Effects of different analgesia methods on early mobilization after knee join replacements

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Abstract


Rationale. Knee join replacement is accompanied by intensive pain syndrome. Prolonged blocks of branches of sciatic and femoral nerves are the most effective. Apart from sensory block and analgesia some types of blocks cause motor block of lower extremities, particularly quadriceps muscle of thigh which may prevent patients’ mobilization. In this connection, the choice of anesthesia strategy is significant concerning the use of prolonged blocks of the branches of sciatic and femoral nerves maintaining the motor function of the lower extremities with adequate analgesia.

The goal of the study is to select a method of pain relief after knee replacement that provides adequate analgesia while maintaining the motor function of the lower limb muscles.

Material and methods. The investigation was carried out in patients undergone knee join replacement according to standard procedure. The operation was performed under combined anaesthesia: spinal anaesthesia plus prolonged block of tibial nerve and femoral nerve or femoral triangle block with perineural space catheterization. The block with the use of local anesthetic in the analgesic concentration for postoperative analgesia during 3 postoperative days. All participants were divided into four groups according to the combinations of the blocks.

Results. The combination of block of branches of sciatic and femoral nervessignificantly improves the quality of postoperative analgesia on the first postoperative day. The block in femoral triangle (subsartorial) in comparison with the block of femoral nerve is accompanied by significantly less weakness of quadriceps muscle of thigh at the equal analgesic potency.

Conclusions. Maintaining the motor function of quadriceps muscle of thigh with the use of the prolonged block in femoral triangle for analgesia can be of certain advantage for patients’ mobilization in the early postoperative period (fast track).


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About the authors

Dmitry V. Morozov

N.N. Burdenko Voronezh State Medical University, 394036, Voronezh, Russian Federation; Voronezh Regional Clinical Hospital No1

Author for correspondence.
Email: dmorozov62@yandex.ru
ORCID iD: 0000-0002-8604-9707

Russian Federation, Voronezh

M.D., associate Professor of anesthesiology and reanimation Department, N. N. Burdenko Voronezh State Medical University, head of the Department of anesthesiology and intensive care No2 of the Voronezh regional clinical hospital No1

I. V. Boronina

N.N. Burdenko Voronezh State Medical University

Email: dmorozov62@yandex.ru
ORCID iD: 0000-0003-2266-3297

Russian Federation, Voronezh

A. A. Ryabtseva

2Voronezh Regional Clinical Hospital No1, 394066, Voronezh

Email: dmorozov62@yandex.ru
ORCID iD: 0000-0002-3771-693X

Russian Federation, Voronezh

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Supplementary files

Supplementary Files Action
1.
Fig. 1. The charts of average values of parameters in groups

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2.
Fig. 2. Evaluation of muscle strength on the manual muscle testing grading scale 8 hours after surgery

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