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POSTOPERATIVE ANALGESIA FOLLOWING RECONSTRUCTIVE KNEE URGERY: COMPARISON OF DIFFERENT PERIPHERAL NERVE BLOCK COMBINATIONS
MARINA BANOVIĆ
; Sveti Duh University Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb, Croatia
VIŠNJA NESEK ADAM
; Sveti Duh University Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb, Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
DAMJAN MARIN
; Sveti Duh University Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb, Croatia
Abstract
The aim was to compare the quality of postoperative analgesia and incidence of adverse effects using two different peripheral nerve block combinations in patients undergoing reconstructive knee surgery under spinal anesthesia. This prospective study included 40 patients undergoing elective reconstructive knee surgery under spinal anesthesia who were randomly divided into two groups of 20 patients each. Patients in AP group received ultrasound guided adductor canal and popliteal block and patients in AG group received ultrasound guided adductor canal and transgluteal sciatic nerve block. Blocks were
performed in all patients using 0.25% levobupivacaine and 4 mg dexamethasone for each block (20 mL total LA volume for transgluteal and popliteal block, 10 mL for adductor canal block). We measured and observed the time needed to perform the blocks, time to each block onset (changed reaction to cold using a cotton swab dipped in medicinal alcohol), postoperative pain level according to 10-cm visual analog scale (VAS; immediately after surgery and 4, 8 and 24 hours postoperatively), adverse effects, total analgesic consumption, and patient overall satisfaction on 1-10 numerical scale. Patients included in the study were 18-30 years old, 70% of them were male. There was no statistically signifi cant difference in VAS scores between the groups during study protocol (mean AP VAS 2.70 vs. AG VAS 2.35 24 hours postoperatively). The time necessary to perform the blocks was signifi cantly shorter in AP group compared to AG group (mean 7.45±1.05 min vs. 10.60±2.11 min). Time to sciatic nerve block onset was signifi cantly shorter in AP group (mean AP 4.45 min vs. AG 7.80 min). Six patients in AG group reported transgluteal approach to be very painful. We recorded no adverse effects in AP group. In AP group, one patient reported nausea and urinary retention each. There was no signifi cant difference in requiring additional analgesia between the groups. Patient overall satisfaction was signifi cantly higher in AP group (mean 9.35 vs. 8.65). In conclusion, both peripheral nerve block combinations provided adequate level of postoperative analgesia but adductor canal block and transgluteal sciatic nerve block combination required longer execution time, patients reported transgluteal application to be painful, and their verall satisfaction was lower. The combination of adductor canal block and popliteal block provided adequate analgesia with no adverse effects and no postoperative opioid consumption, and this combination can be used as part of multimodal analgesia for reconstructive knee surgery.
Keywords
ultrasound guided; adductor canal block; popliteal block; visual analog scale
Hrčak ID:
223015
URI
Publication date:
14.7.2019.
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