الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Arthritis and hip joint pathologies can affect a wide range of populations in different ages. Osteoarthritis (OA) is a common and chronic disease of the joints that typically affects elderly and causes pain, deformities and disability. Articular cartilage and underlying bony structures are damaged by the degenerative joint condition osteoarthritis (OA), its multifactorial etiopathogenesis is characterised by subchondral bone remodelling, joint inflammation, osteophyte generation, and progressive loss of articular cartilage.
Multiple regimens of treatment have been tried; the most common strategy used includes NSAIDs, acetaminophen, physical exercise, weight management, and aquatic therapy. When these measures fail and there is no improvement, total hip arthroplasty may be recommended. is generally regarded as one of the best treatment options for OA and physical issues. It enhances the quality of life for the patients.
After total hip arthroplasty, many approaches are described to manage postoperative pain and its sequelae.The recent regional anaesthesia methods following THR focused on more peripheral, motor-sparing nerve blocks to facilitate early ambulation and high quality of pain management.
The aim of this study was to compare the effect of US guided pericapsular nerve group and lateral femoral cutaneous nerve blocks VS nalbuphine on postoperative pain control and analgesic requirments in immediate postoperative period.
The present study was carried out in El-Hadara University Hospitals on 30 adult patients of both sex aged 40-70 years old, evaluated as American Society of Anaesthesiologists (ASA) I, II or III physical status scheduled for THA surgeries divided into two groups by sealed envelope technique(15 patients each):
• group (A) PENG and LFCN blocks: 15 Patients received general anaethesia and ultrasound guided combined PENG and LFCN blocks.
• group (B) with IV analgesics: 15 Patients received general anaethesia with IV analgesics.
- This study was a prospective randomized comparative study.
- The sample size was approved to be sufficient by the Department of Statistics, Medical Research Institute, University of Alexandria.
- All patients were assessed thoroughly by detailed medical and surgical history, full clinical examination, and all routine laboratory investigation. Also patients were informed how to use the VAS score.
- At the operating room anaesthesia technique was explained and intravenous accesses were established and all patients were connected to multichannel monitor.
- All patients were premedicated with midazolam 0.05 mg/kg IV.
- All patients received general anaesthesia,
• group (A): received general anaethesia and ultrasound guided combined PENG (30 ml of bupivacaine 0.25 %) and LFCN (5 ml bupivacaine 0.25%) blocks.
• group (B): received general anaethesia with IV analgesics. All patients of group B received 10 mg nalbuphine IV immediately post-operative in the PACU then rescue analgesia was given according to VAS.
Measurements:
• Demographic data for all patients.
• Vital signs (heart rate – mean arterial blood pressure- oxygen saturation) were recorded preoperatively, after induction, after skin incision, every 20mins till the end of surgery and every 4 hrs after surgery till the end of first day.
• Visual analogue scale (VAS) score was assessed at 1, 2, 3, 4 hrs postoperatively and every 4 hrs during first 24 hrs.
• Total analgesic requirements of nalbuphine received was calculated for each patient during time of study in mg (regardless the basal 10 mg nalbuphine received in the PACU)
• Duration of Analgesia was recorded for each patient during time of study in minutes.
Results:
• No significant difference was recorded as regards the demographic data.
• Regarding vital signs:
Heart rate : comparing between two groups, , there was a significant statistical difference in heart rate throughout intraoperative and postoperative times Mean heart rates were significantly lower in group A compared to group B at 8hrs (p=0.036), 12hrs (p=0.028), 16 hrs(p=0.020), 20 hrs (p=0.001) and 24 hrs(p<0.001).
Mean arterial blood pressure: Comparing the two groups, there was a significant statistical difference in MABP throughout intraoperative and postoperative times. Mean arterial blood pressure were significantly lower in group A compared to group B at 8hrs (p=0.036), 12hrs (p=0.028), 16 hrs(p=0.020), 20 hrs (p=0.001) and 24 hrs(p<0.001).
Oxygen saturation: Comparing the two groups, there was an insignificant statistical difference in oxygen saturation before the block, after administration of the block, throughout intraoperative and postoperative times.
• Regarding postoperative pain management:
Visual analogue pain scale (VAS): Comparing the two groups, there was an insignificant statistical difference in VAS at 1hr (p = 0.150) and 2 hours(p = 0.065) but there was a statistically significant difference in VAS at 3hr(p <0.001) , 4 hr(p <0.001), 8 hr(p <0.001) , 12 hr(p = 0.005) , 16 hr(p = 0.034) , 20(p = 0.011) and 24(p <0.001) between both groups.
Total opioid consumption: Comparing the two groups, there was a statistically significant increase in total analgesic (nalbuphine) doses needed postoperative in group B more than group A (p < 0.001).
Duration of Analgesia: Comparing the two groups, there was significant statistical difference in the duration of analgesia between the two groups. Prolonged duration of analgesia in group A more than group B (p <0.001).