Eficacia analgésica del bloqueo continuo del nervio femoral en asociación con infiltración de la capsula articular posterior en cirugía de reemplazo total de rodilla
DOI:
https://doi.org/10.22529/me.2022.7(3)06Palabras clave:
reemplazo total de rodilla, analgesia postoperatoria, bloqueo nervioso femoral continuoResumen
El dolor agudo postoperatorio es una entidad subtratada, y así lo demuestra Apfelbaum en 2003, cuando publica uno de los estudios de mayor referencia en torno al tema. A la hora de definir la opción analgésica ideal para el manejo del dolor postoperatorio en la cirugía de reemplazo total de rodilla (RTR) se han descripto múltiples técnicas en torno a la anestesia regional. Algunos autores abogan que la terapéutica analgésica óptima para la cirugía de RTR es aquella que no solo asegure analgesia y seguridad al paciente, sino que también se adecue lo más posible al entorno y a las posibilidades del anestesiólogo. En la búsqueda de la técnica ideal se procedió a comparar dos esquemas analgésicos diferentes, en pacientes operados de RTR en un mismo centro hospitalario. Se realizó un estudio observacional, retrospectivo y analítico en pacientes sometidos a cirugía electiva de RTR en la Clínica Universitaria Reina Fabiola; dichos pacientes fueron separados en un Grupo EV (donde recibieron un esquema analgésico endovenoso) y un grupo BNPC + LIA (los cuales recibieron un bloqueo nervioso periférico de nervio femoral asociado a infiltración de la capsula posterior de la rodilla). El análisis de los resultados demostró un menor consumo global de opiáceos del grupo BNPC + LIA, frente al esquema endovenoso (Grupo BNPC + LIA: 6,16 ± 4,68 mg Vs Grupo EV: 11,33 ± 8,89 mg; p= 0,01) (figura 1 - tabla 2). En cuanto a los días de internación (figura 2) se observó un mayor tiempo de estadía intrahospitalaria en el grupo de BNPC + LIA (BNPC + LIA 3,20 ± 0,92 Vs Grupo EV 2,62 ± 0,96; p=0,008). Finalmente, en cuanto al análisis de las complicaciones (figura 3) surgidas durante el postoperatorio se objetivó una mayor incidencia de las mismas en el grupo EV (Grupo BNPC + LIA: 0,26 ± 0,44 Vs Grupo EV: 0,66 ± 0,78; p=0,04). A partir de los resultados obtenidos en el presente estudio es posible asegurar que la técnica hibrida de bloqueo femoral continuo asociada a la infiltración de la capsula articular posterior con anestésicos locales es una técnica analgésica efectiva y segura para el dolor agudo postoperatorio del reemplazo total de rodilla.Descargas
Referencias
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97:534-40. https://doi.org/10.1213/01.ANE.0000068822.10113.9E
Xu J, Chen XM, Ma CK, Wang XR. Peripheral nerve blocks for postoperative pain after major knee surgery. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD010937. DOI: 10.1002/14651858.CD010937 https://doi.org/10.1002/14651858.CD010937
Barrington JW, Halaszynski TM, Sinatra RS. Perioperative painmanagement in hip and knee replacement surgery. Am J Orthop (Belle Mead NJ). 2014;43 4 Suppl: S1-16.4
Sanchez Freytes S. Técnicas de anestesia regional para analgesia postoperatoria en la cirugía de reemplazo total de rodilla. Artículo de revisión Rev Argent Anestesiol. 2016;74(2):57-63 https://doi.org/10.1016/j.raa.2016.09.003
Kohan, Dennis R Kerr and Lawrence. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery. A case study of 325 patients. Acta Orthopaedica, 2008, Vol. 79. 174-183. https://doi.org/10.1080/17453670710014950
L. Ø. Andersen and H. Kehlet. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review British Journal of Anaesthesia 113 (3): 360-74 (2014). https://doi.org/10.1093/bja/aeu155
ShuYa Mei S, Jin S, Chen Z, Ding X, Zhao X, Li Q. Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block. Clinics. 2015;70(9):648653 https://doi.org/10.6061/clinics/2015(09)09
Affas F, Nygards EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia. Acta Orthop. 2011 Aug;82(4):441-7. https://doi.org/10.3109/17453674.2011.581264
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; 111:1552-1554 https://doi.org/10.1213/ANE.0b013e3181fb9507
J. J. Paauwe, B. J. Thomassen, J. Weterings, E. van Rossum and M. E. Ausems. Femoral nerve block using ropivacaine 0.025%, 0.05% and 0.1%: effects on the rehabilitation programme following total knee arthroplasty: a pilot study. Anaesthesia, 2008, 63, pages 948-953 https://doi.org/10.1111/j.1365-2044.2008.05538.x
Wan Yi Wong, Siska Bjørn. Defining the Location of the Adductor Canal Using Ultrasound. Reg Anesth Pain Med 2017;42: 241-245 https://doi.org/10.1097/AAP.0000000000000539
Adam W. Meier, David B. Auyong, Stanley C. Yuan, Shin-E Lin, James M. Flaherty, and Neil A. Hanson. Comparison of Continuous Proximal Versus Distal Adductor Canal Blocks for Total Knee Arthroplasty. Reg Anesth Pain Med 2018;43: 36-42 https://doi.org/10.1097/AAP.0000000000000692
Joseph M. Neal. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine. Regional Anesthesia and Pain Medicine: Volume 40, Number 5, SeptemberOctober 2015. https://doi.org/10.1097/AAP.0000000000000286
Thobhani S, Thomas L, Osteen K, et al. Effectiveness of Local Anesthetic Infiltration between Popliteal Artery and Capsule of Knee (iPACK) for Attenuation of Knee Pain in Patients Undergoing Total Knee Arthroplasty (Abstract 165). Presented at the 40th Annual Regional Anesthesiology and Acute Pain Medicine Meeting (ASRA), May 14-16, 2015, in Las Vegas, Nevada.
