A Comparative Study On The Effect Of Injection Of "Cocktail" Into Different Parts Of TKA On Postoper Ative Effect

Background:At present,total knee arthroplasty(TKA)is the most common and successful surgical technique for the treatment of advanced knee disease.because of its complex process and greater injury during the operation,patients will have severe pain after operation.In recent years,the application of "cocktail" therapy in TKA has been gradually regarded as an ideal choice for analgesia,but the effect of injection of "cocktail" on the efficacy of different parts of the operation is not clear.Objective:The purpose of this study was to explore the effect of different injection sites of cocktail on the efficacy and safety of TKA.Methods:A total of 90 patients who underwent the first unilateral TKA because of KOA in the Department of Articular surgery of the second affiliated Hospital of Inner Mongolia Medical University from May 2021 to January 2022 were randomly divided into three groups with 30 patients in each group.All the patients in the three groups were diluted with the same dose of mixed analgesics(ropivacaine hydrochloride injection 10 ml and compound betamethasone injection 1ml)and injected around the joint.The difference was that the anterior part of the knee joint was injected in group A(including quadriceps femoris,start and stop point of medial collateral ligament of knee joint,start and stop point of lateral collateral ligament of knee joint,infrapatellar fat pad,patellar tendon and goose foot),group B was injected into the posterior joint capsule of knee joint(medial and lateral side of posterior condyle of femur),and group C was injected into both anterior and posterior parts of knee joint.The visual analogue scale(VAS)of dynamic and static pain at 24 hours,48 hours,72 hours,4 days and 5 days after operation,the maximum flexion of knee joint at 48 hours and 72 hours after operation,the use of rescue analgesia measures(ketorolac tromethamine 30 mg intramuscular injection)within 5 days and the occurrence of postoperative complications were measured and collected,and the collected data were statistically analyzed.Results:There were significant differences in static VAS scores at 24 hours,48 hours and 72 hours after operation among the three groups,with the highest score in group B,the second in group A and the lowest in group C.There were significant differences in dynamic VAS scores at 24 hours,48 hours and 72 hours after operation among the three groups.The results also showed that group B had the highest score,group A had the second score,and group C had the lowest score.There was no significant difference in static and dynamic VAS scores at 4 and 5 days after operation among the three groups.There was no significant difference in the maximum flexion of knee joint between the three groups at 48 h and 72 h after operation(P >0.05).There was no significant difference in the frequency of using analgesic needle within 5 days after operation among the three groups(P > 0.05).There were no complications such as neurovascular injury,poor wound healing,deep infection and pulmonary embolism in the three groups.Conclusion:In TKA,compared with the “cocktail”injection of the anterior part of the knee joint or the posterior part of the knee joint,the combined“cocktail”infiltration injection of the anterior and posterior part of the knee joint can achieve better analgesic effect after operation,and does not increase the incidence of complications such as neurovascular injury and poor wound healing.