Resumo

ILLESCAS, M. et al. Efficacy and side effects of three analgesic techniques for postoperative pain management after total knee arthroplasty. Rev. Soc. Esp. Dolor [online]. 2007, vol.14, n.1, pp.20-25. ISSN 1134-8046.

Purpose: Despite the fact that it is expected and intense, postoperative pain after knee arthroplasty is still an unresolved challenge. In our study we intend to analyse and compare analgesic efficacy, incidence and severity of adverse effects resulting from three different techniques: a )Epidural analgesia , b)Femoral block, and c) intravenous analgesia with mor-phine. Patients and Methods: An observational and retrospective study is presented, re-viewing data obtained from 359 patients who had a total knee arthroplasty: Patients were assigned to three different groups, according to the method of pain relief that was prescribed for each of them: a) Femoral group (n=56).A continuous femoral block was performed using ropivacaine 0.2%. Sciatic block was associated on each patient (single injection at middle femoral point with ropivacaine 0.2%). b) Epidural group (n=135).This figure includes patients in whom an epidural catheter was inserted and bupivacaine 0.07% plus fentanyl 2 mc./mi was administered through the catheter. c) Intravenous group (n=168). Intravenous morphine was administered to this group of patients. Each analgesic plan included continuous perfusión of drugs via PCA devices, and paracetamol (lg iv every 6 hourly) was prescribed as complementary analgesia in all the cases. Parameters to evalúate: analgesia obtained at rest, nausea and vomiting, motor blockade, sedation, pruritus and complementary analgesia given in the first 24 hours postoperatively. Results: Significative differences were not appreciated at the moment of evaluation of the analgesic efficieney of the three analgesic plans. Equally, sedation, nausea and vomiting had the same incidence in all groups. Motor blockade and pruritus appeared more frequently in the cases treated with femoral block and epidural catheter respectively. Conclusión: We can not assert that any of the analgesic strategies was superior to the others as to its analgesic effectiveness, although pruritus appeared in the epidural group and motor blockade did in the femoral group, as adverse effects in few cases.

Palavras-chave : Total knee arthroplasty; Controlled patient analgesia; epidural analgesia; femoral block.

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