Efficacy of Pain Management between General Anesthesia with Ultrasound-Guided Femoral Nerve Block versus Spinal Anesthesia in Patients Undergoing Total Knee Replacement Surgery at Saraburi Hospital
Keywords:
Postoperative pain management,, total knee replacement surgery,, general anesthesia,, femoral nerve block,, spinal anesthesiaAbstract
Introduction: Total knee replacement surgery can be intensely painful. Effective pain management during and after surgery is crucial. A combined approach using general anesthesia with ultrasound-guided femoral nerve block has been proposed to provide effective pain relief and reduce postoperative pain levels efficiently.
Objectives: To compare the efficacy of pain management between general anesthesias combined with ultrasound-guided femoral nerve block and spinal anesthesia in patients undergoing total knee replacement surgery at Saraburi Hospital. This randomized controlled trial (RCT) spanned from September 2020 to September 2021 and involved 60 patients divided into two groups.
Methods: Group 1 received general anesthesia combined with ultrasound-guided femoral nerve block(n=30), while Group 2 received spinal anesthesia (n=30). Data collection included patient demographics, intra-operative complications, pain scores, additional analgesic use, postoperative adverse events and patient satisfaction with pain management.
Results: Initial pain scores in recovery rooms and pre-discharge were statistically similar between the two groups. Significantly more patients in Group 2 required additional postoperative analgesia compared to Group 1 (p=0.015). Hypotension was more prevalent in Group 2 than in Group 1 as a surgical complication. Both groups reported high satisfaction scores (5 points) for pain management services, with percentages of 93.33% and 83.33% respectively.
Conclusion: Combining general anesthesia with ultrasound-guided femoral nerve block effectively manages early postoperative pain in total knee replacement surgery comparable to spinal anesthesia. It also reduces the need for additional postoperative analgesia, contributing to high patient satisfaction levels with pain management services.
References
สมศักดิ์ คุปต์นิรัติศัยกุล.กายวิภาคประยุกต์ของข้อเข่า.[สืบค้นเมื่อ 28 พฤษภาคม 2563].จาก:http://ortho2.md.chula.ac.th/index.php/index/download-เอกสาร.html
Oliver J. The knee joint.[accessed May 28, 2020].Available from:https://teachmeanatomy.info/lower-limb/joints/knee-joint.
O’Donnell R, DolanJ.Anaesthesia and analgesia for knee joint Arthroplasty.BJA Education. 2018;18(1):8-15.
Liu J, Yuan W, Wang X, Royse C, Gong M, Zhao Y, Zhang H. Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery. Clinical Interventions in Aging. 2014;9:341–50.
Guidelines for the Management of Postoperative Pain after Total Knee Arthroplasty. Knee SurgRelat Res. 2012;24(4):201-7.
สุวิมล ต่างวิวัฒน์.Pain Management for Orthopedic Procedures. [สืบค้นเมื่อ 10 มิถุนายน 2563].ได้จาก: http://www1.si.mahidol.ac.th/km/sites/default/files/60.pdf
Upadhyay PS, Tellicherry S, Kulkarni S, Saikia P, Mallick NP, Elmatite W. Postoperative Analgesia in Total Knee Arthroplasty (TKA) - The Changing Trends. Biomed J Sci& Tech Res. 2017;1(3):713-9.
Berninger TM, FriederichsJ,LeidingerW,Augat P, Bühren V, FulghumC,RengW.Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in total knee arthroplasty. BMC Musculoskeletal Disorders.2018;19:232-41.
Song JS. Pain Management and Anesthesia in Total Knee Arthroplasty. Knee SurgRelat Res. 2017;29(2):77-
Sigirci A. Pain management in total knee arthroplasty by intraoperative local anesthetic application and one-shot femoral block. Indian J Orthop. 2017;51(3):280-5.
Wulf H, Biscoping J, Beland B, Bachmann-Mennenga B, Motsch J. Ropivacaine epidural anesthesia and analgesia versus general anesthesia and intravenous patient-controlledanalgesia with morphine in the perioperative management of hip replacement. RopivacaineHip Replacement Multicenter Study Group. AnesthAnalg. 1999;89:111–6.
สุวิมล ต่างวิวัฒน์, อริศรา เอี่ยมอรุณ, พงศ์ธารา วิจิตเวชไพศาล.Ultrasound-guided regional anesthesia การระงับความรู้สึก เฉพาะส่วนโดยอัลตราซาวด์. กรุงเทพมหานคร: สำนักพิมพ์ศิริราช คณะแพทยศาสตร์ศิริราชพยาบาล มหาวิทยาลัยมหิดล, 2558.
Mansour A. Femoral Nerve Block versus Spinal Anesthesia for Lower Limb Peripheral Vascular Surgery. Alexandria Journal of Anaesthesia and Intensive Care. 2006;9(1):44-50.
Davarci I, Tuzcu K, Karcioglu M, Hakimoglu S, Zden R, Yengil E, et al. Comparison between ultrasound-guided sciatic–femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy. Journal of International Medical Research. 2013;41(5):1639-47.
Greimel F, Maderbacher G, Baier C, Keshmiri A, Schwarz T, ZemanF,et al.Multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management: general, regional and combination anesthesia in knee arthroplasty. ScientIfIc Reports. 2018;8:1-9.
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