Perbandingan Adductor Canal Block dan Femoral Nerve Block dengan Kekuatan Otot Kuadrisep Femoris Pascaoperasi Total Knee Replacement

Eva Srigita Tari, Iwan Fuadi, M Andy Prihartono

Abstract


Abstrak

 

Blokade saraf femoral telah digunakan terlebih dahulu dalam penatalaksanaan nyeri pascaoperasi total knee replacement (TKR). Penelitian ini bertujuan mengetahui perbedaan kekuatan otot paha pascaoperasi TKR antara femoral nerve block (FNB) dan adductor canal block ACB dengan mengukur nilai manual muscle test (MMT), selain itu penelitian ini membandingkan nilai numeric rating scale (NRS) dengan total kebutuhan patient controlled anlagesia (PCA) morfin yang digunakan pascaoperasi TKR. Penelitian dilakukan pada periode Oktober–November 2020 di RS Santosa Bandung. Penelitian ini menggunakan metode uji klinis acak terkontrol buta tunggal melibatkan 18 pasien yang menjalani operasi TKR. Pasien dibagi menjadi dua kelompok, kelompok kelompok ACB, n=9 dan kelompok FNB, n=9. Pemeriksaan MMT otot kuadrisep femoris dilakukan pada jam ke-24 pascaoperasi TKR. Analisis data numerik dengan uji T tidak berpasangan dan Mann Whitney. Data kategorik dengan uji chi square. Nilai NRS ACB lebih tinggi pada jam ke- 24 saat diam dan bergerak serta total kebutuhan PCA morfin lebih tinggi pada kelompok ACB, namun tidak bermakna secara statistik (p>0,05). Nilai MMT pascaoperasi TKR pada jam ke-24 pada kelompok ACB lebih tinggi dibanding dengan kelompok FNB dengan perbedaan bermakna (p<0,05). Adductor canal block sebagai modalitas penatalaksanaaan nyeri pascaoperasi total knee replacement memberikan efek analgetik yang tidak berbeda dengan femoral nerve block, namun lebih baik memulihkan kekuatan motorik otot kuadrisep femoris yang dibuktikan  dengan penilaian MMT yang lebih baik.

 

Comparison of Adductor Canal Block and Femoral Nerve Block with Quadriceps Femoris Muscle Strength PostoperativeTotal Knee Replacement

 Femoral nerve blocks (FNB) were previously used in pain management post-total knee replacement (TKR). This study aimed to determine the differences in thigh muscle strength post-TKR surgery between patients with FNB and adductor canal block (ACB) by measuring manual muscle tests (MMT). In addition to MMT scores, this study also compared the NRS scores and total patient-controlled analgesia (PCA) of morphine required post-TKR surgery. The study was conducted in October-November 2020 at Santosa Hospital, Bandung. The study was a controlled, randomized, blinded study of 18 patients who underwent TKR surgery. Patients were divided into two groups, one ACB group, n=9, and one FNB recipient group, FNB n=9. Next, an MMT examination of the quadriceps femoris muscle was performed 24 hours post-TKR surgery. Numerical data were analyzed using the unpaired T-test and Mann-Whitney test. Categorical data using chi-square test. MMT measurements in the ACB group were higher than in the FNB group at 24 hours (p), whereas NRS scores in the ACB group were higher at 24 hours when idle and with movement. The total PCA morphine required was higher in the ACB group but was not statistically significant. MMT examination in postoperative TKR patients was better in ACB patients compared to FNB patients. Adductor canal block as a postoperative pain modality in total knee replacement procedure provides a similar analgesic effect as a femoral nerve block. However, it is better in restoring motor strength of the quadriceps femoris muscle, as evidenced by a better assessment of MMT.


Keywords


Adductor canal block, blokade saraf femoral, kekuatan otot paha, manual muscle test, total knee replacement

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References


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DOI: https://doi.org/10.15851/jap.v10n2.2428

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