Total diz artroplastisi yapılan hastalarda postoperatif ağrı tedavisi amacı ile femoral sinir bloğunda sürekli infüzyon yöntemi ile ropivakaine adjuvan tramadol etkisi

Amaç: Total diz artroplastisi sonrası ağrı tedavisinde periferik sinir blokları kolay, maliyeti ve komplikasyon oranı düşük yöntemler olup yüksek hasta memnuniyeti, erken mobilizasyon ve taburculuk gibi avantajlara sahiptir. Periferik sinir bloklarında lokal anestezik ajanların etkinliğini arttırmak için farklı kombinasyonlar uygulanmaktadır. Bu çalışmada, total diz artroplastisi yapılan hastalarda preemptif "3-in-1" femoral blokta, sürekli infüzyon yöntemiyle ropivakaine tramadol ilavesinin etkisi araştırıldı. Yöntem: Total diz artroplastisi planlanan 60 hasta çalışmaya dahil edildi. Cerrahi öncesi, tüm hastalara periferik sinir stimülatörü kullanılarak % 0,5 ropivakain 0,3 mL kg-1 uygulandı. Hastalar üç gruba ayrıldı ve tüm hastalara genel anestezi uygulandı. Grup I’de cerrahi bitiminde hasta kontrollü analjezi (HKA) yöntemiyle 48 saat boyunca % 0,2 ropivakain 0,1 mL kg-1st -1 uygulandı. Grup II’de % 0,2 ropivakaine 1 mg mL-1 tramadol, Grup III’de % 0,2 ropivakaine 2 mg mL-1 tramadol eklendi. Cerrahi bitiminde VAS, motor blok ve yan etkiler değerlendirildikten sonra HKA başlandı. VAS>40 olan hastalara ek analjezik olarak diklofenak sodyum 75 mg intramusküler uygulandı. Postoperatif 0., 2., 4., 6., 12., 24 ve 48. saatlerde istirahat VAS değerleri, ek analjezik ihtiyacı, kan basıncı, kalp hızı ve yan etkiler kaydedildi. Bulgular: Her üç grupta da 48 saatlik VAS

The effect of tramadol adjunct to ropivacaine in continuous femoral nerve block in patients undergoing total knee arthroplasty for postoperative pain treatment

Objective: The use of peripheral nerve blockade following total knee arthroplasty is a simple and effective method with lesser cost and complications. Besides, this method causes good patient satisfaction, early mobilization and a short period of hospitalization. In the present study we evaluated the effectiveness of tramadol added to ropivacaine during preemptive femoral blockade in patients under going total knee arthroplasty. Method: Sixty patients undergoing total knee arthroplasty were included to the study. In all groups general anesthesia was performed and before the surgery femoral blockade with ropivacaine 0.5 % (0.3 mL kg-1 ) was done. In group I, ropivacaine 0.2 % was infused at a rate of 0.1 mL kg-1 hr-1 for 48 hours. In group II tramadol 1 mg mL-1 and in group III 2 mg mL-1 was added to ropivacaine infusion. At the end of surgery VAS, motor blockade and side effects were evaluated and PCA was done as continous infusion. As additional analgesic, intramuscular diclofenac 75 mg was done in patients with VAS values >40. VAS values, additional analgesic consumptions, blood pressures, heart rates and side effects were recorded at the postoperative 0, 2, 4, 6, 12, 24 and 48th hours. Results: VAS scores for 48 hours were <40 in three groups and was lower in Group III than in Group I and II although it was not statistically significant. Addition of tramadol did not lower additional analgesic requirement but increased analgesia time and quality. The incidence of side effects was higher in Group III (p<0.05). Conclusion: The effect of adding tramadol as an adjuvant to local anesthetics in "3-in-1" femoral block in postoperative anal- gesia was investigated and it was found that although not statistically significant, it increased the duration and quality of analge- sia. However, postoperative additional analgesic requirement was higher in group II and incidence of side effects was higher in group III and this lowers the beneficial effect of adding tramadol to local anesthetics in lower extremity blocks and limits its usage.

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