Comparative Study Of Different Analgesia After Total Knee Arthroplasty

ObjectiveTo compare the analgesic effect, the early recovery of knee joint function,the incidence of adverse reactions among three different methods includingpatient-controlled intravenous analgesia, continuous ultrasound-guidedfemoral nerve block and intra-articular injection cocktail recipes mixed liquidanalgesia after total knee arthroplasty. It is helpful for finding an analgesicmethod which is safe, effective and beneficial for the early recovery of kneejoint function.MethodsSixty-three ASA(American Society of Anesthesiologists, ASA) I-IIIpatients undergoing total knee arthroplasty were selected and randomlydivided into three groups: PCIA group (patient-controlled intravenousanalgesia, n=21), fentanyl0.05mg of a loading dose, background infusion2ml/h, each2ml of the PCA, lockout time10min，analgesia lasted for48h;CFNA (continuous femoral nerve block, n=21), after anesthesia intubation,using the ultrasound to position and catheter, and then pushing0.375%ropivacaine as the loading dose, connecting the PCA pump, the backgrounddose of4.5ml/h, each4ml of the PCA, lockout time60min, continuous48h; CRMA group (cocktail recipes mixed liquid analgesia, n=21), when theartificial joint were placed well, injecting “cocktails”(0.75%ropivacaine50ml+morphine5mg+Kaifen50mg+adrenaline0.5mg+dexamethasone5mg) around them, indwelling catheter, and then pushing a mixed liquid(Kaifen50mg+0.75%ropivacaine20ml) at the24-th hour after operation.Genernal anesthesia was performed in all patients. Pain was assessed using avisual analogue scale(VAS) in postoperative0h，6h,12h,24h,48h while atrest or active and passive activities, and sedation scores, the grading of musclestrength, the angle while active bending knee and the time of the firstambulation, the range of knee motion two weeks after the operation, theadverse reactions and complications, the satisfaction degree of patients werealso recorded. We used the Stata12.0as data analysis statistics software, and aP value﹤0.05was considered significant.ResultsThe VAS pain scores during rest at the instant,6h,12h,24h and48h afterthe TKA in PCIA group were significantly higher than those in CFNA groupand CRMA group, there was significant difference（P﹤0.05）. The VAS painscores during rest at the instant,6h,12h,24h and48h after the TKA had nosignificant difference between CFNA group and CRMA group(P﹥0.05).There was significant difference among the three groups about the VAS painscores during active and passive exercise at the instant,6h,12h,24h and48hafter the TKA.The scores in PCIA group were significantly higher than thosein CFNA group and CRMA group（P﹤0.05）. There was no significant difference between CFNA group and CRMA group about the VAS pain scoresduring active and passive exercise at the instant,6h and24h after the TKA(P﹥0.05), but there was significant difference at12h and48h after the TKA（P﹤0.05）. The scores of sedative effect among the three group had nosignificant difference on the instant,6h,12h,24h,48h after TKA (P﹥0.05).There was no significant difference among three groups on the instant,6h,12h,24h,48h after TKA about the level of limb quadriceps strength (P﹥0.05). The knee flexion angles in PCIA group during the immediatepostoperative period,6h,12h,24h,48h were obviously less than that inCFNA group and CRMA group when the pain caused by action was notsevere（P﹤0.05）. There was no significant difference between CFNA groupand CRMA group about the knee flexion angles at the immediatepostoperative period,6h,24h(P﹥0.05), but on12h and48h after operation,the knee flexion angles in CFNA group were lager than CRMA group（P﹤0.05）. Patients in PCIA group needed significant more time for firstambulation than that in CFNA group and CRMA group, but there was nosignificant difference between CFNA group and CRMA group. Two weeksafter operation, the knee flexion angles in PCIA group were significantsmaller than that in CFNA group and CRMA group（P﹤0.05），but thedifferences between CFNA group and CRMA group were not so significant(P﹥0.05). There were more adverse reactions in PCIA group than that in CFNAgroup and CRMAgroup（P﹤0.05）, but there was no significant differencebetween CFNA group and CRMA group about adverse reactions. PCIA group showed less satisfaction with their method of analgesia than CFNA group andCRMA group（P﹤0.05）, but there was no significant difference betweenCFNAgroup and CRMAgroup.ConclusionThe effect of analgesia in CFNA group and CRMA group was better thanPCIA group in patients after TKA. The early recovery of knee joint functionin CFNA group and CRMA group was also better than that in PCIA group.CFNAgroup has an advantage in persistent analgesia than CRMAgroup.