The Effect of Unilateral Spinal Anaesthesia and Psoas Compartment with Sciatic Block on the Postoperative Pain Management in Total Knee Artroplastic Surgery

Çanakçı, Ebru; Unal, Dogus; Güzel, Yunus

doi:10.1155/2017/4127424

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…Another studies had similar results, Canakci et al [ 14 ] reported, that the psoas compartment block (PCB) provide longer time to first analgesia, comparing with the spinal anesthesia (SA). Although PCB group had significantly lower opioid consumption – 300 mg tramadol versus 1500 mg in SA group.…”

Section: Discussionmentioning

confidence: 61%

Psoas compartment block efficacy and safety for perioperative analgesia in the elderly with proximal femur fractures: a randomized controlled study

Бєлка

Kuchyn

Токар³

et al. 2021

BMC Anesthesiol

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Background Proximal femur fractures are most common fractures in the elderly and associated with significant mortality and morbidity, with high economic and social impact. Perioperative pain management influence outcomes and mortality after surgery with early mobilization being possible. The goal of the study was to compare the efficacy and safety of the psoas compartment block (PCB) with spinal and general anesthesia. Methods We included 90 patients in this randomized controlled study and divided them into three groups. For patients in group 1 ultrasound-guided PCB with bupivacaine 0.125% 6–8 ml / h was performed. Intraoperative anesthesia was provided with PCB and a sciatic nerve block. Postoperative analgesia include prolonged CPB with bupivacaine 0.125% 6–8 ml / h. In group 2 intraoperative spinal anaesthesia were performed. Group 3 patients underwent general sevoflurane inhalation anaesthesia with fentanyl infusion for analgesia. All patients received paracetamol 3 g/day and dexketoprofen 75 mg/day during hospitalization. On-demand, nalbuphine 5 mg SC was used for analgesia. Efficacy outcomes were the ICU length of stay and the total duration of hospitalization, number of patients who had severe pain after surgery, incidence of on-demand analgesia, sleep quality, postoperative mobilization time. Safety outcomes include complication incidence. Results There were no differences in the duration of ICU stay - gr.1 72 [70–75], gr.2 74 [72–76], gr.3 72 [70–75] hours respectively (p = 0.29), and the total duration of hospitalization - gr.1144 [170–184], gr.2170 [148–188], gr.3178 [144–200] hours respectively. Patients in gr.1 had significantly lower nalbuphine consumption in the first 24 h after surgery and total during hospitalization (0 [0–5] mg versus 15 [10–20] and 20 [15–25] mg in the first 24 h in groups 2 and 3, respectively (p < 0.001). Gr. 1 had lower number of patients with severe pain (10% vs. 47 and 60% in groups 2 and 3, respectively, p < 0.05), lower number of on demand analgesia (0 [0–1] vs. 3 [2–4] and 4 [3, 4] in groups 2 and 3, respectively), better sleep quality (8 [7–9] vs. 6 [5–7] and 4 [3, 4] in groups 2 and 3, respectively, p < 0.001), significantly faster mobilization after surgery – sitting in bed and getting to his feet. MINS was diagnosed significantly more often in gr. 2 and 3 compared with gr. 1 (OR 9 95 CI 1,01–77, p = 0,048 for gr. 2 and OR 11 95 CI 1,2–91, p = 0, 03 for gr. 3). However, none of the patients had symptoms of myocardial ischemia and was not diagnosed with myocardial infarction. There were no difference in the incidence of nosocomial pneumonia and delirium. Conclusion Perioperative PCB in elderly patients with a proximal femur fracture could be an effective analgesia technique, as it decrease the number of patients with severe pain, need for on demand analgesia and opioid consumption. PCB also decrease the incidence of opioid-associated nausea and vomiting, comparing to general anesthesia, and increase the number of patients, who was mobilized in the 1st day (sitting) and 2nd day (getting up) after surgery. PCB may reduce the incidence of MINS, although to assess this outcome more studies are needed. Trial registration Clinicaltrials.gov: NCT04648332, first registration date 1/12/2020.

