Contrastive Analysis Of The Efficacy Of Different Analgesic Methods After Total Knee Arthroplasty

Objective:To compare the clinical effects of four different multimodal analgesia in total knee arthroplasty.Methods:Between march 2017 and November 2017,120 severe osteoarthritis patients who met inclusion criteria were treated,and randomly divided into 4 groups(n=30),4 groups were all treated with preoperative preemptive analgesia and injection with mixed analgesics around the knee joint in the operation.Control group(group A,n=30)received analgesia by patient-controlled intravenous analgesia pump(PCIA)after the operation,Research group B(n=30)received continuous femoral nerve block(CFNB),group C(n=30)received continuous adductor canal nerve block(CACNB),group D(n=30)received continuous sciatic-femoral nerves block(CSFNB).Rest and active VAS scores were recorded at preoperation and at 12 h,24h,48 h,72h,1 week,2 weeks,4 weeks after operation,and the knee joint mobility and the American Hospital for Special Surgery(HSS)score at preoperation and at 1,2,4 weeks after operation,and perioperative complications occurrence.Results:(1)comparison of static VAS scores after operation in four groups of patients: 12 h,24h,48 h,72h,group B,group C,and group D were all less than group A,and P<0.05,which was statistically significant.In group B and group C,there was no significant difference in the scores at each stage of postoperative resting state,and no statistically significant difference was found in,P> 0.05.In group D,postoperative 12 h,24h,48 h and 72 h resting VAS score were lower than the other three groups,P<0.05,which was statistically significant.1,2,4 weeks after surgery,the resting VAS scores of group A,group B,group C and group D were compared,and P > 0.05,the difference was not statistically significant.(2)patients after the operation,four group active VAS score comparison: after 12 h,24 h,48 h,72 h,four groups of patients were compared with A,B,C,D group activities VAS scores are less than that in group A(P < 0.05,statistically significant;In group B and group C,there was no significant difference in the scores at each stage of postoperative activity,and no statistically significant difference was found in,P > 0.05.In group D,postoperative 12 h,24h,48 h and 72 h activities VAS score were lower than the other three groups,P<0.05,which was statistically significant.1,2,4 weeks after surgery,group A,group B,group C and group D were compared in the activity VAS score,and P >0.05,the difference was not statistically significant.(3)single factor analysis of variance was used.In the first four groups of patients,ROM was compared,and P>0.05 was not statistically significant.Using paired t test,the knee motion of the four groups decreased gradually over time.Four groups of patients with range of motion 1,2,3 days after surgery and postoperative 1,2,4 weeks respectively,1,2,3 days postoperatively,group B and group C and group D motion in are better than that of group A,P < 0.05,with statistical significance.The ROM of group B,group C and group D showed no significant difference between 1,2 and 3 days after surgery,and P > 0.05,was not statistically significant.There was no significant difference between the four groups in 1,2 and 4 weeks after surgery,and P > 0.05,was not statistically significant.(4)the HSS scores of the four groups before the operation were compared with each other,and the differences were not statistically significant(P>0.05).Postoperative 3 days,1,2 weeks,group B,group C,and group D were all higher than group A,and P<0.05,which was statistically significant,B,C,D group of HSS score is no significant difference,P > 0.05,no statistical significance;4 weeks after surgery,there was no significant difference in HSS scores between the four groups in the fourth week after the operation,and P > 0.05,was not considered statistically significant.(5)there were 1 and 2 cases of skin itching in group A and group B,and the incidence rate was 3.3% and 3.37% respectively,and no skin itching occurred in group C and D.However,there was no statistically significant differencebetween the groups(P> 0.05).The incidence of headache in group B and group D was 3.33%.No headache occurred in group A and group C,but there was no statistically significant difference between the groups(P > 0.05).The incision location of the four groups was completely healed in the first stage,with no symptoms of necrosis,infection and other complications.Conclusion:Preemptive analgesia combined with multimodal analgesia can achieve satisfactory analgesia after total knee arthroplasty.Injection with mixed analgesics around the knee joint combined with postoperative FNB,ACNB and SFNB achieves better analgesic effects than injection with mixed analgesics around the knee joint combined with patient-controlled intravenous analgesia pump.Analgesic drugs have fewer side effects and patients are more satisfied.FNB connection SFNB can obviously optimize the early pain after operation,and then help the early joint function training,and can also help the patients recover their health at an early date.The mechanism of multimodal analgesia is still the trend of this kind of research.