The Research On Thepostoperative Rehabilitation Of Continuous Ultrasound-guided Saphenous Nerve Block For Postoperative Analgesia Of Total Knee Arthroplasty

Purpose: The aim of this study was to investigate the postoperative rehabilitation of continuous ultrasound-guided saphenous nerve block compared with continuous femoral nerve block for total knee arthroplasty.Methods: 50 patients undergoing unilateral total knee arthroplasty with spinal anesthesia in our hospital were selected(ASA,Ⅰ-Ⅲ;weight,50-80kg;age 50-70 years).All patients were divided randomly into two groups: continuous saphenous nerve block group(S,n=25);continuous femoral nerve block group(F,n=25).Peripheral vein was opened for sodium potassium and glucose injection at 8-10ml/kg after entering operation room.The infusion speed was maintained at 5-10ml/kg/h according to the blood loss and the operation time.Ultrasound-guided saphenous nerve and femoral nerve catheter was performed respectively in S group and in Fgroup after spinal anesthesia.Ropivacaine hydrochloride 2ml + 0.9%NS 1ml was used in spinal anesthesia and the puncture space was L3-4.Alcohol swab was used to examine the anesthetic effect and the anesthesia level should be controlled below T8.Peripheral nerve catheter was connected with the disposable portable infusion system 20 min before the end of the surgery.Infusion pump included 1% ropivacaine hydrochloride 40 ml,hexadecadrol 5mg and 0.9%NS 120 ml for 48 hours.Local anesthetic drugs were reconfigured as above after 48 hours(background dose-rate 3ml/h;patient-controlled dose 4ml/h;lock time intervals 15min).Opioid dose,sleep interruption times,resting and exercise VAS,quadriceps muscle power,assay of knee joint motion using CPM,walking distance,IL-6 level,Blood glucose and C reactive protein in plasma and postoperative complications were compared between two groups.Results: The demographic characteristics including age,weight,sex,operative time,preoperative quadriceps muscle power,preoperative IL-6 level and C reactive protein in plasma and hospital stays were not different between two groups(P>0.05).There was no significant difference in opioid dose in postoperative 24 h,sleep interruption times in postoperative 48 h and resting and exercise VAS between two groups(P>0.05).The quadriceps muscle power,assay of knee joint motion using CPM,walking distance,IL-6 level,Blood glucose and C reactive protein in plasma in postoperative 4-72 h were higher in S group than that in F group(P<0.05).Conclusions: The continuous ultrasound-guided saphenous nerve block is more favourable to TKA patients,which makes quadriceps muscle more powerful.The continuous ultrasound-guided saphenous nerve block can make ambulation time earlier,reduce stress response,shorten rehabilitation process,improve self-care ability,increase confidence and make patients recovered quickly.