Original scientific paper

Femoral nerve block- or intravenous- guided patient control analgesiafor early physical rehabilitation after anterior cruciate ligament reconstruction in "fast-track" orthopedics: what is optimal?

DUBRAVKA BARTOLEK HAMP ; "St. Catherine" Orthopaedics, Surgery, Neurology and Physical Medicine and Rehabilitation Specialty Hospital, Zabok, Croatia
EDUARD ROD ; "St. Catherine" Orthopaedics, Surgery, Neurology and Physical Medicine and Rehabilitation Specialty Hospital, Zabok, Croatia
ANDREJ RADIĆ ; "St. Catherine" Orthopaedics, Surgery, Neurology and Physical Medicine and Rehabilitation Specialty Hospital, Zabok, Croatia
DARJA GRANEC ; "St. Catherine" Orthopaedics, Surgery, Neurology and Physical Medicine and Rehabilitation Specialty Hospital, Zabok, Croatia
MLADEN RAKIĆ ; "St. Catherine" Orthopaedics, Surgery, Neurology and Physical Medicine and Rehabilitation Specialty Hospital, Zabok, Croatia

Abstract

Background and purpose: "Fast-track" orthopaedics characterizes early
start of physical rehabilitation (PHR). Quality of mobilization depends on
pain therapy success and preservation of motor function and muscle strength. Patient-control-analgesia (PCA), as an upgrade of continuous intravenous (IV) or regional analgesia (FB) makes the modern base in treatment of acute pain. The aim of the study was to determine more effective post-operative PCA-analgesia (IV-PCA vs. FB-PCA) for early PHR in "fast-track" orthopaedics.

Materials and Methods: Prospective, observer-blinded study included
40 adults (bought gender, ASA I/II) scheduled for anterior cruciate ligament reconstruction (RACL). Spinal anaesthesia (12.5 mg, 0.5% levobupivacaine; G27-Pencil-Point) was performed in all patients. Patients were divided in two equal groups. In Group IV-PCA intravenous (fentanyl 0.5-1μg kg–1h–1), and in Group FB-PCA regional (femoral block: 0.125% levobupivacaine, 8 ml h–1) PCA-analgesia (Group IV-PCA: fentanil 10μg/8min/x6max; Group FB-PCA: 0.125% levobupivacaine, 8ml/30min/x3max) was established after surgery. Pain score (VAS) was assessed during 24-hours and accepted as satisfactory by 3. Diclofenac 75 i.v. was given in two doses, immediatelly and 12 hours after surgery. Paracetamol 1g was added intravenously if VAS was
³ 4. Start of early PHR was planned six hours after surgery.

Result: FB- and IV-PCA provided equally effective analgesia during first 24-hours after RACL (VAS3). Early PHR was possible 6-hours after surgery in 85% of Group FB-PCA (Group IV-PCA=20%) (P=0,0001) due to significantly
lower VAS 0,7+/–0,2 (Group IV-PCA=3,0+/–0,2)(P<0,0001). Residual
motor block, presented in three patient (15%) with FB-PCA, disabled the
onset of PHR.Additional analgesic dose wasmore need inGroup IV-PCA(40%)
(Group FB-PCA=10%) (P<0,0001).

Conclusion: FB-PCA allows more successful pain-free early PHR for orthopaedics "fast-track" ACL reconstruction compare to IV-PCA, excluding 15% of the FB-PCA patients in whom residual muscle weakness was present.

Keywords

Hrčak ID:

105980

URI

https://hrcak.srce.hr/105980

Publication date:

1.6.2013.

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