Sigirci Aykut
Department of Orthopaedics, Evliya Celebi Training and Research Hospital, Kütahya, Turkey.
Indian J Orthop. 2017 May-Jun;51(3):280-285. doi: 10.4103/0019-5413.205688.
Pain after total knee arthroplasty (TKA) is a big problem in orthopaedic surgery. Although opioids and continuous epidural analgesia remain the major options for the postoperative pain management of TKA, they have some undesirable side effects. Epidural analgesia is technically demanding, and the patient requires close monitoring. Different types of local anesthetic applications can successfully treat TKA pain. Local anesthetics have the advantage of minimizing pain at the source. This study investigates the efficacy of different local anesthetic application methods on early, (1 day) pain control after total knee arthroplasty.
200 patients who underwent unilateral TKA surgery under spinal anesthesia were randomly assigned into four different groups (fifty in each group) and were administered pain control by different peri- and postoperative regimens. Group A was the control group wherein no postsurgical analgesia was administered to assess spinal anesthesia efficacy; in Group B, only postsurgical one-shot femoral block was applied; in Group C, intraoperative periarticular local anesthetic was applied; in Group D, a combination of the one-shot femoral block and intraoperative periarticular local anesthetics were applied. Demographic data consisting of age, weight, gender and type of deformity of patients were collected. The data did not differ significantly between the four groups.
Group D patients experienced significantly better postoperative pain relief ( < 0.05) and were therefore more relaxed in pain (painless time, VAS score) and knee flexion (degrees) than the other patient groups in the 1 postoperative day followup. Painless time of Group D was 10.5 hours and was better than Group C (6.8 hours), Group B (6.2 hours) and Group A (3.0 hours) ( < 0.05). Group A got the best pain Vas score degrees in the 1 postoperative day which showed the success of combined periarticülar local anesthetic injection and femoral nerve block.
The intraoperative periarticular application of local anesthetics in addition to one-shot femoral block is an efficient way of controlling postsurgical pain after TKA.
全膝关节置换术（TKA）后的疼痛是骨科手术中的一个重大问题。尽管阿片类药物和持续硬膜外镇痛仍然是TKA术后疼痛管理的主要选择，但它们有一些不良副作用。硬膜外镇痛技术要求高，且患者需要密切监测。不同类型的局部麻醉应用可成功治疗TKA疼痛。局部麻醉药具有从源头上将疼痛降至最低的优势。本研究调查了不同局部麻醉应用方法对全膝关节置换术后早期（1天）疼痛控制的疗效。
200例在蛛网膜下腔麻醉下行单侧TKA手术的患者被随机分为四组（每组50例），并通过不同的围手术期和术后方案进行疼痛控制。A组为对照组，不给予术后镇痛以评估蛛网膜下腔麻醉效果；B组仅应用术后单次股神经阻滞；C组术中应用关节周围局部麻醉药；D组应用单次股神经阻滞与术中关节周围局部麻醉药联合使用。收集患者的年龄、体重、性别和畸形类型等人口统计学数据。四组之间的数据无显著差异。
在术后1天的随访中，D组患者术后疼痛缓解明显更好（<0.05），因此在疼痛（无痛时间、视觉模拟评分法[VAS]评分）和膝关节屈曲（度数）方面比其他患者组更轻松。D组的无痛时间为10.5小时，优于C组（6.8小时）、B组（6.2小时）和A组（3.0小时）（<0.05）。A组在术后1天的疼痛VAS评分度数最佳，这表明关节周围局部麻醉药注射与股神经阻滞联合使用成功。
除单次股神经阻滞外，术中关节周围应用局部麻醉药是控制TKA术后疼痛的有效方法。
