American Journal of Drug Delivery and Therapeutics Offener Zugang

Abstrakt

Lokale Infiltrationsanästhesie (LIA) und neuartige Technik zur wirksamen Schmerzlinderung nach elektivem primären Hüft- und Knieersatz – innovative Studie

Mohammed Salhab

Hintergrund: 

Die akute Schmerzkontrolle nach elektiven, notwendigen Kniegelenkersatzoperationen (TKR) und Hüftgelenkersatzoperationen (THR) ist häufig schlecht und mit chronischen Schmerzzuständen auf lange Sicht verbunden. In den ersten 48 Stunden nach der Operation treten häufig mäßige bis starke Schmerzen auf, die verschiedene Schmerzbehandlungsmethoden erfordern, wie z. B. chronische kontrollierte Schmerzfreiheit und multimodale Schmerzfreiheit. Die Methode der lokalen Infiltrationsanästhesie (LIA) ist derzeit eine etablierte Methode zur perioperativen Schmerzlinderung; Studien haben jedoch bisher widersprüchliche Beweise geliefert. In einer aktuellen Studie von 29 Studien zur Verwendung von LIA bei TKR erwies sich LIA als sichere Methode mit verbesserter Schmerzkontrolle (Gibbs DMR 2012). Wir haben die LIA-Methode so entwickelt, dass sie einen intraartikulären Katheter umfasst, der eine Infusion einer neuartigen Mischung (NM) ermöglicht, die postoperativ dauerhaft gemischt werden kann. Präventive Schmerzfreiheit, eine antinozizeptive Behandlung, ist die Behandlung, die vor der Operation begonnen wird, um die durch Schnittwunden und brennende Wunden während der Operation hervorgerufene Schmerzverstärkung zu verhindern. Neben der Behandlung vor der Operation kann präventive Schmerzfreiheit auch in der frühen postoperativen Phase eingesetzt werden. Diese schützende Wirkung wird durch präventive Schmerzfreiheit auf das nozizeptive System erzielt. Um das Schmerzempfinden zu unterdrücken, wurden in der Literatur mehrere Methoden beschrieben, darunter Medikamente und Behandlungen.

Joint substitution medical procedures are considered as one of the most excruciating orthopedic techniques. This excruciating method is the aftereffect of lacking and inadequately rewarded postoperative torment after significant joint substitution medical procedure. This agony scene must be ideal tended to in light of the fact that not exclusively does this fundamentally drag out the restoration procedure, yet in addition purposes the expanded danger of different inconveniences. If not tended to inside time or without legitimate methodology, these postoperative excruciating scenes can advance into constant torment, which in the long run drags out the general length of hospitalization and cost. The excursion to accomplish the total and long haul help with discomfort starts before the medical procedure is performed. A significant premise to accomplish long haul help with discomfort and practical recuperation after the joint medical procedure includes adequate peri-employable absense of pain. One of the significant angles to accomplish effective result after joint medical procedure is the early joint preparation with the commencement of non-intrusive treatment. A few new medications and novel procedures to enhance the post-employable agony post-medical procedure are being presented each year, yet the greater part of the patients despite everything wind up experiencing extraordinary torment following medical procedure which frequently advances into constant torment.

Arthroscopic knee medical procedure has gotten progressively well known in present day orthopedics. In any case, the post-employable knee torment the board including early help and agony free postoperative consideration to the patient stays a test to a few clinicians. Now and again, torment the board in itself has become a need for the board as a childcare methodology. Tenacious agony after knee arthoplasty stays an uncertain issue for some patients. Torment is considered as an exceptionally emotional occasion since everybody has an alternate recognition and edge of agony. What's more, hence, it turns out to be hard to normalize any agony system for a specific medical procedure. A few factors that cause knee torment, which incorporate aggravation of free sensitive spots of the joint case, synovial tissue, front fat cushion.

The point of neighborhood penetration is to anesthetize sensitive spots in a limited territory of tissue by the infusion of neighborhood sedatives close by. This stands as opposed to fringe nerve obstructs, in which nerve axons are the objective and the infusion may occur in a region expelled from the careful site (eg, brachial plexus hinder for hand medical procedure). The profundity of the region to be worked on commonly decides the necessary degree of invasion. For shallow skin methods, for example, stitching of slashes and skin biopsies, subcutaneous or intradermal penetration is adequate. Increasingly broad tasks may request invasion into muscle, belt, and other profound tissues. Two general methodologies exist for anesthetizing skin and subcutaneous tissue. The first includes infusing neighborhood sedative legitimately into the line of cut and close by tissues, successfully flooding the individual nearby sensitive spots to deliver sedation. This can be exceptionally successful, yet may require huge volumes of neighborhood sedative to accomplish total inclusion.

Aims and Objectives:

In this study we find out the results on our experience using LIA in addition to the Novel Techniques and Proprietary NM developed in Leeds-Bradford and infiltrated at 4-5 mls/hour for 48 hours post surgery.

Materials and Methods:

Between October 2013 and October 2015, 62 patients undergoing primary TKR were prospectively followed up. Three groups of patients were studied. All patients studied had spinal anaesthesia (SA) with 300-400mcg diamorphine.

Group 1.  GA. No LIA and no NM. 20 patients.

Group 2.   SA plus NM for 48 hours post operatively with catheter placed anteriorly under the patella.  21 patients.

Group 3.  SA plus LIA plus NM for 48 hours post operatively with catheter placed posteriorly in the knee joint.  21 patients.

Between June 2011 and July 2014, 173 consecutive patients undergoing primary THR using the posterior approach were also prospectively followed up.

Results and complications: 

The patients without LIA or NM required more morphine in the initial 12 hours postoperative period than different gatherings. 70% (n=14) of these gathering 1 patients required 10mg morphine following TKR contrasted with just 2% (n=1) of patients requiring 10mg of morphine when LIA and NM were utilized. The expanded morphine necessity proceeded for 48 hours postoperatively in bunch 1, while none of the patients in bunches 2 or 3 required morphine following 36 hours. Factual investigation uncovered no distinction of morphine necessities with various catheter situation. Less patients experienced sickness and heaving or urinary maintenance in the gathering with LIA and NM (p-esteem <0.05, Mann-Whitney test). There were no contaminations DVT or different difficulties in any of the gatherings.

Conclusion:

Diese Untersuchung zeigt, dass Patienten, die nach einer TKR 48 Stunden lang mit LIA und NM behandelt wurden, in dieser Zeit wesentlich weniger Morphin benötigten. Dieser Vorteil wurde im Allgemeinen in den ersten 24 Stunden nach der Operation festgestellt und blieb 48 Stunden lang bestehen. Im Vergleich zu anderen Gruppen benötigten weniger Patienten eine sedierende Schmerzlinderung, wenn LIA zusätzlich zu NM verwendet wurde. Die höchste Zentralität lag bei 0-12 Stunden für Patienten, die bis zu 20 mg Morphin benötigten (χ2(2) = 46,713, p = 0,000); und bei 0-12 Stunden für Patienten, die 30 mg Morphin benötigten (χ2(2) = 46,310, p = 0,000).