Diz Protezi Yapılan Bir Olguda Adduktor Kanal Bloğu ile Postoperatif Analjezi Yönetimi
Özet
Total diz protezi (DP) ameliyatları son dönem osteoartrit gibi problemleri olan hastalara uygulanan, ortopedi pratiğinde de yaygın olarak yapılan ameliyatlardandır (1-3). Yapılış yöntemlerinde ve perioperatif dönemde hasta takibinde kaydedilen bütün gelişmelere rağmen, hastaların yaklaşık %20’sinde operasyon sonrasında memnuniyetsizlik gözlenmektedir ve bu açıdan ele alındığında ağrı anahtar rol oynayan faktörlerdendir (4).
Genellikle DP vakalarında postoperatif dönemde hayat kalitesini bozan, orta dereceden şiddetli dereceye kadar ağrılar görülmektedir (1). Bu durum da klinisyenleri postoperatif dönem ağrıları açısından daha etkili yöntemler geliştirmeye yöneltmiştir. Bu yöntemler arasında, oral ve intravenöz (iv) medikal tedavilerin yanında, epidural analjezi (EA), femoral sinir bloğu (FSB), siyatik sinir bloğu (SSB), lokal infiltratif analjezi (LİA), adduktor kanal bloğu (AKB) gibi yöntemler sayılabilir (1,5,6).
Bu olguda hastanemizde yapılan bir DP vakası sunulması amaçlanmıştır. Hastamıza, preoperatif dönemde rutin muayeneden ve tahlillerden geçirildikten sonra, nümerik derecelendirme ölçeği (numerical rating scale, NRS) skorlaması öğretildi. Ayrıca spinal anestezi ve AKB hakkında kapsamlı bilgilendirme yapıldı ve hastanın onamları alındı. Operasyon günü ameliyathaneye alınan hastaya spinal anestezi uygulandı ve sonrasında postoperatif dönemde hastaya AKB uygulandı. Peroperatif takibi sonrasında herhangi bir problem yaşamayan hasta servise gönderildi.
Total knee arthroplasty (TKA) is a commonly performed procedure in orthopedic practice, applied to patients with problems such as end-stage osteoarthritis (1-3). Despite all the advancements recorded in surgical techniques and perioperative patient follow-up, dissatisfaction is observed in approximately 20% of patients after the operation, and pain is one of the key factors in this regard (4). Moderate to severe pain that impairs the quality of life in the postoperative period is generally observed in TKA cases (1). This situation has led clinicians to develop more effective methods for managing postoperative pain. Among these methods, in addition to oral and intravenous (IV) medical treatments, techniques such as epidural analgesia (EA), femoral nerve block (FNB), sciatic nerve block (SNB), local infiltrative analgesia (LIA), and adductor canal block (ACB) can be listed (1,5,6). This case report aims to present a TKA case performed at our hospital. After undergoing routine preoperative examination and laboratory tests, our patient was taught the numerical rating scale (NRS) scoring system. Furthermore, comprehensive information regarding spinal anesthesia and ACB was provided, and the patient's informed consent was obtained. On the day of the operation, spinal anesthesia was administered to the patient in the operating room, followed by the performance of an ACB for the postoperative period. The patient, who experienced no problems during perioperative follow-up, was transferred to the ward.
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