Analgetska efikasnost i bezbednost četiri različita protokola anestezije/postoperativne analgezije kod pacijenata nakon aloartroplastike kuka

  • Mirjana L Kendrišić General Hospital Sremska Mitrovica, Department of Anesthesiology, Reanimatology and Intensive Care, Sremska Mitrovica, Serbia
  • Maja Šurbatović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Anesthesiology and Intensive Therapy, Belgrade, Serbia
  • Dragan Djordjević University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Anesthesiology and Intensive Therapy, Belgrade, Serbia
  • Bratislav Trifunović Military Medical Academy, Clinic for General Surgery, Belgrade, Serbia Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Jasna Jevdjić Anesthesiology and Reanimation Department, Kragujevac, Serbia; University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
DOI: https://doi.org/10.2298/VSP160225099K
Ključne reči: arthroplasty, replacement, hip||, ||artroplastika kuka, pain, postoperative||, ||bol, postoperativni, nerve block||, ||blokada živca, lumbosacral plexus||, ||lumbosakralni predeo, analgesia||, ||analgezija, methods||, ||metode, analgesia, epidural||, epiduralna, pain measurement||, merenje,

Sažetak


Uvod/ Cilj. Zamena totalne proteze kuka može prouzrokovati značajne bolove nakon operacije, kako zbog hirurške traume kosti i prisustva implanta, tako i zbog oštećenja mekih tkiva i živaca. Metode postoperativne analgezije koje uključuju neku od tehnika regionalne anestezije imaju mnogobrojne prednosti u odnosu na intravensku primenu morfina postoperativno. Međutim, u skorije vreme su objavljeni mnogobrojni neželjeni efekti i komplikacije kontinuirane epiduralne analgezije. Cilj ove prospektivne, randomizovane studije bio je da se utvrdi da li kontinuirani blok lumbalnog pleksusa predstavlja sigurnu i efikasnu alternativu za postoperativnu analgeziju u poređenju sa epiduralnom analgezijom i pacijent kontrolisanom analgezijom (PKA) morfinom kod aloartroplastike kuka. Metode. U ovu prospektivnu studiju bilo je uključeno 60 pacijenata, predviđenih za aloartroplastiku kuka. Pacijenti su bili raspoređeni u četiri grupe: grupa centralni neuroblok – epidural (CNB), grupa periferni neuroblok – blok lumbalnog pleksusa (PNB), grupa spinalna anestezija – PKA morfin (SAM), i opšta anestezija – PKA morfin (OAM). Kvalitet analgezije i učestalost neželjenih efekata (hipotenzije, muke, povraćanja, retencije urina) praćeni su u svim grupama 4 h, 12 h i 24 h nakon operacije. Jačina bola procenjivana je pomoću vizuelne analogne skale (VAS), tokom mirovanja i pri pokretima. Rezultati. Ovo istraživanje pokazalo je da se primenom kontinuiranog bloka lumbalnog pleksusa obezbeđuje efikasna analgezija u mirovanju i pri pokretima tokom 24 h nakon aloartroplastike kuka. Jačina postoperativnog bola varirala je značajno među grupama 4 h nakon operacije (F = 21,827; p < 0,01), 12 h nakon operacije (F = 41,925; p < 0,01) kao i nakon 24 h (F = 33,768; p < 0,01), sa najvećim zabeleženim skorom ≥ 3 u grupi OAM. Pacijenti iz grupe PNB imali su zadovoljavajuću analgeziju, sličnu pacijentima iz CNB grupe. Incidencija muke bila je značajno niža u PNB grupi 12 h nakon operacije (χ2 = 9,712; p < 0,01). Incidencija retencije urina značajno se razlikovala 12 h nakon operacije i pojavljivala se jedino u grupi CNB, sa učestalošću od 33,3% (χ 2 = 16,365; p < 0,01). Nije bilo statistički značajnih razlika u učestalosti hipotenzije u ispitivanim grupama. Zaključak. Postoperativna analgezija nakon aloartroplastike kuka kontinuiranom blokadom lumbalnog pleksusa obezbeđuje zadovoljavajuću analgeziju sa malim brojem neželjenih efekata, u poređenju sa epiduralnom analgezijom i parenteralnom primenom opioida.

Biografija autora

Mirjana L Kendrišić, General Hospital Sremska Mitrovica, Department of Anesthesiology, Reanimatology and Intensive Care, Sremska Mitrovica, Serbia
lekar specijalista anesteziologije sa reanimatologijom

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Objavljeno
2017/09/19
Broj časopisa
Vol. 74 Br. 9 (2017)
Rubrika
Originalni članak