Bulgular: Gruplar arasında demografik veriler açısından fark yoktu. Grup 2’nin 60. dakika ve 2. saatteki ek analjezi ihtiyacı Grup 1’den anlamlı olarak yüksek bulundu (p<0.05). Altmışıncı dakika ve 2. saatteki bulantı-kusma oranları Grup 1’de Grup 2’ye kıyasla daha yüksekti (sırasıyla, p<0.05 ve p<0.01). Altmışıncı dakika ve 2. saatteki Bromage skoru yine Grup 1’de anlamlı düzeyde yüksek olarak saptandı (p<0.01). Grup 2’nin 60. dakika ve 2. saat GAS skoru ortalaması Grup 1’den istatistiksel anlamda yüksek olarak bulundu (p<0.05). Olguların 60. dakika SAB ölçümleri arasında istatistiksel olarak anlamlı farklılık varken (p<0.05), DAB ve kalp tepe atımı oranları arasında anlamlı bir fark saptanmadı. Çıkarımlar: Lokal infiltrasyon yöntemiyle sağlanan analjezi, epidural analjeziden daha geç olsa da, başlangıçta ek analjezi desteğiyle aynı etkinlikte ağrı kontrolü sağlanabilir. Yan etkisinin az olması ve erkan mobiliteye izin vermesi nedeniyle lokal infiltrasyon, epidural analjeziye göre daha üstün bir yöntemdir.

Anahtar Kelimeler:

Ameliyat sonrası ağrı; diz protezi; epidural analjezi; lokal infiltratif analjezi

A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty

Objective: The aim of this study was to compare the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty.Methods: Thirty patients (28 female, 2 male; mean age: 69.37±5.11 years, range: 61 to 80 years) undergoing total knee arthroplasty between May 2011 and September 2011 were randomly divided into 2 groups. All patients received spinal anesthesia with bupivacaine. Postoperative analgesia of 72 ml 0.9% NaCl + 48 ml bupivacaine (1 ml = 5 mg, total 120 ml) was administered throughout 24 hours to Group 1 (n=15) by epidural catheter and to Group 2 (n=15) by ON-Q infiltration pump. Groups were compared based on the Bromage scores and visual analog scale (VAS), blood pressure, postoperative analgesia requirement and side effects.Results: Demographic data were similar in both groups. Rates of additional analgesia requirement at the postoperative 60th minute and 2nd hour were significantly higher in Group 2 than Group 1 (p<0.05). Rates of nausea-vomiting at the postoperative 60th minute and 2nd hour were significantly higher in Group 1 than Group 2 (p<0.05 and p<0.01, respectively). Bromage scores at 60 minutes and 2 hours was significantly higher in Group 1 than in Group 2 (p<0.01). Mean VAS scores at 60 minutes and 2 hours were significantly higher in Group 2 than Group 1 (p<0.05). While a statistically significant difference was found between systolic arterial pressure measurements at 60 minutes (p<0.05), there was no significant difference in diastolic arterial pressure and peak heart rate.Conclusion: Although the analgesic effect of local infiltration is provided later than by epidural analgesia, the same level of pain control can be achieved with initial additional analgesia. Local infiltration is superior to epidural analgesia in respect of few side effects and early mobilization.

Keywords:

Epidural analgesia, knee arthroplasty, local infiltrative analgesia postoperative pain,

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