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Section: Discussionmentioning

confidence: 61%

Psoas compartment block efficacy and safety for perioperative analgesia in the elderly with proximal femur fractures: a randomized controlled study

Бєлка

Kuchyn

Токар³

et al. 2021

BMC Anesthesiol

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“…Although in some patients CFNB is inadequate, a lower dose of subarachnoid morphine (0.035mg) in addition to CFNB has been shown to be effective, with minimal adverse effects 81 . The technique of SPC blockade with bupivacaine HCL has guaranteed greater hemodynamic efficiency in the perioperative period in high-risk elderly patients 82,83 . The use of LB and plain bupivacaine showed superiority over pain control strategies, but they were relatively equivalent to each other in direct comparison 84 .…”

Section: Discussionmentioning

confidence: 99%

Strategies for the management of postoperative pain in total knee arthroplasty: integrative review

Morete-Pinto¹,

Sousa-Correa²

2021

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES:Total knee arthroplasty is one of the most common surgeries performed on patients with osteoarthritis or rheumatic arthritis of the knee. However, total knee arthroplasty is associated with moderate to severe pain after the operation. In orthopedics, the prevalence of chronic pain after total knee arthroplasty is much higher than after total hip arthroplasty. The aim of this study was to analyze the current knowledge about postoperative pain in knee arthroplasty. CONTENTS: An integrative review of clinical trials published in English and Portuguese was carried out in the Scielo, Pubmed and LILACS databases. The inclusion criteria consisted of articles published in the last five years, available in full, that addressed the proposed theme. Editorials, letters to the editor, dissertations, repeated articles that did not correspond to the theme were excluded. The search and selection process of the studies followed the PRISMA recommendations. Of the 155 articles found, 58 articles were selected for the present study following the above-mentioned recommendations. CONCLUSION: Several classes of local and systemic drugs, including non-steroidal anti-inflammatory drugs, opioids, and local anesthetics have been used to fight the nociceptive component of postoperative pain. Furthermore, early rehabilitation contributes to better quality of life, self-esteem and reduce the time of hospitalization and hospital expenses.

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“…Canakci et al . compared spinal anesthesia and psoas compartment with sciatic block (PCS) in 60 patients undergoing total knee arthroplasty 28 . VAS-scores were measured in the postoperative course until 24 h postoperative on a scale from 0–100.…”

Section: Discussionmentioning

confidence: 99%

Multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management: general, regional and combination anesthesia in knee arthroplasty

Greimel

Maderbacher

Baier

et al. 2018

Sci Rep

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Numbers of knee replacement surgeries have been rising over the past years. After having ameliorated operation techniques and material, pain management and anesthetic methods have come into focus. All 15326 patients included had undergone primary knee arthroplasty within this multicenter cohort-study, conducted in 46 orthopedic departments. Parameters were evaluated on first postoperative day. Primary outcome values were pain levels (activity, minimum and maximum pain, and pain management satisfaction). Pain medication necessity was analyzed. Parameters were compared between the types of anesthesia used: general, regional and combination anesthesia. Pain scores and pain management satisfaction were significantly better in the groups of either spinal or peripheral anesthesia combined with general anesthesia (p < 0.001, respectively). Patients who received the combination of general and spinal anesthesia were associated with the lowest need for opioids (p < 0.001). The use of a combined general and spinal anesthesia as well as using a combination of general and peripheral anesthesia in knee arthroplasty was associated with a highly significant advantage to other anesthetic techniques regarding perioperative pain management in daily clinical practice, but maybe below clinical relevance. Furthermore they were associated with positive tendency considering side effects and subjective well-being parameters.

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The Effect of Unilateral Spinal Anaesthesia and Psoas Compartment with Sciatic Block on the Postoperative Pain Management in Total Knee Artroplastic Surgery

Cited by 6 publications

References 16 publications

Psoas compartment block efficacy and safety for perioperative analgesia in the elderly with proximal femur fractures: a randomized controlled study

Psoas compartment block efficacy and safety for perioperative analgesia in the elderly with proximal femur fractures: a randomized controlled study

Strategies for the management of postoperative pain in total knee arthroplasty: integrative review

Multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management: general, regional and combination anesthesia in knee arthroplasty

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