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Efecto analgésico de la anestesia local en la artroplastia total de rodilla: protocolo de un ensayo clínico
Weilong Diwu1, Wenhao Tang1, Ming Yan1
1Department of Orthopedics, Xijing Hospital of Air Force Medical University, Xi'an, Shaanxi, China.
International journal of surgery protocols
|August 27, 2025
Resumen
Este estudio muestra que una nueva estrategia de control del dolor que combina bloqueos nerviosos con una inyección de acción prolongada mejora significativamente el alivio del dolor y la función después de la cirugía de reemplazo de rodilla. Este enfoque ofrece una mejor alternativa a los métodos actuales para controlar el dolor postoperatorio.
Área de la Ciencia:
- Cirugía ortopédica
- Anestesiología
- Tratamiento del dolor
Sus antecedentes:
- El dolor postoperatorio después de la artroplastia total de rodilla (TKA) afecta la recuperación funcional.
- La analgesia de infiltración local convencional (LIA) tiene limitaciones que incluyen corta duración y toxicidad potencial.
- Se propone una estrategia de doble optimización para mejorar el manejo del dolor TKA.
Objetivo del estudio:
- Evaluar una estrategia de doble optimización para el manejo del dolor TKA.
- Comparar un nuevo enfoque que combina el bloqueo del nervio cutáneo periarticular (PCN) con una formulación de liberación sostenida con las técnicas estándar.
- Abordar las limitaciones de las actuales ACV, incluida la duración y los riesgos sistémicos.
Principales métodos:
- Un ensayo controlado aleatorio factorial 2x2 en un solo centro con asesor ciego en el que participaron 120 pacientes con TKA.
- Se compararon cuatro brazos de intervención: el iPACK convencional con formulación nueva/estándar y el bloque PCN con formulación nueva/estándar.
- Los resultados primarios incluyeron la intensidad del dolor (VAS), el consumo de opiáceos y la recuperación funcional (flexión, prueba TUG).
Principales resultados:
- El bloqueo de la PCN guiado por mapeo anatómico con la formulación de triamcinolona-ropivacaína mejoró significativamente la analgesia postoperatoria.
- Se observaron mejores resultados funcionales en comparación con las técnicas convencionales de LIA.
- La estrategia de doble optimización demostró un control superior del dolor y las métricas de recuperación.
Conclusiones:
- El bloqueo de la PCN guiado por mapeo anatómico con una formulación de liberación sostenida de triamcinolona-ropivacaína es eficaz para el tratamiento del dolor por TKA.
- Esta estrategia de doble optimización ofrece una mejora significativa con respecto a la LIA convencional.
- Este enfoque puede establecer nuevos estándares para la infiltración periarticular en TKA, especialmente para pacientes de alto riesgo.
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