Местная инфильтрационная анестезия при тотальном эндопротезировании коленного сустава

Мохаммад Али Алькатауне, Е.В. Жук, П.И. Беспальчук УО «Белорусский государственный медицинский университет»

2022 №2 | Лекции

Аннотация

Список литературы

Гонартроз – хроническое прогрессирующее дегенеративно-дистрофическое заболевание коленного сустава, характеризующееся деструкцией суставного хряща, изменениями суставных поверхностей эпифизов костей и околосуставных мягких тканей. Тотальное эндопротезирование коленного сустава (ТЭКС) является эффективным и часто единственным способом восстановления утраченной функции конечности, когда консервативное лечение или сохраняющие сустав оперативные вмешательства не дают результата. ТЭКС – это реконструктивное хирургическое вмешательство, заключающееся в замещении патологически измененных сочленяющихся суставных поверхностей бедренной и большеберцовой костей (в некоторых случаях и надколенника) на искусственные для ликвидации или уменьшения интенсивности болевого синдрома, восстановления подвижности в коленном суставе и опороспособности нижней конечности. Неудовлетворенность качеством послеоперационного обезболивания при проведении (ТЭКС) требует поиска новых схем и методик лечения. В последние годы все более популярным становится использование местной инфильтрационной анестезии и блокады периферических нервов. Объект исследования – 138 пациентов (114 женщин и 24 мужчины) с эндопротезированием коленного сустава, находившихся на лечении в УЗ «6 ГКБ г. Минска» с 2019 по 2020 годы.

Ключевые слова:

коленный сустав, эндопротезирование, анестезия, ропивакаин

Local infiltration anesthesia in total knee endoproshesis

Gonarthrosis is a chronic progressive degenerative-dystrophic disease of the knee joint, characterized by destruction of the articular cartilage, changes in the articular surfaces of the epiphyses of the bones and periarticular soft tissues. Total knee arthroplasty (TKA) is an effective and often the only way to restore lost limb function when conservative treatment or joint-preserving surgery fails. TKA is a reconstructive surgical intervention that consists in replacing pathologically altered articular surfaces of the femur and tibia (in some cases, the patella) with artificial ones to eliminate or reduce the intensity of the pain syndrome, restore mobility in the knee joint and support ability of the lower limb. Dissatisfaction with the quality of postoperative pain relief (TKA) requires the search for new schemes and methods of treatment. In recent years, the use of local infiltration anesthesia and peripheral nerve blocks has become increasingly popular. The object of the study is 138 patients (114 women and 24 men) with knee arthroplasty who were treated at the 6th City Clinical Hospital of Minsk from 2019 to 2020.

Keywords

knee joint, arthroplasty, anesthesia, ropivacaine

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3. Chan, E. Y. Femoral nerve blocks for acute postoperative pain after knee replacement surgery / E. Y. Chan, M. Fransen, D. A. Parker, P. N. Assam, N. Chua // Cochrane Database Syst Rev. – 2014. – № 13. – P. CD009941.
4. Charous, M. T. Continuous femoral nerve blocks: varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block / M. T. Charous, S. J. Madison, P. J. Suresh [et al.] // Anesthesiology. – 2011. – Vol. 115. – P. 774–781.
5. Chelly, J. E. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty /J. E. Chelly, J. Greger, R. Gebhard, K. Coupe, T. A. Clyburn, R. Buckle, A. Criswell // J Arthroplasty. – 2001. – Vol. 16. – P. 436–445.
6. De Neumann, L. Search of the Perfect Balance: A Narrative Review of Analgesic Techniques for Total Knee Arthroplasty /L. De Neumann, A. Clairoux, V. Brulotte, C. J. McCartney // Current Anesthesiology Reports. – 2017. – Vol. 7(2). – P. 201–211.
7. Dixit, V. Effectiveness of continuous versus single injection femoral nerve block for total knee arthroplasty: a double blinded, randomized trial / V. Dixit, S. Fathima, S. M. Walsh [et al.] // Knee. – 2018. – Vol. 25. – P. 623–630.
8. Kampe, S. Ropivacaine 0.1 % with sufentanil 1 microg/mL inhibits in vitro growth of Pseudomonas aeruginosa and does not promote multiplication of Staphylococcus aureus / S. Kampe, C. Poetter, S. Buzello, H. M. Wenchel, M. Paul, P. Kiencke [et al.] // Anesth Analg. – 2003. – Vol. 97. – P. 409–11.
9. Karkhur, Y. A comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty: a systematic literature review / Y. Karkhur, R. Mahajan, A. Kakralia, A. P. Pandey, M. C. Kapoor // J Anaesthesiol Clin Pharmacol. – 2018. – Vol. 34. – P. 433–438.
10. Li, D. Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty / D. Li, G. G. Ma // Knee Surg Sports Traumatol Arthrosc. – 2016. – Vol. 24. – P. 2614–2619.
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12. Palmer, A. J. R. Acute pain management in total knee arthroplasty / A. J. R. Palmer, E. Carlos Rodrìguez-Merchàn // Total Knee Arthroplasty. – 2015. – Vol. 69.
13. Porter, J. The effects of ropivacaine hydrochloride on platelet function: An assessment using the platelet function analyser (PFA-100) / J. Porter, B. Crowe, M. Cahill, G. Shorten // Anaesthesia. – 2001. – Vol. 56. – P. 15–8.
14. Sadigursky, D. Local periarticular analgesia in total knee arthroplasty / D. Sadigursky, Pereira Simões D., R. Araújo de Albuquerque, Silva M. Zórnio, R. Jamil Carneiro Fernandes, P. Oliveira Colavolpe // Acta Orthop Bras. – 2017. – Vol. 25. – P. 81.
15. Shah, N. A. Adductor canal blockade following total knee arthroplasty-continuous or single shot technique? Role in postoperative analgesia, ambulation ability and early functional recovery: a randomized controlled trial / N. A. Shah, N. P. Jain, K. A. Panchal // J Arthroplasty. – 2015. – Vol. 30. – P. 1476–1481.
16. Singelyn, F. J. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty / F. J. Singelyn, T. Ferrant, M. F. Malisse, D. Joris // Reg Anesth Pain Med. – 2005. – Vol. 30. – P. 452–457.
17. Tan, Z. A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage / Z. Tan, P. Kang, F. Pei, B. Shen, Z. Zhou, J. Yang // Medicine (Baltimore). – 2018. – Vol. 97. – P. e13391.
Поступила 28.01.2022 г.