Uvod: Totalna artroplastika kolena (eng. Total Knee Arthroplasty, TKA) je standardna ortopedska procedura koja poboljšava kvalitet života i smanjuje bol. Praćena je intenzivnim bolom, posebno u prva 24h posle operacije i tokom izvođenja aktivnih pokreta. Različite strategije postoperativne kontrole bola deo su multimodalnog koncepta analgezije u cilju obezbeđivanja adekvatne analgezije u odsustvu mišićne slabosti i sprečavanja pojave hroničnog bola. Hronični posthirurški bol (eng. Chronic Post-Surgical Pain, CPSP) posle TKA ima do 44% bolesnika, od kojih 15% ima bol visokog intenziteta koji utiče na kvalitet života, pojavu nezadovoljstva i predstavlja jedan od razloga za revizionu hirurgiju. Metod: Ova studija je imala za cilj da proceni efekat primene aduktor kanal bloka i IPACK bloka (eng. Infiltration in the space between the Popliteal Artery and the Capsule of posterior Knee)(blok vs. bez bloka) na potrošnju opioida, intenzitet postoperativnog bola kao i pojavu CPSP dve godine nakon TKA. Rezultati: Dve godine nakon operacije analizirano je 166 bolesnika (82 vs. 84). Intenzitet bola je bio manji u grupi sa blokovima tokom mirovanja i aktivnosti, kao i potrošnja opioidnih analgetika (9,74 ± 3,87 mg vs. 30,63 ± 11,52 mg) (p < 0,001). Viši KOOS (eng.Knee injury and Osteoarthritis Outcome Score) je bio 6, 12 i 24 meseca posle operacije u grupi sa blokovima. Grupe su se statistički značajno razlikovale i u vrednostima FJS (eng.Forgotten Joint Score) dve godine nakon operacije (92,52% naspram 78,72%, p < 0,001). CPSP je bio prisutan kod 20,24% bolesnika u grupi bez bloka i 6,1% bolesnika sa blokovima (p = 0, 011). Prediktor varijable za pojavu CPSP bile su: preoperativni intenzitet bola (granična vrednost 5,5), bol u mirovanju (granična vrednost od 2,35), bol tokom aktivnosti (granična vrednost: 2,5) i potrošnja opioida (granična vrednost: 8 mg). Zaključak: Blokovi perifernih nerava obezbeđuju adekvatnu analgeziju, značajno smanjuju potrošnju opioida, poboljšavaju funkcionalne ishode i smanjuju CPSP dve godine nakon TKA. Introduction: Total knee arthroplasty (TKA) is a standard orthopedic procedure that improves life quality and reduces pain. It is associated with significant pain, especially within the first 24 hours postoperatively and during active movements. Different pain management strategies are suggested as a part of a multimodal analgesia regimen to prevent the occurrence of chronic pain and provide adequate analgesia without inducing muscle weakness. Chronic post-surgical pain (CPSP) after TKA was experienced in up to 44% of patients, and 15% were in severe pain, affecting the quality of life, causing dissatisfaction, and becoming one of the reasons for revision surgery. Methods: This study aimed to assess adductor canal block and IPACK block (blocks vs. no blocks) on opioid consumption, postoperative pain score, the functional oucomes, and chronic post-surgical pain two years after TKA. Results: 166 patients (82 vs. 84) were analyzed two years after surgery. Pain intensity was less in the group with blocks in the rest and during activity, as well as opioid consumption (9.74 ± 3.87 mg vs. 30.63 ± 11.52 mg) (p < 0.001). HigherKnee injury and Osteoarthritis Outcome Score6, 12, and 24 months after surgery were in the group with blocks. A statistically significant difference between groups was in Forgotten Joint Score two years after surgery (92.52% vs 78.72%, p < 0. 001). CPSP was present in 20.24% of patients in the group without blocks and 6.1% of patients with blocks (p = 0.011). Predictor variables of CPSP included pain before surgery (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off: 2.5), and opioid consumption (cut-off: 8 mg). Conclusion: Peripheral nerve blocks provide adequate analgesia, significantly decrease opioid consumption, improve functional outcomes, and reduce CPSP two years after surgery. Medicina - Rekonstruktivna hirurgija / Medicine- Reconstructive surgery Datum odbrane: 01.07.2024. srp 112 str. 3385638 bytes Efekti primene perifernih nervnih blokova kolena na postoperativnu kontrolu bola i funkcionalne rezultate nakon ugradnje totalne proteze kolena : doktorska disertacija Kadija, Marko, 1961- Lađević, Nebojša, 1965- Tulić, Goran, 1963- Palibrk, Ivan, 1964- Janković, Radmilo, 1973- info:eu-repo/semantics/bachelorThesis OSNO - Opšta sistematizacija naučnih oblasti, Plastična i rekonstruktivna hirurgija OSNO - Opšta sistematizacija naučnih oblasti, Plastična i rekonstruktivna hirurgija periferni nervni blokovi, totalna proteza kolena, postoperativna analgezija, hronični posthirurški bol, aduktor kanal blok, IPACK blok peripheral nerve block, knee arthroplasty, postoperative analgesia, chronic pain, adductor canal block, IPACK block 617.583-089.168(043.3) http://creativecommons.org/licenses/by-nc-nd/3.0/at/legalcode 2024 https://phaidrabg.bg.ac.rs/o:39103 cobiss:193959433 thesis:10387 Srećković, Svetlana, 1978-