DOI: https://doi.org/10.22263/2312-4156.2020.1.66
Khadzkou Y.K.1, Balaboshka K.B.1, Kubrakov K.M.1, Usovich A.K.1, Lovikov D.N.2
Comparative efficiency of analgesia methods for total knee arthroplasty
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus
Vestnik VGMU. 2020;19(1):66-72.
Abstract.
Objectives. To improve the results of total knee arthroplasty (TKA) by minimizing postoperative pain syndrome by means of a new, anatomically based, local infiltration analgesia use.
Material and methods. A prospective, comparative clinical study was conducted involving 75 patients with knee osteoarthritis of the 3rd stage who had undergone primary TKA. To treat patients of group 1 (n=15) we used the method of local infiltration analgesia (LIA) developed by us, taking into account the topography of the main nerve trunks. In group 2 (n=15), we used standard method of LIA. In group 3 (n=15), a single femoral nerve block was performed by an anesthesiologist. In group 4 (n=15), a single saphenous nerve block was performed by an anesthesiologist. In group 5 (n=15), LIA and peripheral nerve block methods were not used. The level of pain syndrome as well as functional result were evaluated.
Results. The best results in reducing pain syndrome were obtained in group 1 and group 3 in comparison with groups 2, 4, 5 (p<0.05), without a statistically significant difference between these groups (group 1 and group 3) (p>0.05) at each time interval. The highest pain intensity was noted by patients of group 5 (p<0.05). The best functional results were obtained in groups 1, 2, 4, in comparison with groups 3, 5 (p<0.05).
Conclusions. Local infiltration analgesia performed by an orthopedic surgeon intraoperatively taking into account the topography of the main nerve trunks is a highly effective, affordable and safe method of pain relief at the postoperative period of TKA, the use of which provides conditions for early rehabilitation and improves treatment outcomes in patients with knee osteoarthritis.
Key words: knee replacement, pain syndrome, analgesia, local infiltration analgesia, femoral nerve block, saphenous nerve block.
References
1. Wylde V, Rooker J, Halliday L, Blom A. Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res. 2011 Apr;97(2):139-44. doi: http://dx.doi.org/10.1016/j.otsr.2010.12.003
2. Lee YS. Comprehensive Analysis of Pain Management after Total Knee Arthroplasty. Knee Surg Relat Res. 2017 Jun;29(2):80-86. doi: http://dx.doi.org/10.5792/ksrr.16.024
3. Beswick AD, Dennis J, Gooberman-Hill R, Blom AW, Wylde V. Are perioperative interventions effective in preventing chronic pain after primary total knee replacement? A systematic review. BMJ Open. 2019 Sep;9(9):e028093. doi: http://dx.doi.org/10.1136/bmjopen-2018-028093
4. Saraev AV, Kornilov NN, Kulyaba TA. The effectiveness of a multimodal approach to analgesia for total knee arthroplasty. Khirurgiia Zhurn im NI Pirogova. 2018;(6):83-90. (In Russ.)
5. Soffin EM, Memtsoudis SG. Anesthesia and analgesia for total knee arthroplasty. Minerva Anestesiol. 2018 Dec;84(12):1406-1412. doi: http://dx.doi.org/10.23736/S0375-9393.18.12383-2
6. Zhang Z, Shen B. Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: a systematic review. J Int Med Res. 2018 Dec;46(12):4874-4884. doi: http://dx.doi.org/10.1177/0300060518799616
7. Quinn M, Deakin AH, McDonald DA, Cunningham IK, Payne AP, Picard F. An anatomic study of local infiltration analgesia in total knee arthroplasty. Knee. 2013 Oct;20(5):319-23. doi: http://dx.doi.org/10.1016/j.knee.2013.06.008
8. Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop. 2008 Apr;79(2):174-83. doi: http://dx.doi.org/10.1080/17453670710014950
9. Koh IJ, Choi YJ, Kim MS, Koh HJ, Kang MS, In Y. Femoral Nerve Block versus Adductor Canal Block for Analgesia after Total Knee Arthroplasty. Knee Surg Relat Res. 2017 Jun;29(2):87-95. doi: http://dx.doi.org/10.5792/ksrr.16.039
10. Albrecht E, Guyen O, Jacot-Guillarmod A, Kirkham KR. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth. 2016 May;116(5):597-609. doi: http://dx.doi.org/10.1093/bja/aew099
11. Koryachkin VA, Geras'kov EV, Korshunov DYu. Safety assessment of infiltration anesthesia for total knee replacement. Novosti Khirurgii. 2015;23(4):436-9. (In Russ.)
12. Affas F. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety. Scand J Pain. 2016 Oct;13:59-66. doi: http://dx.doi.org/10.1016/j.sjpain.2016.05.041
Information about authors:
Khadzkou Y.K. – lecturer of the Chair of Traumatology, Orthopedics & Military Surgery, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0002-9216-7929
Balaboshka K.B. – Candidate of Medical Sciences, associate professor, head of the Chair of Traumatology, Orthopedics & Military Surgery, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0002-5599-3439
Kubrakov K.M. – Candidate of Medical Sciences, associate professor of the Chair of Neurology & Neurosurgery, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0001-6723-0589
Usovich A.K. – Doctor of Medical Sciences, head of the Chair of Human Anatomy, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0002-7817-1083
Lovikov D.N. – anesthesiologist-resuscitator, Vitebsk Regional Clinical Hospital.
Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Traumatology, Orthopedics & Military Surgery. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Yauheni K. Khadzkou.
