REGIONAL ANAESTHESIA AND ACUTE PAIN

Abstract

Introduction and objectives. Total knee arthroplasty(TKA) is a major orthopedic procedure with severe postoperative pain.We decided to improve traditional pain menagement (iv, Epidural.) with continious psoas compartment block (CPCB) after TKA and study its effectivness. Methods: Retrospectively were analyzed 82 patients,age 67-92 years old,ASA I-III,operated in 2010/2011.CPCB was performed before surgery with Contiplex Tuhou 18G (B. Braun AG, Germany) 100mm needle with catheter and Stimuplex (B, BraunAG,Germany) nerve stimulator. Patientwas in lateralpositionwith upper leg flexed. Puncture was at level L4,5cm lateral and 3cm caudal. M.Quadriceps contraction at 0,5-0,8 mA (o,1ms) was considered as an adequate response. After negative aspiration,catheter was placed 6-8 cm deep inside. PCA pump(CADDLegacy, SmithMedical,UK)wasusedforcontinious infusionof 0,2%levobupivacain (6-10 ml/h,4ml bolus doze and 30 minutes lock out), started half an hour before the end of the procedure. CPCB was maintained 72 hours. Active mobilization started 24 hours after the operation. Visual Analog Scale (VAS) was used for postoperative pain evaluation. Results: Out of total 82 subjects, 43 were male, 39 were female. In 96% CPCB was successful. 4% had an inadequate analgesia (VAS greater than 8) and Pyritramid 3mg iv. was added supplementary. Four patients had m.quadriceps weekness, when physical rehabilitation started.No complication related CPCB was noticed. Patients satisfaction was 96%. There were no differences between male and female group. Mobilisation was better and more comfortable. There were no systemic or neurological side effects. Improvement of the quality of rehabilitation were noticed. Conclusion: Our study proved that Continious psoas compartment block(CPCB) is clinicly safe, useful and effective technique for pain teatment after total knee arthroplasty(TKA).