Peripheral regional analgesia with femoral catheter versus intravenous patient controlled analgesia after total knee arthroplasty: a prospective randomized study [Periferna regionalna analgezija versus intravenozna "patient controlled" analgezija nakon ugradnje totalne proteze koljena: prospektivna, randomizirana studija]

Baranović, Senka and Maldini, Branka and Milošević, Milan and Golubić, Rajna and Nikolić, Tatjana (2011) Peripheral regional analgesia with femoral catheter versus intravenous patient controlled analgesia after total knee arthroplasty: a prospective randomized study [Periferna regionalna analgezija versus intravenozna "patient controlled" analgezija nakon ugradnje totalne proteze koljena: prospektivna, randomizirana studija]. Collegium Antropologicum, 35 (4). pp. 1209-1214. ISSN 0350-6134

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Abstract

The aim of this study is to compare the effects of femoral analgesia (FA) with 0.25% levobupivacain and intravenous patient controlled analgesia (PCA) with morphine on postoperative pain assessed by a visual-analog scale (VAS) score and their complications during the first 24 postoperative hours after the a total knee arthroplasty in a prospective randomized study. Secondary outcomes included: morphine use, patient satisfaction, complication of analgesia and duration of hospital stay. We analyzed 71 patients with an ASA score of II or III. The patients were randomized into two groups: group PCA (n = 36) was given the PCA pump, which contained morphine; and group FA (n = 35) was given first a bolus dose, then a continuous infusion 0.25% levobupivacain via a femoral catheter. The assessment of VAS was performed every 2 hours. There were no differences between the PCA and FA groups regarding demographic characteristics, operation duration, ASA score distribution, duration of hospital stay and satisfaction with analgesia (although there were more satisfied patients in the FA group). Significant differences were noted in the quantity of morphine used (higher values were in the PCA group; p < 0.001). More complications were recorded in PCA group (p < 0.001). The VAS score was lower in the FA group (p < 0.001). The highest difference occurred 4 hours after the operation, with the PCA group having significantly higher VAS score values compared to the FA group. Femoral analgesia leads to a stronger pain relief with less side effects, less morphine use and more patient satisfaction than intravenous PCA with morphine.

Abstract in Croatian

Cilj ove prospektivne, randomizirane studije je usporediti učinak femoralne analgezije (FA) 0,25% levobupivakainom i intravenozne »patient controlled« analgezije (PCA) morphinom na ishod poslijeoperacijske boli, kao i njihove komplikacije 24 h nakon ugradnje totalne proteze koljena. Sekundarni cilj uključuje: razliku u potrošnji morphina po grupama, zadovoljstvo bolesnika analgezijom, komplikacije analgezije, trajanje hospitalizacije. Analizirali smo 71 bolesnika, ASA II i III skora. Bolesnici su randomizirani u dvije grupe: grupa PCA (n=36) je analgezirana intravenoznom PCA morphinom; grupa FA (n=36) je analgezirana preko femoralnog katetera kontinuiranom infuzijom 0,25% levobupivakainom. Procjena VAS boli je vršena svaka 2 sata u mirovanju i pokretu. Nije bilo statistički značajne razlike među grupama u demografskim karakteristikama, trajanju operacije, ASA distribuciji, trajanju hospitalizacije i zadovoljstvu analgezijom (premda je grupa FA bila zadovoljnija). Statistički značajna razlika je bila u potrošnji morphina (veća potrošnja kod PCA grupe; p<0,001). Više komplikacije je bilo u grupi PCA (p<0,001). VAS je bio niži u grupi FA (p<0,001). Najveća razlika u VAS-u je bila 4 sata nakon operacije; grupa PCA je imala signifikantno veći VAS nego grupa FA. Femoralna analgezija doprinosi boljoj kontroli boli sa manje nuspojava, manjom potrošnjom morphina i većim zadovoljstvom bolesnika nego intravenozna PCA sa morphinom.

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