Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2023; 90(6):416-421 | DOI: 10.55095/achot2023/050

Efektivita metody lokální infiltrační analgezie při operacích totální endoprotézy kolenního kloubuPůvodní práce

S. AKBEN¹, G. TUNCEL², G. ARGUN², T. ASKiN², I. KAYA³

¹ University of Health Sciences, Gulhane Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey

² University of Health Sciences, Dr. A. Y. Ankara Oncology Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey

³ Sorgun State Hospital, Department of Anesthesiology and Reanimation, Yozgat, Turkey

Purpose of the study: Postoperative pain after total knee arthroplasty (TKA) is severe because of bone and soft tissue trauma during the surgery and is difficult to control with oral analgesics. The primary aim of the study was to investigate the effects of the local infiltration anesthesia (LIA) method on postoperative analgesia quality and opioid consumption in patients undergoing TKA. The secondary aims were to evaluate knee flexion angle, side effects, and patient satisfaction.

Material and Methods: Total 40 patients, who underwent unilateral TKA surgery under spinal anesthesia were included in the prospective randomized study. Patients who underwent patient-controlled intravenous analgesia (PCA) (Group A) or LIA + PCA (Group B), were divided into two groups, randomly. For LIA application, 0.25% bupivacaine solution 150 mg in 60 ml volume was used.

The postoperative pain was evaluated in 48^th hour after the recovery of motor block, and during exercise at 24, 36, and 48 hours by using the visual analogue scale (VAS). An additional morphine was administered with the PCA device when VAS ≥ 4. The total amount of morphine consumption and the side effects were recorded. The knee flexion joint angles at the 48^th hour and the patients' satisfaction was recorded.

Results: Resting VAS values were lower in Group B in the first 24 hours (p<0.05). However, the 36^th and 48^th hour measurements were not different in groups. The exercises VAS values and the total morphine consumption were significantly higher in Group A at 24, 36 and 48 hours. The knee flexion joint angles in Group B were higher than Group A in terms of 48^th hour. The incidence of side effects was not different in the two groups. Patients' satisfaction was higher in the PCA+ILA group (p<0.05).

Discussion: In many studies the periarticular injection with multimodal drugs has been shown to reduce the requirements for analgesia, with no apparent risks, following TKA, similar to our results. LIA reduced postoperative opioid use and increased exercise tolerance.

Conclusions: In our study, we found that LIA reduced pain scores and opioid consumption during rest and exercise after TKA operation. For TKA patients where post-operative exercise is particularly important, we recommend the easy-to-use LIA method for a pain-free and unrestricted postoperative period.

Klíčová slova: total knee arthroplasty, local infiltration analgesia, postoperative analgesia, knee flexion angle, opioid consumption.

Zveřejněno: 1. prosinec 2023  Zobrazit citaci