| Objective:Knee osteoarthritis is a degenerative pathological changes in the basis of disease which may cause joint deformity and even disability.It is generally accepted that knee osteoarthritis and persistent severe pain are the main indications for total knee arthroplasty.It can effectively eradicate late knee-joint pain and greatly improve the quality of life for patients.This study intends to combine the femoral nerve block combined with "cocktail" periaticular analgesia in patients undergoing total knee arthroplasty,to observe the effects of multimodal analgesia on postoperative analgesia,and early rehabilitation process postoperatively,to explore the clinical significance of multimodal analgesia in total knee arthroplasty accelerated rehabilitation surgeries,and to provide a theoretical basis for the promotion of multimodal analgesia.Methods:One hundred and fifty patients from the first affiliated hospital of University of Science and Technology of China were selected into the study.Inclusion criterias:unilateral total knee arthroplasty;aged between 50 to 80 years old;BMI < 30;ASA grade I-III.Exclusion criterias: multiple chronic diseases;severe heart,liver and kidney dysfunction;local anesthetic allergy;with extra-articular pain;previous or recent history of opioids use;infection around the puncture point;blood coagulation disorder;neuromuscular injury;morbidly obese(BMI >40kg/m2);knee revision.All patients were randomly divided into three groups(n=50): femoral nerve block combined with "cocktail" periaticular analgesia group(group M),femoral nerve block group(group F)and control group(group C).In group M,femoral nerve was blocked 30 minutes before operation,periarticular infiltration analgesia were performed before knee prosthesis implantation and patient controlled intravenous analgesia was received.In Group F,femoral nerve was blocked 30 minutes before operation and patient controlled intravenous analgesia was received.Group P just received patient controlled intravenous analgesia.Before operation,immediately after intubation of endotracheal tube,1 hour after the start of operation,the end of operation,time of extubation of endotracheal tube and 30 min after endotracheal tube was removed,mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(Sp O2)and EEG monitoring(Narcotrend)were recorded.Before operation,on postoperative days 1?2 and 3,the day of discharge and 1 month after opration,VAS scores in resting and with movement,active and positive knee range of motion(ROM),morphine dosage on postoperative day 1 and 2 after operation,hospitalization time after the surgery,HSS scores and complications were measured.Resullts:Compared with the group C,MAP and HR decreased at the time of extubation and 30 minutes after operation;VAS scores at rest and with movement were decreased on postoperative day 1;active and passive knee range of motion was increased at each corresponding time after operation;rescue analgesic dosage was reduced on postoperative day 1 and 2;the incidence of postoperative nausea and vomiting,drowsiness and retention of urine was diminised;HSS scores was increased;hospitalization time was shortened postoperatively;medical expense was decreased in group M and group F(P < 0.05).Compared with group F,MAP and HR decreased at the time of extubation and 30 minutes after operation;VAS scores at rest and during movement were decreased on postoperative day 1 and 2;active and passive knee range of motion was increased at each corresponding time postoperatively;rescue analgesic dosage was reduced on postoperative day 1 and 2;HSS scores was increased;hospitalization time was shortened after the surgery in group M(P < 0.05).There were no significantly differences in MAP,HR,Sp O2 and Narcotrend values between the three groups during the surgery(P<0.05).Conclusion:In combination with femoral nerve block and "cocktail" periarticular analgesia for patients undergoing total knee arthroplasty can effectively keep the circulation system stable during the operation,relieve postoperative pain,improve knee range of motion,reduce postoperative complications,shorten length of hospital stay and accelerate the process of rehabilitation. |
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