Abstract
Background: Total knee arthroplasty has become a standard for treatment of endstage knee osteoarthritis. Due to intense and complex knee innervation, there is a need to improve the anaesthetic/analgesic approach to such operations. The aim of this randomised clinical trial was to compare the analgesic efficacy of the classical regimen and two of those based on the nerve blocks. Methods: A total of 60 patients was included and subjected to elective total knee arthroplasty under the general balanced anaesthesia. They were randomised to receive postoperatively (1) only morphine 5-10 mg q6h and paracetamol 1 g q6h (MP), (2) femoral nerve block (FNB) or (3) fascia iliac compartment nerve block (FICNB). Nerve blocks were produced by a single administration of 30-40 ml of bupivacaine 0.5%. Pain intensity, duration of neural block and additional consumption of analgesics were recorded postoperatively. Results: There were no demographic differences among the three groups of patients. Pain intensity was significantly lower in the two nerve block groups than in the MP group. The same two groups also demanded significantly less analgesics postoperatively than the MP group. Cardiovascular control was significantly better in the nerve block groups. There were no significant differences between the FNB and FICNB groups of patients regarding any of the studied parameters. Conclusion: In comparison with the classical MP analgesia, use of FNB or FICNB after the elective total knee arthroplasty results in lower pain scores, lower systolic blood pressure and less consumption of analgesics in the immediate postoperative course.
Highlights
Osteoarthritis (OA) is the leading form of arthritis in humans and is responsible for suffering of the 15-18% of the population.[1]
It is projected that between the 2005 and 2030 the number of performed Total knee arthroplasty (TKA) in the US will increase 673% to 3.5 million procedures annually and if the revision operations are taken into consideration, the overall increase is expected to be over eight-fold[15]
Additional explanation for this phenomenon is in the fact that TKAs, despite the increased rate of postoperative complications, represent a rational solution for the end-stage knee OA even in the population aged over 80.16 In Spain, a 10-year prospective cohort study in patients diagnosed with OA of the knee or hip joint revealed a significantly higher average lifetime risk for knee than for hip replacement - 30% (95% confidence interval – CI – 25-36%) versus 14%
Summary
Osteoarthritis (OA) is the leading form of arthritis in humans and is responsible for suffering of the 15-18% of the population.[1]. According to the Korean study performed in patients aged >50 who underwent knee radiography, prevalence of knee OA was 13% and it was positively associated with risk factors, such as older age, female gender, obesity, hypertension, low educational level, and infrequent strength exercises.[3]. It remains the main cause of the dysfunctionality of the knee joint[4] and contributes significantly to the disability retirement[5]. Several non-pharmacological (body weight loss, muscle strength-increasing exercises, physiotherapy) and pharmacological regimens (non-steroidal anti-inflammatory drugs po or im, intraarticular injections of viscosupplementation with hyaluronic acid, corticosteroids or biologicals) are used to treat this very painful and disabling condition.[12] analgesic scheme and to compare their postoperative analgesic efficacy between themselves in patients undergoing TKA
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