RESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Prótese do Joelho/tendências , Prótese do Joelho , Medicação Pré-Anestésica/normas , Medicação Pré-Anestésica/tendências , Tramadol/uso terapêutico , Medicina Baseada em Evidências/normas , Medicina Baseada em Evidências/tendências , Tramadol/metabolismo , Cuidados Pós-OperatóriosRESUMO
OBJECTIVE: Pain after total knee replacement surgery is intense. The aim of this study was to compare 3 techniques for providing postoperative analgesia (epidural analgesia, femoral nerve block, and a combined femoral-sciatic nerve block) in total knee arthroplasty. MATERIAL AND METHODS: Observational study of 1550 elective primary unilateral total knee replacement operations. The safety and efficacy of the following 3 techniques were compared: epidural analgesia, femoral nerve block, and femoral-sciatic nerve block. Demographic, anesthetic, and surgical data were recorded. Study variables included pain intensity on a visual analog scale every 4 hours, need for rescue analgesia (morphine), complications and adverse events within 5 postoperative days. RESULTS: No significant differences were found in demographic, anesthetic, or surgical variables. In the first 24 hours after surgery, pain intensity was significantly less for patients who received a femoral-sciatic nerve block. The mean levels of morphine consumption in the first 96 hours after surgery were similar in the femoral-sciatic nerve block group (3.18 mg) and the epidural analgesia group (3.19 mg); morphine consumption in the femoral block group was significantly higher (4.51 mg). Epidural analgesia was associated with the highest rate of complications (17%). CONCLUSIONS: A sciatic nerve block combined with a femoral nerve block attenuates pain more effectively and is associated with less postoperative morphine consumption in comparison with a femoral nerve block alone. Peripheral nerve block techniques have fewer adverse side effects than epidural analgesia.
Assuntos
Analgesia Epidural , Artroplastia do Joelho , Bloqueio Nervoso , Dor Pós-Operatória/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Analgesia Epidural/efeitos adversos , Analgesia Epidural/estatística & dados numéricos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Feminino , Nervo Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Entorpecentes/uso terapêutico , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Medição da Dor , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Estudos Prospectivos , Nervo Isquiático , Retenção Urinária/induzido quimicamenteRESUMO
OBJETIVOS: El dolor postoperatorio de la prótesis totalde rodilla es de una gran intensidad. El objetivo fuecomparar tres técnicas de analgesia postoperatoria (epidural,bloqueo del nervio femoral y bloqueo de los nerviosfemoral y ciático combinados) después de intervenciónde prótesis total de rodilla.MATERIAL Y MÉTODOS: Estudio observacional de 1.550intervenciones de prótesis de rodilla unilateral primariaselectivas. Se compararon tres técnicas de analgesia postoperatoria(epidural, bloqueo femoral y bloqueo femoralciático)para valorar eficacia y seguridad. Se recogierondatos demográficos, anestésicos y quirúrgicos, intensidaddel dolor según escala visual analógica cada 4 horas,rescate analgésico con morfina, complicaciones e incidenciasdurante los 5 primeros días del postoperatorio.RESULTADOS: No hallamos diferencias en las variablesdemográficas, anestésicas y quirúrgicas. La intensidad deldolor fue significativamente menor en el grupo bloqueofemoral y ciático respecto a los grupos epidural y bloqueofemoral durante las primeras 24 horas del postoperatorio.El consumo medio de morfina a las 96 horas tras la intervenciónfue similar en el grupo con bloqueo femoral y ciático(3,18 mg) y epidural (3,19 mg), y significativamentemayor con el bloqueo femoral (4,51 mg). La analgesia epiduralpresento el mayor índice de complicaciones (17%).CONCLUSIONES: Asociar un bloqueo ciático al bloqueofemoral disminuye el dolor y el consumo de morfina postoperatoriorespecto al bloqueo femoral aislado. Las técnicasanalgésicas de bloqueo periférico presentan menosefectos indeseables que la analgesia epidural (AU)
OBJECTIVE: Pain after total knee replacement surgeryis intense. The aim of this study was to compare 3techniques for providing postoperative analgesia(epidural analgesia, femoral nerve block, and acombined femoral-sciatic nerve block) in total kneearthroplasty.MATERIAL AND METHODS: Observational study of 1550elective primary unilateral total knee replacementoperations. The safety and efficacy of the following 3techniques were compared: epidural analgesia, femoralnerve block, and femoral-sciatic nerve block.Demographic, anesthetic, and surgical data wererecorded. Study variables included pain intensity on avisual analog scale every 4 hours, need for rescueanalgesia (morphine), complications and adverse eventswithin 5 postoperative days.RESULTS: No significant differences were found indemographic, anesthetic, or surgical variables. In thefirst 24 hours after surgery, pain intensity wassignificantly less for patients who received a femoralsciaticnerve block. The mean levels of morphineconsumption in the first 96 hours after surgery weresimilar in the femoral-sciatic nerve block group(3.18 mg) and the epidural analgesia group (3.19 mg);morphine consumption in the femoral block group wassignificantly higher (4.51 mg). Epidural analgesia wasassociated with the highest rate of complications (17%).CONCLUSIONS: A sciatic nerve block combined with afemoral nerve block attenuates pain more effectively andis associated with less postoperative morphineconsumption in comparison with a femoral nerve blockalone. Peripheral nerve block techniques have feweradverse side effects than epidural analgesia (AU)
