TOTAL KALÇA ARTROPLASTİSİ SONRASI SUPRAİNGUİNAL FASYA İLİAKA BLOĞU (SFIB) İLE PENG VE LATERAL FEMORAL KÜTANÖZ SİNİR (LFCN) BLOKLARININ ANALJEZİK ETKİNLİKLERİNİN KARŞILAŞTIRILMASI

Abstract

Total hip arthroplasty is a surgical procedure whose frequency increases day by day and causes severe pain in the postoperative period. The anterior part of the hip capsule, which is responsible for the majority of pain, is innervated by branches of the femoral and obturator nerves, and SFIB is frequently used for targeting these nerves for analgesia in patients undergoing hip surgery. However, SFIB may negatively affect the physiotherapy process by causing quadriceps weakness due to motor involvement of the femoral nerve. PENG block is a block that selectively targets the branches of the femoral, obturator and accessory obturator nerves that innervate the hip capsule. Therefore, it is not expected to cause motor weakness and is successful in postoperative pain management in total hip arthroplasty patients. Since analgesia of the skin cannot be achieved with this block, it is insufficient by itself and must be combined with the LCFN block to provide analgesia for the surgical incision. Our aim in this study is; to compare the analgesic efficacy of SFIB and PENG with LCFN block, and study their effects on opioid consumption, motor strength and physiotherapy in the postoperative period in patients who underwent primary total hip arthroplasty under general anesthesia. Following the approval of the ethics committee, 48 patients who were diagnosed with coxarthrosis and were to undergo total hip arthroplasty under general anesthesia were included in the study after consenting to participate in the study. SFIB or PENG with LFCN blocks were applied to the patients to provide postoperative analgesia, and the patients were followed in the postoperative period. In the postoperative period, patients' resting and movement VAS scores and morphine consumption at 3, 12, 24 and 48 hours; quadriceps motor strength at 6 and 24 hours, ability to do physiotherapy on days 1 and 2, and the presence of block and opioid-related complications were recorded. In our study, the demographic characteristics of the patients in both groups were similar. No significant difference in VAS scores and opioid consumption was found between the groups. v Quadriceps weakness was observed in 7 (29.17%) patients in the PENG group at the 6th hour, while it was observed in 13 (54.17%) patients in the SFIB group. However, no statistically significant difference was found. No difference was found between the groups in terms of ability to perform physiotherapy. No side effects related to opioid use were observed in any patient. Likewise, no complications related to the blocks were observed in any patient. In conclusion, it was observed that both SFIB and PENG with LFCN blocks provide adequate pain control without increasing opioid consumption and side effects, and both methods can be used safely to provide pain control after total hip arthroplasty.