The comparison of postoperative analgesic methods in patients undergoing total knee arthroplasty

Total joint arthroplasty is one of the most successful surgical procedures. Management of pain following total joint arthroplasty is an important aspect of this procedure. Adequate pain control allows faster rehabilitation and reduces the risk of postoperative complications. 26 patients aged between 18 ? 85 scheduled for elective TKA(total knee arthroplasty) were included in this study after the approval by the local ethic board. The study was conducted prospectively between May 2011 and December 2011. The patients were divided into two groups. In FB group, femoral block before awakining and IV PCA(pacient controlled analgesia) postoperatively were applied. In group PCA, only postoperative PCA was administered. Two patients in group FB were taken to intensive care unit due to intraoperative instability and were excluded from the study. PCA continued 24 hours postoperatively. VAS scores during resting were recorded in 4 hours intervals. Hemodynamic and demographic variables were similar. Operation day and postoperative first day VAS scores were lower in Group FB. We determined the first pain time to be 24th hour in Group FB and 18th hour in Group PCA. Although the first pain times were different in two groups, paracetamol doses used as additional analgesic were alike (Group FB: 0,59 gr, Group PCA: 0,76 gr). Morphine consumption were 26 mg in Group FB and 30 mg in Group PCA and was significantly lower in Group FB. Neurological complications due to femoral block were not seen. 2 of 11 patients in Group FB had vomiting and 1 one 13 patients in Group PCA had nausea and except these, no complications were seen. In our study, femoral nerve blocking and IV PCA methods used as postoperative analgesia in patients undergoing total knee arthroplasty were compared. As morphine consumption and VAS scores on operation and postoperative first day were lower, it can be concluded that femoral blocking is an effective, safe and easily practised method for analgesia in patients undergoing total knee arthroplasty.