Diz Artroplasti Hastalarında Epidural Anestezi ile Adduktor Kanal ve IPACK Blok Kombinasyonunun Karşılaştırılması

Abstract

Objective: Motor function-preserving peripheral nerve blocks have begun to play an important role in multimodal analgesic approaches of the patients with total knee arthroplasty (TKA). The aim of this study is to compare the effects of anesthesia methods on postoperative analgesia and early rehabilitation of patients after total knee arthroplasty. Methods: In this retrospective study, in which patients with unilateral TKA were screened, two groups were formed from selected patients. Group EA was administered 0.03 mg kg-1 of morphine with 10 cc saline through the epidural catheter in the postoperative period. In Group Adductor Canal Block (ACB)+ infiltration of local anesthetic between the popliteal artery and capsule of the knee block (IPACK), 10 mL 0.5% bupivacaine, 10 mL 2% lidocaine and 20 mL local anesthetic mixtures were made separately for ACB and IPACK blocks at one time. Primary postoperative outcome was Visual Analogue Scale (VAS), secondary outcomes were physical therapy ambulation test results. Results: In this study, postoperative pain score rates as the primary outcome were measured as follows: VAS8: 5 / 4 (p=0.041); VAS12: 5 / 4 (p=0.004) and VAS24: 4 / 3 (p=0.001) and lower pain scores were obtained in the ACB + IPACK group. In timed up to go (TUG) tests, TUG24 was 36/34 (p=0.001), TUG48 32.5/30 (p=0.012) and TUG72 20/12. Better ROM measurements were recorded in group ACB+IPACK at both 24 and 48 hours. Conclusion: In the ACB + IPACK group, better pain scores, more significant ambulation values, and less side-effect profile were obtained. Keywords: Adductor canal block, analgesia, epidural analgesia, total knee arthroplasty