Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.12.020
Brazilian Journal of Anesthesiology
Original Investigation

Comparison of different local analgesia protocols in postoperative pain management after total knee arthroplasty

Comparação de diferentes protocolos de analgesia local no manejo da dor pós-operatória após artroplastia total do joelho

Yang Wang, Guoqing Li, Muhtar Momin, Baochao Ji, Li Cao, Aishajiang Aisikeerbayi

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Abstract

Objectives
This study was to compare the effects of different local analgesia protocols on osteoarthritis patients undergoing total knee arthroplasty (TKA).

Methods
Medical records of 148 osteoarthritis patients who underwent unilateral TKA between October 2016 and October 2017 in our hospital were retrospectively analyzed. All these patients were divided into three groups according to the pain management protocol (morphine, morphine + cocktail [100 mg ropivacaine, 10 mg morphine, and 30 mL 0.9% sodium chloride solution containing 2 mL betamethasone (4 mg)], or cocktail). The postoperative visual analog scale (VAS) score, muscle strength, and complications were compared between the groups.

Results
At 6 and 12 hours post-operation, the VAS score in group C was significantly higher than that in group A or group B. In addition, the muscle (quadriceps femoris) strength score of group C (3.7 ± 2.8) was significantly higher than that in groups A and B at 6 and 12 hours post-operation. The VAS score and muscle strength score showed no significant differences among the three groups at 24 and 36 hours post-operation. The time of postoperative first void of group C was significantly shorter than that of groups A and B. Groups A or B had a significantly higher incidence of nausea and emesis compared with group C. The incidence of pruritus was higher in groups A or B than that in group C.

Conclusion
Epidural anesthesia combined with local analgesic cocktail injection is a preferable effective multimodal analgesia for TKA

Keywords

Epidural anesthesia;  Morphine;  Cocktail injection;  Total knee arthroplasty

Resumo

Objetivos: Este estudo foi comparar os efeitos de diferentes protocolos de analgesia local em pacientes com osteoartrite submetidos à artroplastia total do joelho (ATJ). Métodos: Prontuários de 148 pacientes com osteoartrite submetidos a ATJ unilateral entre outubro de 2016 e outubro de 2017 em nosso hospital foram analisados retrospectivamente. Todos esses pacientes foram divididos em três grupos de acordo com o protocolo de manejo da dor (morfina, morfina + coquetel [100 mg de ropivacaína, 10 mg de morfina e 30 mL de solução de cloreto de sódio 0,9% contendo 2 mL de betametasona (4 mg)] ou coquetel). A pontuação da escala visual analógica pós-operatória (EVA), força muscular e complicações foram comparadas entre os grupos. Resultados: Às 6 e 12 horas de pós-operatório, o escore EVA no grupo C foi significativamente maior do que no grupo A ou grupo B. Além disso, o escore de força muscular (quadríceps femoral) do grupo C (3,7 ± 2,8) foi significativamente maior do que nos grupos A e B às 6 e 12 horas de pós-operatório. O escore EVA e o escore de força muscular não apresentaram diferenças significativas entre os três grupos em 24 e 36 horas de pós-operatório. O tempo da primeira micção pós-operatória do grupo C foi significativamente menor do que o dos grupos A e B. Os grupos A ou B tiveram uma incidência significativamente maior de náusea e vômito em comparação com o grupo C. A incidência de prurido foi maior nos grupos A ou B do que que no grupo C. Conclusão: A anestesia peridural combinada com injeção de coquetel analgésico local é uma analgesia multimodal eficaz preferível para ATJ.

Palavras-chave

Anestesia peridural; Morfina Injeção de coquetéis; Artroplastia total do joelho

References

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