The effect of 3-in-1 femoral nerve block with ropivacaine 0.375% on postoperative morphine consumption in elderly patients after total knee replacement surgery.

Ortopedik cerrahi operasyonlar› icinde en ar›l› prosedurlerden biri total diz protezi (TDP) operasyonlar›d›r. Cal›flmam›zda, TDP operasyonlar›nda , 40 ml % 0.375 ropivakain ile uygulanan preoperatif 3'e1 femoral sinir blounun (FSB), postoperatif hasta kontrollu analjezi (HKA) yontemi ile uygulanan morfin tuketimine etkisini araflt›rmak amaclanm›flt›r. Ayn› zamanda, bloun yan etki insidans›na etkisi de incelenmifltir. Cal›flmaya 34 hasta dahil edilerek , grup R'ye (n=17), 40 ml, % 0.375 ropivakain ile preoperatif donemde 3'e1 FSB uygulanm›flt›r. Grup S'ye (n=17), blok uygulanmay›p, operasyon bitiminden 30 dk once 2 mg morfin yukleme dozu olarak verilmifltir. Her iki gruba genel anestezi verilmifl ve postoperatif donemde HKA uygulanm›flt›r. Hastalar›n VAS skalalar›, total morfin tuketimi ve yan etkileri not edilmifltir. Her gruptan 2 hasta cal›flma d›fl› b›rak›lm›flt›r. Cal›flmam›zda postoperatif 0,1,2,3,4,6,8 saatlerde takip edilen VAS skorlar› blok uygulanan grupta anlaml› olarak dufluk bulunmufltur (p<0.05). Grup R uyanma odas›nda ve postoperatif 8 saat boyunca hic ar› tan›mlamazken, grup S VAS≤3 duzeyine postoper- atif 1. saatte ulaflabilmifltir. Morfin ihtiyac›, grup R de 12., 18., 24., 48. postoperatif saatlerde anlaml› olarak dufluk bulunmufltur (p<0.001). Yan etki insidans› da grup R de daha dufluk olarak tespit edilmifltir. TDP ameliyat› gecirecek olan yafll› hastalarda, 40 ml % 0.375 ropivakain ile uygulanan preoperatif 3'e1 FSB daha etkili analjezi, daha dufluk morfin tuketimi ve daha az yan etkiye sebep olmufltur. Anahtar kelimeler: Postoperatif analjezi, ucu bir arada femoral sinir blou, ropivakain SUMMARY Total knee replacement (TKR) is one of the most painful orthopedic surgical procedures. This study was aimed to investigate the effect of a single-shot preoperative 3-in-1 femoral nerve block on postoperative pain by using 0.375 % ropivacaine, and on the consumption of morphine by using PCA following the TKR surgery. Side effects were also evaluated in this setting. 34 patients were included in this study. Group R (n=17) received a 3-in-1 femoral nerve block (FNB) with 40 mll of ropivacaine 0.375 %. Group S (n=17) received only a 2 mg loading dose of morphine 30 minutes before the end of surgery, and no block was performed. Both groups received general anesthesia and post- operatively had a PCA pump programmed to deliver morphine. VAS scores at rest, morphine consumption and adverse effects were recorded. Two patients were excluded from each group. Pain scores at 0, 1, 2, 3, 4, 6, 8 postop- erative hours were significantly lower in group R in resting position (p<0.05). Group R experienced no pain at the recovery room and this state lasted 8 hours after the surgery while group S reached the acceptable score (VAS ≤ 3) one hour after leaving the recovery room. The morphine requirement was significantly lower in Group R at 12, 18, 24, 48 hr after TKR (p<0.001). Side effects were also lower in this group. Preoperative single-shot 3-in-1 FNB with 40 cc of ropivacaine 0.375 % provides better VAS scores, less morphine consumption and fewer side effects in elderly patients when compared to the group with no block.