Effectiveness of Pain Control in Total Knee Arthroplasty between Different Anesthetic Techniques in Phrae Hospital
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Abstract
Background: Anesthetic techniques in total knee arthroplasty (TKA) include general anesthesia (GA), spinal anesthesia (SA), adductor canal block (ACB), periarticular infiltration (PAI) and SA combined with intrathecal morphine (SA+MO). There is diversity of utilizing these techniques.
Objective: To evaluate the efficacy of postoperative pain control and walking ability between different anesthetic techniques used in TKA.
Material and method: A retrospective analytical study was conducted among 153 patients receiving TKA during August 2018 – July 2019 under 5 different anesthetic techniques; group 1: SA+ACB 55 cases, group 2: SA+PAI 13 cases, group 3: SA+MO 63 cases, group 4: GA+PAI/ACB 9 cases and group 5: GA 13 cases. Postoperative pain score at 2, 24, 48 hours and ability to walk with walker within 48 hours were compared between groups.
Result: The mean 2-hrs pain score in GA group was 4.5 (SD 2.2), significantly higher than group 1−4. The average 24-hrs pain score in GA group was 4.3 (SD 2.0), significantly higher than group 1, 3 and 4. At 48 hours, the mean pain
score in GA group (3.5, SD 1.3) was higher than SA+ACB (2.6, SD 0.9, p=0.035) and GA+PAI/ACB group (2.1, SD 0.6, p=0.012). The pain scores in group 1−4 were not significantly different, no matter when assessed at 2, 24 or 48 hours. Percentages of patients with satisfied walking ability in SA+ACB and SA+PAI groups were higher than those of GA+PAI/ACB and GA groups (92.7% and 92.3% vs 55.6% and 53.8% respectively, p=0.002)
Conclusion: Using PAI or ACB, combined with either SA or GA provided similar effectiveness of postoperative pain control in TKA, and not different from SA+ MO. Combination of these techniques had better results than using GA alone.
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บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
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