Study The Effect Of Ultrasound-guided Adductor-canal-blockade On Post-operative Pain After Total Knee Arthroplasty

Objective:To observe the effect of ultrasound-guided adductor-canal-blockade on postoperative pain in patients undergoing total knee arthroplasty?TKA?,and to investigate the effectiveness and feasibility.Methods:In this prospective,randomized,controlled study,Forty patients scheduled for elective TKA were randomly divided into 2 groups?n=20 each?using a random number table:ACB plus PCIA group?group A?and PCIA group?group P?.Both two groups received general anesthesia and group A received ultrasound-guided ACB?0.5% Ropivacaine 20mL?after surgery before recovery and the patients in group P were given the PCIA alone.Measured the value of blood glucose,the plasma concentrations of epinephrine?E?,norepinephrine?NE?and dopamine?DA?at the time before anesthesia?T1?,the middle of surgery?T₂?,surgery completion?T₃?,24h?T₄?after surgery in both groups.The analgesic effect was measured by Visual analogue scale?VAS?pain scores at1h?POH1?,2h?POH₂?,4h?POH₄?,6h?POH₆?,8h?POH₈?and 24?POH₂4?on the rest and 45-degree flexion of the knee in both groups,and Ramsay scores,side effect of PCIA were also recorded.Results: The value of blood glucose at T₄ was significantly higher than that at T1,T₂,T₃?P<0.05?in two groups;the value of blood glucose at T₄ in group A was significantly lower than that in group P?P=0.001?.The concentration of E at T₂,T₃ were significantly lower than those at T1,T₄?P<0.05?in two groups;the concentration of E at at T₄ in group A was significantly lower than that in group P?P=0.029?.The concentration of NE at T₄ were significantly higher than those at T1,T₂,T₃?P<0.05?in two groups;the concentration of NE at T₄ in group A was significantly lower than that in group P?P<0.001?.The concentration of DA at T₄ were significantly higher than those at T1,T₂,T₃?P<0.05?in group P;the concentration of DA at T₄ in group A was significantly lower than that in group P?P=0.004?.The VAS scores at POH1 in group A at rest was significantly lower than that in group P?P <0.05?,there is significant difference between two groups?P<0.05?.The VAS scores at POH₂,POH₄,POH₆ in group A was lower than those in group P,higher at POH₈,POH₂4,but no significant difference between two groups?P>0.05?.The VAS scores at POH1,POH₂,POH₄,POH₆,POH₈ of flexion time point in group A was significantly lower than those in group P,there is significant difference between two groups?P<0.05?,which is higher than that in group P at POH₂4,but no significant difference between two groups?P>0.05?.There was no significant difference between two groups at all time points on Ramsay scores?P>0.05?.The amounts of nausea and PCIA in group A was lower than that in group P?P<0.05?,but no significant difference about vomiting?P>0.05?.Conclusion: ACB showed promising results regarding the analgesic efficacy in postoperative pain treatment after TKA,decreasing stress reaction and opioid analgesics consumption and related side combined with PCIA.