This journal is
indexed in Scopus
Year 2020 Vol. 28 No 1
K.B. BALABOSHKA, YU.K. KHADZKOU, K.M. KUBRAKOV, Z.N. ABDULINA
EFFICACY OF INTEGRATED APPROACH TO TOTAL KNEE REPLACEMENT PERIOPERATIVE MANAGEMENT
Vitebsk State Medical University, Vitebsk,
The Republic of Belarus
Objective. To improve the results of total knee replacement by creating conditions for the early active rehabilitation of a patient on the basis of the integrated approach to reduce perioperative blood loss and pain intensity.
Methods. A prospective, comparative clinical study was conducted involving 100 patients with the knee osteoarthritis of the 3rd stage who had undergone primary total knee replacement. Monolateral spinal anesthesia, preemptive analgesia, combined administration of aminocaproic acid and local infiltration analgesia considering the anatomy of the main neural structures were used in the treatment of patients of the study group (n=50). In the control group (n=50) surgeries were performed using spinal anesthesia, without the use of preemptive analgesia, inhibitors of fibrinolysis and local infiltration analgesia. The volume of perioperative blood loss, hematological parameters (hemoglobin, erythrocytes, hematocrit), frequency of transfusion of donor blood components, pain syndrome, functional result were evaluated.
Results. The total volume of the perioperative blood loss in patients of the control group was 1425 (911; 1762) ml and was significantly higher (p<0.01) than in the study group 943 (758; 1135) ml, which required transfusion of donor blood components to 11 patients of the control group. The average value of erythrocytes, hemoglobin and hematocrit in the postoperative period in patients of the study group was significantly higher than in the control group (p<0,01). The intensity of pain syndrome was significantly lower in patients of the study group both at rest and with movements in the knee joint (p<0,01). We observed statistically significantly better functional result in patients of the study group (p<0,01).
Conclusions. The integrated approach to perioperative management of knee replacement allows reducing the volume of total blood loss, eliminating the need for donor blood transfusion, reducing the intensity of pain syndrome, which creates favorable conditions for patient’s early active rehabilitation, improves the functional result and reduces economic costs.
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210009, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Traumatology, Orthopedics
And Military Field Surgery.
Tel. office: +375(212)574084,
Kanstantsin B. Balaboshka
Balaboshka Kanstantsin B., PhD, Associate Professor, Head of the Department of Traumatology, Orthopedics and Military Field Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Khadzkou Yauheni K., Assistant of the Department of Traumatology, Orthopedics and Military Field Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Kubrakov Konstantsin M., PhD, Associate Professor of the Neurology and Neurosurgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Abdulina Ziamfira N., Assistant of the Department of Anesthesiology and Intensive Care with the Course of the Faculty of Advanced Training and Retraining, Vitebsk State Medical University, Vitebsk, Republic of Belarus.