| Objective To investigate the effect of mufti-mode analgesia on the recovery of joint function,aerodynamics and cognitive function in patients undergoing knee arthroplasty with continuous femoral nerve block combined with lacal anesthesia and paroxepin sodium preemptive analgesiaMethods Two hundreds cases of patients with knee arthroplasty were selected from October2014 to October 2016 and randomly divided into five groups by the envelope method:simple femoral nerve block analgesia group,femoral nerve block with local anesthesia group,femoral nerve block with local anesthesia and vein Continuous administration of Parecoxib sodium group(mufti-mode group),intravenous controlled analgesia group,which group have 50 cases of patients.(1)The mean arterial pressure and heart rate were monitored in the four groups at 30 mins,60 mins after induction of anesthesia,at the end of surgery,extubation and five minutes after extubation and 6h,12 h,24h,48 h and 72 h after the operation respectively.(2)At 6h,12 h,24h,48 h and 72 h after operation,the pain visual analogue scale was used to compare the pain degree among the four groups when resting and exercising.(3)On the second,third,fifth and seventh day after operation,the knee joint angle of the active and passive motion among the four groups were evaluated(4)Before operation and 6 hours after operation,24 h,48h and 72 h after operation,Serum levels of interleukin-6 were measured by enzyme-linked immunosorbent assay(ELISA)and serum levels of C-reactive protein were detected by immunoturbidimetry.(5)The levels of interleukin-6 and tumor necrosis factor-a in the drainage fluid were measured at 12 h,24h and 48 h after operation.(6)The MMSE scale was used to evaluate the cognitive function at 6h,24 h and 72 h after operation,and the MMSE scores were calculated at different time points.The incidence of cognitive impairment,arrhythmia,nausea and vomiting,dizziness,cerebral thrombosis and the amount of sufentanil(ug)in 72 hours after operation were compared between the four groups.(7)Before operation and 24 hours after operation,The left ventricular atresia,left ventricular diastolic fraction,left ventricular diastolic fraction,left ventricular ejection fraction(EF),left ventricular ejection fraction(EF),left ventricular ejection fraction(E peak),mitral valve diastolic peak peak flow velocity(A peak)and E/Ea,E/A ratio were calculated by using GE VIVid color Doppler ultrasound diagnostic apparatus.(8)The level of plasma natriuretic peptide was measured by electrochemiluminescence immunoassay and the level of plasma D-dimer was detected by immunoturbidimetry.The white blood cell count,blood glucose level,neutrophil/lymphocyte ratio,platelet/lymphocyte ratio were compared among the four groupsResults(1)The mean arterial pressure and heart rate fluctuation were not statistically significant at 30 minutes,60 min after operation,at the end of operation,extubation,5min after extubation among the simple femoral nerve block analgesia group,femoral nerve block with local anesthesia group,femoral nerve block with local anesthesia and vein Continuous administration of Parecoxib sodium group(multi-mode group)(P<0.05).Compared with intravenous patient-controlled analgesia group.The mean arterial pressure and heart rate level at the time of extubation,5min after extubation were statistically significant(P< 0.05).At 6h,12 h,24h,48 h and 72 h after operation,the mean arterial pressure and heart rate changes were statistically significant(P<0.05).Among them,the mean arterial pressure and heart rate of the patients in the multi-model group were the most stable,while those of the intravenous patient-controlled analgesia group had a larger fluctuation.Femoral nerve block plus local anesthesia group and the patients with femoral nerve block group had followed.(2)At 6h,12 h,24h,48 h and 72 h after operation,there were significant differences in resting and active VAS scores among the multimodal group,femoral nerve block with local anesthesia group,simple femoral nerve block group and intravenous control group(P<0.05).There was no significant difference on resting VAS score among the multi model group,femoral nerve block and local anesthesia group,simple femoral nerve block group patients(P> 0.05).However,there was significant difference in VAS score when exercising(P < 0.05).(3)On the second,third,fifth and seventh day after operation,There was significant difference in active movement and passive exercise angle among the multi model group,femoral nerve block and local anesthesia group,simple femoral nerve block group,intravenous patient-controlled group.Among them,exercise angle of patients in multi mode group were the best.There was no significant difference among the multi model group,femoral nerve block and local anesthesia group,simple femoral nerve block group when having passive exercise(P>0.05).But there was significant difference in active exercise(P<0.05).(4)Before operation and 6 hours after operation,24 h,48h and 72 h after operation,The levels of serum interleukin-6 and C-reactive protein in the multimodal group were significantly lower than those others.The levels of serum interleukin-6 and C-reactive protein in femoral nerve block and local anesthesia group,simple femoral nerve block group and intravenous control group were gradually increasing.There was a significant difference between every each two groups(P<0.05).There was no significant difference in the levels of serum interleukin-6 and C-reactive protein in patients with femoral nerve block with local anesthesia group and simple femoral nerve block group(P> 0.05). (5)The levels of interleukin-6 and tumor necrosis factor-a in the drainage fluid have significant difference among the four groups at 12 h,24h and 48 h after operation.But the levels of interleukin-6 and tumor necrosis factor-a in the drainage fluid have no significant difference between the multi-model group and femoral nerve block and local anesthesia group.(P>0.05).(6)There were no significant differences in MMSE scores in the multi-model group at 6h,24 h,72h after operation(P>0.05).The MMSE score of femoral nerve block plus local anesthesia group,simple femoral nerve block group and intravenous group gradually decreased at different time points,there were statistically significant difference(P<0.05).There were significant differences in cognitive impairment,arrhythmia,nausea,vomiting,dizziness,cerebral thrombosis and the dosage of sufentanilamong within 72 hours postoperative among the four groups(P<0.05).and the incidence of patients in the intravenous analgesia group was the highest,but that in the multi-model group was the lowest.(7)Before operation and 24 hours after operation,There were no significant difference in left atrial and left ventricular end diastolic diameter and left ventricular wall thickness,end diastolic diameter and left ventricular ejection fraction of left ventricular end diastolic(EF)among the four groups.But the E/Ea ratio of patients in the multi model group,femoral nerve block and local anesthesia group,simple femoral nerve block group,intravenous analgesia group increased,the E/A ratio decreased gradually,the difference between groups was statistically significant(P<0.05).(8)Before operation and 24 hours after operation,the levels of plasma natriuretic peptide,two D-dimer,white blood cell count,blood glucose level,plasma natriuretic peptide,plasma D-dimer,white blood cell count,blood glucose level,neutrophil/lymphocyte ratio,platelet/lymphocyte ratio gradually increased.there had significantly difference among the four groups(P<0.05).Conclusions The multimodal combined analgesia can significantly improve the degree of pain in patients with knee joint arthroplasty,increase the activity degree of the joint of the affected limb,and has less influence on the hemodynamics of the patients after operation.The incidence of cognitive dysfunction,cerebral thrombosis,cardiac dysfunction and other adverse events were decreased.Analysis of the reasons may be related to the multimodal joint analgesia effectively reduce the postoperative pain stimulating response,down regulating the level of inflammatory response to the body. |
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