Ostalo

Regional anaesthesia and analgesia in fast track knee arthroplasty

SANJA HUTERER orcid.org/0000-0002-9359-7138 ; Herz Jesu Krankenhaus, Vienna, Austria

Sažetak

Total knee arthroplasty is a surgery that provokes intense postoperative pain and requires special care. An effective analgesia with minimal side effects is vital in elderly patients, who often have significant comorbid diseases. Delays in postoperative mobilisation induce tissue retraction, adherences and atrophy. They also can lead to different complications such as thromboembolism, increase morbidity and decline in cognitive function. Fast track surgery is defined as the synergetic effect on convalescence achieved by adding multi-modal evidence-based care principles and combining these with optimal logistics. The yield is quicker functional recovery, reduced need of hospitalisation, rapid resumption of normal activities of daily life and high levels of patient satisfaction. At the same time there are large economic benefits as a result of shorter hospitalisations. Effective postoperative pain relief is a prerequisite for successful early mobilisation and intensive physiotherapy rehabilitation.
Compared with general anaesthesia and/or systemic analgesia regional
anaesthesia reduces opioid consumption and opioid-related side effects. The use of epidural anaesthesia cannot be suggested due to the risk of bleeding, hypotension and other side effects. Ultrasound guided placed catheters for continuous peripheral nerve blocks on femoral and sciatic nerve are proved to be of advantage to other techniques. Different studies also suggest that the addition of an obturator nerve block
to femoral and sciatic blockade improves postoperative analgesia following total knee replacement especially on the day of the surgery.
Femoral and sciatic nerve block is well documented option for post-
-operative analgesia, but a prolonged motor block, which may occur, can
prevent early mobilisation and increase the length of hospitalisation.
In order to prevent quadriceps weakness a new technique of an adductor
canal block has been developed. The saphenous nerve and in part the obturator nerve are traversing the adductor canal of the thigh. Repeated administration of local anaesthetic into this aponeurotic space could be a useful option for postoperative analgesia after knee replacement surgery. The preliminary results are very encouraging, but need to be confirmed in randomized control trials. The anaesthesiology challenge to provide sufficient analgesia with preserve muscle function and minimal side effects still remains.

Ključne riječi

Hrčak ID:

105967

URI

https://hrcak.srce.hr/105967

Datum izdavanja:

1.6.2013.

Posjeta: 2.684 *