Effects Of Different Analgesic Methods On Pain And Early Rehabilitation After Total Knee Arthroplasty

Objective To compare the effects of three different analgesic methods on pain and early rehabilitation after total knee arthroplasty.Methods Among the patients hospitalized in our hospital from September 2016 to September 2017,75 patients who would undergo unilateral total knee arthroplasty were enrolled in this study.In term of postoperative analgesia,75 patients were randomly divided into three groups,including the continuous adductor canal block combined with periarticular local infiltration analgesia(the CA+P group),continuous femoral nerve block combined with periarticular local infiltration analgesia(the CF+P group),continuous epidural analgesia group(the CE group).All patients received TKA under combined spinal and epidural anesthesia.Patients in CA + P,CF + P group were treated with infiltration of 50 m L 0.2% ropivacaine for soft tissue around the knee during operation,underwent ultrasound-guided adductor canal block and femoral nerve block respectively after operation,while patients in CE group were applied to epidural postoperative analgesia.These 75 patients were followed up.The pain visual analogue scale(VAS)score and quadriceps muscle strength were recorded before operation and 6,12,24,48 and 72 hours after operation.The maximal active flexion angle of knee joint(o)were calculated in postoperative 1,2,3 days.The dosage of analgesic analgesics and adverse reactions were compared among the three groups.Results 1.Compared with the CA + P group,there was no significant difference in resting and moving VAS of the CF + P group(P >0.05).The resting VAS of the CE group was similar with the CA + P group(P >0.05),While the moving VAS was statistically higher than the CA + P group at 24,48 and 72 hours postoperatively(P <0.05).2.Compared with the CA + P group,the strength of quadriceps femoris of the CF+P group and the E group statistically decreased at postoperative 6,12 and 24 hours(P <0.05)while there was no difference at postoperative 48,72 hours(P >0.05).3.Compared with the CA + P group,the flexion angle of knee joint was significantly decreased in the CF+P group and the E group at 1,2 and 3 days(P <0.05).4.Postoperative Dizocine remedy was performed in 8 patients in the CA+P group with an average drug dose of(1.8±2.84 mg);12 patients in the CF+P group with an average drug dose of(3.13±3.55 mg);18 patients in the CE group with an average drug dose of(7.39±4.23 mg).Compared with the CA+P group,there was no statistical difference in the use of Dizocine of the CF+P group(P >0.05).However,the dose of Dizocine was increased in the CE group and the difference was statistically significant(P <0.05).5.Compared with the CA+P group,the incidence of postoperative lower limb weakness was significantly increased in the CF+P group(P <0.05),but the complications of itching and urinary retention were not statistically significant(P >0.05).The incidence of itching,lower limb weakness,and urinary retention in the CE group were increased,and the difference was statistically significant(P < 0.05).NO postoperative complications such as nausea and vomiting,local anesthetic poisoning,and hypoxia occurred in all three groups.Conclusion Compared with the analgesic methods of continuous epidural analgesia and continuous femoral nerve block combined with periarticular local infiltration analgesia,continuous adductor canal block combined with periarticular local infiltration analgesia is more effective and has little impact of quadriceps muscle strength as well as less adverse reactions,which can help the patients to perform functional exercises better and contribute to the early rehabilitation after TKA.