James E. Paul, Aman Arya, Lindsay Hurlburt, Ji Cheng, Lehana Thabane. Femoral Nerve Block Improves Analgesia Outcomes after Total Knee Arthroplasty. Anesthesiology 2010; 113:1144 - 62 https://doi.org/10.1097/ALN.0b013e3181f4b18
L. Ø. Andersen and H. Kehlet. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. British Journal of Anaesthesia 113 (3): 360-74 (2014) https://doi.org/10.1093/bja/aeu155
Sandra L. Kopp, Jens Børglum, Asokumar Buvanendran, Terese T. Horlocker, Brian M. Ilfeld, Stavros G. Memtsoudis, Joseph M. Neal, Narinder Rawal and Jessica T. Wegener. Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty An Evidence-Based Review by the American and European Societies of Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med 2017;42: 683-697). https://doi.org/10.1097/AAP.0000000000000673
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97:534-40. https://doi.org/10.1213/01.ANE.0000068822.10113.9E
Xu J, Chen XM, Ma CK, Wang XR. Peripheral nerve blocks for postoperative pain after major knee surgery. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD010937. DOI: 10.1002/14651858.CD010937 https://doi.org/10.1002/14651858.CD010937
Barrington JW, Halaszynski TM, Sinatra RS. Perioperative painmanagement in hip and knee replacement surgery. Am J Orthop (Belle Mead NJ). 2014;43 4 Suppl: S1-16.4
Sanchez Freytes S. Técnicas de anestesia regional para analgesia postoperatoria en la cirugía de reemplazo total de rodilla. Artículo de revisión Rev Argent Anestesiol. 2016;74(2):57-63 https://doi.org/10.1016/j.raa.2016.09.003
Kohan, Dennis R Kerr and Lawrence. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery. A case study of 325 patients. Acta Orthopaedica, 2008, Vol. 79. 174-183. https://doi.org/10.1080/17453670710014950
L. Ø. Andersen and H. Kehlet. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review British Journal of Anaesthesia 113 (3): 360-74 (2014). https://doi.org/10.1093/bja/aeu155
ShuYa Mei S, Jin S, Chen Z, Ding X, Zhao X, Li Q. Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block. Clinics. 2015;70(9):648653 https://doi.org/10.6061/clinics/2015(09)09
Affas F, Nygards EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia. Acta Orthop. 2011 Aug;82(4):441-7. https://doi.org/10.3109/17453674.2011.581264
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; 111:1552-1554 https://doi.org/10.1213/ANE.0b013e3181fb9507
J. J. Paauwe, B. J. Thomassen, J. Weterings, E. van Rossum and M. E. Ausems. Femoral nerve block using ropivacaine 0.025%, 0.05% and 0.1%: effects on the rehabilitation programme following total knee arthroplasty: a pilot study. Anaesthesia, 2008, 63, pages 948-953 https://doi.org/10.1111/j.1365-2044.2008.05538.x
Wan Yi Wong, Siska Bjørn. Defining the Location of the Adductor Canal Using Ultrasound. Reg Anesth Pain Med 2017;42: 241-245 https://doi.org/10.1097/AAP.0000000000000539
Adam W. Meier, David B. Auyong, Stanley C. Yuan, Shin-E Lin, James M. Flaherty, and Neil A. Hanson. Comparison of Continuous Proximal Versus Distal Adductor Canal Blocks for Total Knee Arthroplasty. Reg Anesth Pain Med 2018;43: 36-42 https://doi.org/10.1097/AAP.0000000000000692
Joseph M. Neal. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine. Regional Anesthesia and Pain Medicine: Volume 40, Number 5, SeptemberOctober 2015. https://doi.org/10.1097/AAP.0000000000000286
Thobhani S, Thomas L, Osteen K, et al. Effectiveness of Local Anesthetic Infiltration between Popliteal Artery and Capsule of Knee (iPACK) for Attenuation of Knee Pain in Patients Undergoing Total Knee Arthroplasty (Abstract 165). Presented at the 40th Annual Regional Anesthesiology and Acute Pain Medicine Meeting (ASRA), May 14-16, 2015, in Las Vegas, Nevada.
James E. Paul, Aman Arya, Lindsay Hurlburt, Ji Cheng, Lehana Thabane. Femoral Nerve Block Improves Analgesia Outcomes after Total Knee Arthroplasty. Anesthesiology 2010; 113:1144 - 62 https://doi.org/10.1097/ALN.0b013e3181f4b18
L. Ø. Andersen and H. Kehlet. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. British Journal of Anaesthesia 113 (3): 360-74 (2014) https://doi.org/10.1093/bja/aeu155
Sandra L. Kopp, Jens Børglum, Asokumar Buvanendran, Terese T. Horlocker, Brian M. Ilfeld, Stavros G. Memtsoudis, Joseph M. Neal, Narinder Rawal and Jessica T. Wegener. Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty An Evidence-Based Review by the American and European Societies of Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med 2017;42: 683-697). https://doi.org/10.1097/AAP.0000000000000673
