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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(02): e241-e246
DOI: 10.1055/s-0044-1785449
Artigo Original
Joelho

Infiltração periarticular comparada ao bloqueio do nervo femoral único na artroplastia total de joelho: Um estudo prospectivo randomizado

Article in several languages: português | English
Osmar Valadão Lopes Júnior 
1   Instituto de Ortopedia e Traumatologia de Passo Fundo, Passo Fundo, RS, Brasil
2   Departamento de Ortopedia e Traumatologia, Hospital São Vicente de Paulo, Universidade Federal da Fronteira Sul, Passo Fundo, RS, Brasil
,
Juliano Munhoz Viana
2   Departamento de Ortopedia e Traumatologia, Hospital São Vicente de Paulo, Universidade Federal da Fronteira Sul, Passo Fundo, RS, Brasil
,
Juliany Aguirre de Carvalho
1   Instituto de Ortopedia e Traumatologia de Passo Fundo, Passo Fundo, RS, Brasil
,
Bruno Lunardi Folle
1   Instituto de Ortopedia e Traumatologia de Passo Fundo, Passo Fundo, RS, Brasil
,
Vinícius Canelo Kuhn
1   Instituto de Ortopedia e Traumatologia de Passo Fundo, Passo Fundo, RS, Brasil
,
Paulo Renato Fernandes Saggin
1   Instituto de Ortopedia e Traumatologia de Passo Fundo, Passo Fundo, RS, Brasil
› Author Affiliations
Suporte Financeiro Os autores declaram que não receberam financiamento de agências dos setores público, privado ou sem fins lucrativos para a realização deste estudo.
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Resumo

Objetivo Avaliar pacientes submetidos a artroplastia total do joelho (ATJ) sob raquianestesia e bloqueio do nervo femoral (BNF) único e comparar com pacientes que submetidos a ATJ sob raquianestesia e infiltração periarticular (IPA).

Materiais e Métodos Um total de 100 pacientes submetidos a ATJ foram randomizados em dois grupos. O grupo 1 incluiu pacientes submetidos a ATJ sob BNF associado à raquianestesia, ao passo que o grupo 2 incluiu pacientes submetidos a ATJ sob IPA associada à raquianestesia. Os indivíduos foram avaliados no pós-operatório precoce quanto à dor, à flexão e extensão ativas, à elevação do membro estendido e ao uso de morfina.

Resultados Não se observou diferença significativa associada ao tipo de analgesia em relação à dor, à elevação do membro em extensão e ao consumo de morfina. Houve melhor flexão e extensão ativas no grupo que recebeu IPA (p = 0,04 e p = 0,02, respectivamente).

Conclusão Concluímos que as técnicas utilizadas são semelhantes quanto ao controle da dor, à elevação de membro e ao uso de morfina. O uso de IPA proporcionou uma melhor flexão e extensão ativas durante o período de internação hospitalar comparado ao uso de BNF único em pacientes submetidos a ATJ.

Palavras-chave

analgesia - anestesia local - artroplastia do joelho - bloqueio nervoso - infiltração - nervo femoral

Trabalho desenvolvido no Instituto de Ortopedia e Traumatologia de Passo Fundo e no Hospital São Vicente de Paulo, da Universidade Federal da Fronteira Sul (UFFS), Passo Fundo, RS, Brasil.




Publication History

Received: 13 June 2022

Accepted: 19 September 2023

Article published online:
10 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • Referências

