Normal view MARC view ISBD view

174 Postoperative pain-management strategiesand its complications in mega prosthesis totalknee replacement in onco-surgery: compar-ison of epidural analgesia and opioid-basedintravenous patient-controlled analgesia.

In Anaesthesia.
By: Solanki S.
Contributor(s): Katwale B.
Material type: materialTypeLabelArticlePublisher: 2018Description: .Subject(s): Pain management | Knee replacement | Analgesia In: Anaesthesia Vol.73., no.S4., p.98Summary: MethodsOnco-surgical procedures on the lower limb, such as total knee replacement(TKR) with mega-prosthesis, is associated with moderate (30%) to severe pain(60%). It hinders early intense physical therapy, the most influential factor forgood postoperative knee rehabilitation [1, 2]. Also, resection of large section ofbone, along with soft tissues, for these procedures may injure nerves and causemotor weakness. In a retrospective study, data were collected from electronicrecords in patients who underwent TKR surgery and received epidural analgesiaor intravenous (i.v.) patient-controlled analgesia (PCA) with opioids as analgesicmodality. Sixty-eight patients were divided accordingly into an epidural groupand an i.v. PCA group. Average and maximum pain scores in both groups werecompared on day 1 and day 3, and complications, including unilateral and bilat-eral motor weakness, were noted.ResultsThe average pain score on day 1 was significantly higher in the i.v. PCA group(p=0.001), but on day 2 and day 3 there was no significant difference. The max-imum pain score was higher in the i.v. PCA group on day 1 and day 2, but nosignificant difference was noted on day 3. A total of 21.9% in the epidural grouphad motor weakness vs. none in the i.v. PCA group. However, 7.4% were occa-sionally drowsy in the i.v. PCA group.DiscussionBoth epidural with local anaesthetics and i.v. PCA with opioids were effective inrelieving postoperative pain, but the local anaesthetic epidural technique pro-vided better pain relief than i.v. PCA with opioids after total knee arthroplasty incancer surgery. Motor weakness was significantly more common in epiduralgroup. Onco-surgical procedures on the lower limb, such as TKR, are associatedwith moderate to severe pain. Under-treatment of acute postoperative pain canlead to chronic pain with neuronal plasticity and result in poor surgical out-comes, such as prolonged immobilisation, delayed functional recovery and pro-longed hospital stay. The cumulative prevalence of peroneal nerve palsyfollowing total knee reconstruction is 0.6%, as reported in the literature [3].
Tags from this library: No tags from this library for this title. Add tag(s)
Log in to add tags.
    average rating: 0.0 (0 votes)
Item type Current location Call number Status Date due Barcode
Articles Articles Tata Memorial Hospital
Available AR19264

Abstract presented in the Annual Congress 2018, 26‐28 September 2018, Dublin, Ireland

MethodsOnco-surgical procedures on the lower limb, such as total knee replacement(TKR) with mega-prosthesis, is associated with moderate (30%) to severe pain(60%). It hinders early intense physical therapy, the most influential factor forgood postoperative knee rehabilitation [1, 2]. Also, resection of large section ofbone, along with soft tissues, for these procedures may injure nerves and causemotor weakness. In a retrospective study, data were collected from electronicrecords in patients who underwent TKR surgery and received epidural analgesiaor intravenous (i.v.) patient-controlled analgesia (PCA) with opioids as analgesicmodality. Sixty-eight patients were divided accordingly into an epidural groupand an i.v. PCA group. Average and maximum pain scores in both groups werecompared on day 1 and day 3, and complications, including unilateral and bilat-eral motor weakness, were noted.ResultsThe average pain score on day 1 was significantly higher in the i.v. PCA group(p=0.001), but on day 2 and day 3 there was no significant difference. The max-imum pain score was higher in the i.v. PCA group on day 1 and day 2, but nosignificant difference was noted on day 3. A total of 21.9% in the epidural grouphad motor weakness vs. none in the i.v. PCA group. However, 7.4% were occa-sionally drowsy in the i.v. PCA group.DiscussionBoth epidural with local anaesthetics and i.v. PCA with opioids were effective inrelieving postoperative pain, but the local anaesthetic epidural technique pro-vided better pain relief than i.v. PCA with opioids after total knee arthroplasty incancer surgery. Motor weakness was significantly more common in epiduralgroup. Onco-surgical procedures on the lower limb, such as TKR, are associatedwith moderate to severe pain. Under-treatment of acute postoperative pain canlead to chronic pain with neuronal plasticity and result in poor surgical out-comes, such as prolonged immobilisation, delayed functional recovery and pro-longed hospital stay. The cumulative prevalence of peroneal nerve palsyfollowing total knee reconstruction is 0.6%, as reported in the literature [3].

There are no comments for this item.

Log in to your account to post a comment.

Powered by Koha