RESUMEN
STUDY OBJECTIVE: Total knee arthroplasty (TKA) is associated with significant pain post-operatively. Our hypothesis is that adductor canal block (ACB) would be superior to local infiltration analgesia (LIA) in terms of providing analgesia, while still preserving quadriceps strength and enabling early postoperative rehabilitation. DESIGN: A prospective, blinded and randomized clinical trial between LIA and ACB was conducted. SETTING: Tertiary care urban hospital. PATIENTS: 40 patients (ASA I to III) undergoing primary TKA under single-dose spinal anesthesia were prospectively randomized from January 2014 to October 2015. INTERVENTIONS: The LIA group received local infiltration of Ropivacaine 150â¯mg, Ketorolac 30â¯mg, Morphine 10â¯mg, and Adrenaline 200â¯mcg in a total volume of 75â¯mls, administered intraoperatively by the surgeon. The ACB group was given an ACB postoperatively by one of the study investigators at the end of surgery with 30â¯mls of 0.5% Ropivacaine. MEASUREMENTS: The primary outcome was total Morphine consumption in the first 24â¯h. Secondary outcomes included total Morphine consumption in the first 48â¯h, pain scores, quadriceps strength, the Timed Up and Go test (TUG), the 30â¯s Chair Stand Test (30s-CST) and length of hospital stay. MAIN RESULTS: The median (interquartile range) 24â¯h Morphine consumption was 6â¯mg (2.3-18.3) in the ACB group and 17.5â¯mg (12-24.3) in the LIA group, pâ¯=â¯0.004. The 48â¯h Morphine consumption was 14.5â¯mg (7.5-28.5) in the ACB group as compared to 24â¯mg (14-33.8) in the LIA group, pâ¯=â¯0.03. There were no statistically significant differences in the other secondary outcomes. CONCLUSION: ACB group had statistically significant reduced total Morphine consumption in the first 24 and 48â¯hours as compared to LIA group, with no statistically significant differences in functional outcomes of TKA patients.
Asunto(s)
Analgesia/métodos , Anestésicos Locales/administración & dosificación , Artroplastia de Reemplazo de Rodilla/efectos adversos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/terapia , Anciano , Analgésicos Opioides/administración & dosificación , Anestesia Raquidea/métodos , Femenino , Humanos , Ketorolaco/administración & dosificación , Masculino , Persona de Mediana Edad , Morfina/administración & dosificación , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Estudios Prospectivos , Ropivacaína/administración & dosificación , Resultado del TratamientoRESUMEN
PURPOSE: The Supreme laryngeal mask airway (SLMA) is a new single-use advanced form of the Proseal laryngeal mask airway (PLMA). This study tested the hypothesis that the SLMA is equally as effective as the PLMA as a supraglottic ventilatory device in anesthetized paralyzed adult patients. METHODS: Size 4 SLMAs and PLMAs were compared in a randomized crossover study involving 60 patients aged 21-75 yr and American Society of Anesthesiologists physical status I and II. Once the patients were anesthetized and paralyzed, the SLMA and the PLMA were inserted into each patient in random order. The primary outcome measure was the laryngeal seal pressure (LSP) at an intracuff pressure of 60 cm H(2)O. Secondary outcome measures included the ease of inserting the laryngeal mask airway devices (LMADs) and the fibreoptic position of the airway tube. RESULTS: There was no statistically significant difference in LSP between the SLMA and the PLMA. The mean LSP was 19.6 +/- 5.8 cm H(2)O and 20.9 +/- 6.7 cm H(2)O for the SLMA and the PLMA, respectively. There was a similarity between the SLMA and the PLMA regarding the number of attempts required and the duration for insertion. However, fibreoptic positioning was better with the PLMA than with the SLMA (P < 0.0001). CONCLUSION: The clinical performance of the SLMA as a ventilatory device is comparable with that of the PLMA, as illustrated by the similar LSPs. The inferior position of the SLMA airway tube compared with that of the PLMA does not affect its ease of ventilation.