  • 1 Chou R, Gordon DB, de Leon-Casasola OA. et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 2016; 17 (02) 131-157
    CrossrefPubMedSearch in Google Scholar
  • 2 Berghmans DDP, Lenssen AF, Emans PJ, de Bie RA. Functions, disabilities and perceived health in the first year after total knee arthroplasty; a prospective cohort study. BMC Musculoskelet Disord 2018; 19 (01) 250
    CrossrefPubMedSearch in Google Scholar
  • 3 Terkawi AS, Mavridis D, Sessler DI. et al. Pain management modalities after total knee arthroplasty. Anesthesiology 2017; 126 (05) 923-937
    CrossrefPubMedSearch in Google Scholar
  • 4 Ferreira MC, Oliveira JCP, Zidan FF, Franciozi CEDS, Luzo MVM, Abdalla RJ. Total knee and hip arthroplasty: the reality of assistance in Brazilian public health care. Rev Bras Ortop 2018; 53 (04) 432-440
    CrossrefPubMedSearch in Google Scholar
  • 5 Albrecht E, Guyen O, Jacot-Guillarmod A, Kirkham KR. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2016; 116 (05) 597-609
    CrossrefPubMedSearch in Google Scholar
  • 6 Dalury DF, Lieberman JR, MacDonald SJ. Current and innovative pain management techniques in total knee arthroplasty. J Bone Joint Surg Am 2011; 93 (20) 1938-1943
    CrossrefPubMedSearch in Google Scholar
  • 7 Zhang LK, Ma JX, Kuang MJ, Ma XL. Comparision of periarticular local infiltration analgesia with femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplasty 2018; 33 (06) 1972-1978.e4
    CrossrefPubMedSearch in Google Scholar
  • 8 Wang C, Cai XZ, Yan SG. Comparison of periarticular multimodal drug injection and femoral nerve block for postoperative pain management in total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2015; 30 (07) 1281-1286
    CrossrefPubMedSearch in Google Scholar
  • 9 Berninger MT, Friederichs J, Leidinger W. et al. Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in total knee arthroplasty. BMC Musculoskelet Disord 2018; 19 (01) 232
    CrossrefPubMedSearch in Google Scholar
  • 10 Wall PDH, Parsons NR, Parsons H. et al; P. D. H. Wall on behalf of A. P. Sprowson,† M. L. Costa, PAKA Study Group. A pragmatic randomised controlled trial comparing the efficacy of a femoral nerve block and periarticular infiltration for early pain relief following total knee arthroplasty. Bone Joint J 2017; 99-B (07) 904-911
    CrossrefPubMedSearch in Google Scholar
  • 11 Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty 2007; 22 (6, Suppl 2) 33-38
    CrossrefPubMedSearch in Google Scholar
  • 12 Chan EY, Fransen M, Parker DA, Assam PN, Chua N. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev 2014; 2014 (05) CD009941
    PubMedSearch in Google Scholar
  • 13 Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg 2013; 26 (03) 191-196
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Elmallah RK, Cherian JJ, Pierce TP, Jauregui JJ, Harwin SF, Mont MA. New and common perioperative pain management techniques in total knee arthroplasty. J Knee Surg 2016; 29 (02) 169-178
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2004; 100 (06) 1573-1581
    CrossrefPubMedSearch in Google Scholar
  • 16 Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg 2017; 152 (07) 691-697
    CrossrefPubMedSearch in Google Scholar
  • 17 Pereira RJ, Munechika M, Sakata RK. Pain Management after Outpatient Surgical Procedure. Rev Dor (São Paulo) 2013; 14 (01) 61-67
    Search in Google Scholar
  • 18 Feibel RJ, Dervin GF, Kim PR, Beaulé PE. Major complications associated with femoral nerve catheters for knee arthroplasty: a word of caution. J Arthroplasty 2009; 24 (6, Suppl) 132-137
    CrossrefPubMedSearch in Google Scholar
  • 19 Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg 2010; 111 (06) 1552-1554
    CrossrefPubMedSearch in Google Scholar
  • 20 Muraskin SI, Conrad B, Zheng N, Morey TE, Enneking FK. Falls associated with lower-extremity-nerve blocks: a pilot investigation of mechanisms. Reg Anesth Pain Med 2007; 32 (01) 67-72
    PubMedSearch in Google Scholar
  • 21 Jæger P, Zaric D, Fomsgaard JS. et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 2013; 38 (06) 526-532
    CrossrefPubMedSearch in Google Scholar
  • 22 Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res 2010; 468 (01) 135-140
    CrossrefPubMedSearch in Google Scholar
  • 23 Jiang X, Wang QQ, Wu CA, Tian W. Analgesic efficacy of adductor canal block in total knee arthroplasty: a meta-analysis and systematic review. Orthop Surg 2016; 8 (03) 294-300
    CrossrefPubMedSearch in Google Scholar
  • 24 Wang CG, Ding YL, Wang YY, Liu JY, Zhang Q. Comparison of adductor canal block and femoral triangle block for total knee arthroplasty. Clin J Pain 2020; 36 (07) 558-561
    CrossrefPubMedSearch in Google Scholar
  • 25 Gao F, Ma J, Sun W, Guo W, Li Z, Wang W. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a systematic review and meta-analysis. Clin J Pain 2017; 33 (04) 356-368
    CrossrefPubMedSearch in Google Scholar
  • 26 Goytizolo EA, Lin Y, Kim DH. et al. Addiction of adductor canal block to periarticular injection for total knee replacement. J Bone Joint Surg Am 2019; 101 (09) 812-820
    CrossrefPubMedSearch in Google Scholar