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Influence of pain relief management on early patents rehabilitation after total hip replacement

Vitaliy Kolomachenko

Abstract


Adequate pain relief after total hip replacement can promote to decrease chronic pain, to improve muscles function and to increase joints movements.

Objective: to compare different methods of pain management with scores of pain reduction and physical activity after total hip replacement.

Methods: 150 patients were included into the study, patients average age (63,3 ± 12,5) years old after total hip replacement. 4 methods of anesthesia were used: general (group G , n = 25), paravertebral block in combination with caudal epidural anesthesia (group PVE, n = 25), spinal anesthesia (group S , n = 75), pe­ripheral nerve blocks (group NB = 25). After surgery patients got a nesthesia: systemic opiods (group O , n = 75), paravertebral block (group PV, n = 50), epidural anesthesia (group E, n = 25). We estimated the time which was needed to get the next three criteria: adequate pain relief (pain intensity less than 4 according to VAS), without injections of opoids more than during 12 hours, ability to walk distance of 30 m.

Results: patients from the group G took much more time (61,2 ± 23,5) hours to get three criteria after surgery comare with group PVE — (40,8 ± 17,1) hours, р = 0.0009; S — ( 48,6 ± 19,3) hours, р = 0.009; NB — (47,6 ± 15,1) hours, р = 0,02. In the group PVE we have got the best recovery result after operation. Patients of the group PV have to take significantly less time to get three criteria after surgery (38,4 ± 14,8) hours compare with group O — (56,2 ± 20,6) hours, p = 0.000001; E — (50.0 ± 17.4) hours, р = 0.003.

Conclusions: prolong paravertebral anesthesia can improve postoperative course and provide better conditions for physical patient’s recovery after total hip replacement.


Keywords


hip replacement; anesthesia; analgesia; rehabilitation

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DOI: https://doi.org/10.15674/0030-59872018153-58

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