TOTAL KALÇA ARTROPLASTİSİ SONRASI SUPRAİNGUİNAL FASYA İLİAKA BLOĞU (SFIB) İLE PENG VE LATERAL FEMORAL KÜTANÖZ SİNİR (LFCN) BLOKLARININ ANALJEZİK ETKİNLİKLERİNİN KARŞILAŞTIRILMASI
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Tarih
2024-04-01Yazar
Çelebioğlu, Güneş
Ambargo Süresi
Acik erisimÜst veri
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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.
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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.