Levent ŞAHİN, Halil Fatih KORKMAZ, Mahircan ŞAHİN, Güneri ATALAN

Ultrasound-guided single-injection femoral nerve block provides effective analgesia after total knee arthroplasty up to 48 hours

Amaç: Bu çalışmanın amacı spinal anestezi ile total diz artroplastisi (TDA) yapılan hastalarda postoperati f 48 saatlik periyotta ultrason (US) kılavuzluğunda tek doz femoral sinir bloğunun (FSB) ağrı kontrolü, morfin tüketimi, olumsuz etkiler ve hasta mem- nuniyeti üzerine etkilerini değerlendirmek. Gereç ve Yöntem: Dejenerati f eklem hastalığı nedeniyle tek taraflı TDA uygulanacak, ASA fiziksel durumu I-III olan 104 hasta bu çalışmaya dahil edildi. Hastalar rastgele iki guruba ayrıldı: Grup F (n=51) hastalara US kılavuzluğunda FSB da 1: 200,000 epinefrin ilave edilmiş 40 ml %0.5 bupivakain, Grup P (n=53) hastalara aynı metod ile koruyucu serbest salin enjeksiyonu yapıldı. Ağrı skorları, morfin tüketimi, olumsuz olaylar ve hasta memnuniyeti 48 saat boyunca değerlendirildi. Bulgular: Cerrahi sonrası ilk 48 boyunca Grup F de Grup P ile kıyaslandığında anlamlı olarak daha az morfin tüketilmiştir (18.7 mg ile 39.6 mg, p

Ultrasonografi eşliğinde yapılan tek doz femoral sinir bloğu diz artroplasti sonrası 48 saate kadar etkin analjezi sağlar

Summary Objectives: The purpose of this study is to evaluate the effects of ultrasound (US) guided single-injection femoral nerve block (FNB) spinal anesthesia on pain control, morphine consumption, adverse effects, and patient satisfaction during the postop- erative 48-hour period in patients undergoing total knee arthroplasty (TKA). Methods: One hundred four ASA physical status IIII patients undergoing single TKA for degenerative joint disease were enrolled in this clinical study. Patients were randomly distributed into two groups: US-guided single-injection FNB with 40 ml of 0.5% bupivacaine and 1:200,000 epinephrine was administered to Group F (n=51) patients. Preservative-free saline was injected in Group P (n=53) patients using the same method as Group F. Pain scores, morphine consumption, incidences of adverse events, and patient satisfaction were assessed over the course of 48 hours. Results: Group F used significantly less morphine compared with Group P (18.7 mg vs. 39.6 mg) during the first 48 hours after surgery (p<0.001). When compared with group P, the VRS scores both at rest and during movement were significantly lower in Group F at 4, 8, 12, 24, and 48 hours after TKA (for all comparisons p<0.001). In addition, patient satisfaction was better in Group F than Group P. Conclusion: This study suggests that a US-guided single-injection femoral nerve block following TKA improves patient satisfaction and reduces consumption of morphine during the first 48 hours.

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1. M ahoney OM, Noble PC, Davidson J, Tullos HS. The effect of continuous epidural analgesia on postoperative pain, reha- bilitation, and duration of hospitalization in total knee ar- throplasty. Clin Orthop Relat Res 1990;(260):30-7. 2. W ang H, Boctor B, Verner J. The effect of single-injection femoral nerve block on rehabilitation and length of hospi- tal stay after total knee replacement. Reg Anesth Pain Med 2002;27(2):139-44. 3. de Lima E Souza R, Correa CH, Henriques MD, de Oliveira CB, Nunes TA, Gomez RS. Single-injection femoral nerve block with 0.25% ropivacaine or 0.25% bupivacaine for postopera- tive analgesia after total knee replacement or anterior cruci- ate ligament reconstruction. J Clin Anesth 2008;20(7):521-7. 4. D uarte VM, Fallis WM, Slonowsky D, Kwarteng K, Yeung CK. Effectiveness of femoral nerve blockade for pain control af- ter total knee arthroplasty. J Perianesth Nurs 2006;21(5):311- 6. 5. Hunt KJ, Bourne MH, Mariani EM. Single-injection femoral and sciatic nerve blocks for pain control after total knee ar- throplasty. J Arthroplasty 2009;24(4):533-8. 6. C apdevila X, Biboulet P, Morau D, Mannion S, Choquet O. How and why to use ultrasound for regional blockade. Acta Anaesthesiol Belg 2008;59(3):147-54. 7. A brahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of ran- domized controlled trials. Br J Anaesth 2009;102(3):408-17. 8. Barrington MJ, Olive D, Low K, Scott DA, Brittain J, Choong P. Continuous femoral nerve blockade or epidural analgesia after total knee replacement: a prospective randomized con- trolled trial. Anesth Analg 2005;101(6):1824-9. 9. Sundarathiti P, Ruananukul N, Channum T, Kitkunasathean C, Mantay A, Thammasakulsiri J, et al. A comparison of con- tinuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) in postoperative analgesia and knee rehabili- tation after total knee arthroplasty (TKA). J Med Assoc Thai 2009;92(3):328-34. 10. Hogan MV, Grant RE, Lee L Jr. Analgesia for total hip and knee arthroplasty: a review of lumbar plexus, femo- ral, and sciatic nerve blocks. Am J Orthop (Belle Mead NJ)2009;38(8):E129-33. 11. A llen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg 1998;87(1):93-7. 12. S erpell MG, Millar FA, Thomson MF. Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement. Anaesthesia 1991;46(4):275-7. 13. C apdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubeno- vitch J, d Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 1999;91(1):8-15. 14. M arhofer P, Schrögendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg 1997;85(4):854-7. 15. K ardash K, Hickey D, Tessler MJ, Payne S, Zukor D, Velly AM. Obturator versus femoral nerve block for analgesia after to- tal knee arthroplasty. Anesth Analg 2007;105(3):853-8. 16. O zen M, Inan N, Tümer F, Uyar A, Baltaci B. The effect of 3-in- femoral nerve block with ropivacaine 0.375% on postop- erative morphine consumption in elderly patients after total knee replacement surgery. Agri 2006;18(4):44-50. 17. Sites BD, Beach M, Gallagher JD, Jarrett RA, Sparks MB, Lund- berg CJ. 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. 18. Ng HP, Cheong KF, Lim A, Lim J, Puhaindran ME. Intraop- erative single-shot 3-in-1 femoral nerve block with ropi- vacaine 0.25%, ropivacaine 0.5% or bupivacaine 0.25% pro- vides comparable 48-hr analgesia after unilateral total knee replacement. Can J Anaesth 2001;48(11):1102-8. 19. P aul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized con- trolled trials. Anesthesiology 2010;113(5):1144-62. 20. C uvillon P, Ripart J, Lalourcey L, Veyrat E, LHermite J, Bois- son C, et al. The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 2001;93(4)