| Objective:To observe the analgesic effect of ropivacaine combined with dexmedetomidine in ultrasound-guided adductor canal block(ACB)optimized total knee arthroplasty(TKA),and to compare with femoral nerve block(FNB).Methods:From August 2020 to January 2021,Sixty patients who were scheduled to undergo TKA were selected,aged 55～75 years old,gender not limited,ASA grade II～III,BMI of 18～30kg/m~2.There were divided into three groups(n=20)using a random number table method:ropivacaine for femoral nerve block group(Group F),ropivacaine for adductor canal block group(Group A)and ropivacaine combined with dexmedetomidine for adductor canal block group(Group AD).The patients in Group F were given 0.375%ropivacaine(20 ml)for FNB;the patients in Group A were given 0.375%ropivacaine(20 ml)for ACB;the patients in Group AD were given 0.375%ropivacaine+0.75μg/kg dexmedetomidine(a total volume of 20 ml)for ACB.All nerve blocks were performed before general anesthesia induction.Before the operation to close the joint cavity,the surgeon performed a cocktail(75mg ropivacaine+5 mg dexamethasone+0.25 mg epinephrine+saline to 50 ml)of periarticular local infiltration anesthesia(PLIA)at the posterior capsule of the knee,the medial and lateral head of the gastrocnemius muscle,and the end of the medial and lateral collateral ligament.After the operation,the patients were sent to the anesthesia recovery room,and connection of patient-controlled intravenous analgesia(PCIA),PCIA formula including1.5μg/kg sufentanil+1.2 mg remosetron hydrochloride+saline to 100 ml,the load is 2 ml,the background dose is 2 ml/h,the automatic additive dose is0.5ml,the locking time is 15 minute.The day after the patients were sent back to the ward,celecoxib is taken orally at 200 mg daily.If the patient has postoperative pain,analgesic pump self-controlled additional dose effect is not good,and when the rest VAS score is greater than 4,oxycodone hydrochloride tablets 5 mg orally.The observation indexes include:preoperative quadriceps muscle strength,tourniquet time,operation time;the rest VAS and movement VAS scores of 2 h,6 h,24 h and 48 h after the operation,quadriceps muscle strength,Ramsay sedation score were recorded;the number of effective analgesic pump pressings and the amount of remedial analgesics were recorded within 48 h after the operation;the time of first straight leg raising after the operation,the time of first out-of-bed activity after the operation,and the condition of deep vein thrombosis of lower extremity at 72 h were recorded.Results:1.There was no significant difference in age,sex,ASA grade,BMI,preoperative quadriceps muscle strength,tourniquet time and operation time between the three groups(P>0.05).2.The median rest VAS score of the three groups at the time of 2 h、6h、24 h、48 h after the operation was 0、0、2、and 1,respectively,and there was no significant difference between the three groups(P>0.05).The median score of movement VAS at time of 2 h、6 h after the operation was 0.The score of 24 h movement VAS(the median is 4)in Group AD was significantly lower than that in Group F(the median is 5)and Group A(the median is 5)(P<0.05).The postoperative 48 h movement VAS score(the median is 3)in the Group AD was lower than that in the Group F(the median is 4)and the Group A(the median is 4),but the difference was not statistically significant(P>0.05).3.The quadriceps muscle strength in Group A and Group AD was higher than that in Group F(P<0.05),but there was no significant difference between Group AD and Group A(P>0.05).4.The scores of Ramsay in Group AD at the time of 2 h,6 h after the operation were higher than those in the Group F(the median of the two time point is 3 and 2,respectively)and the Group A(the median is 3 and 2,respectively),the difference was statistically significant(P<0.05).5.There was no significant difference in the number of the effective times of analgesia pump pressings and the use of remedial analgesics within48 h after the operation between the three groups(P>0.05).6.The time of first straight leg raising and the time of first out-of-bed activity after the operation in Group A were 2.1±0.7 h and 3.9±1.0 h,respectively;Group AD were 2.0±0.6 h and 4.3±1.0 h,significantly shorter than Group F(21.7±8.7 h and 13.3±7.6 h)(P<0.05),There was no significant difference between Group AD and Group A(P>0.05).7.Deep venous thrombosis of lower extremity was observed in 5 cases of Group AD,5 cases of Group A and 8 cases of Group F at 72 h after the operation,and there was no significant difference between the three groups(P>0.05).Conclusion:Adductor canal block with ropivacaine and 0.75μg/kg dexmedetomidine can optimize the analgesic effect of total knee arthroplasty.Compared with femoral nerve block,it better retained quadriceps muscle strength in the early period of postoperation,which is beneficial to exercise in the early postoperative stage. |
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