| BackgroundThe pain is the one of the most common symptoms after the knee arthroplasty,and it may cause seriously results.On the one hand,postoperative pain can trigger body stress response,inflammatory factors,and increase the probability of deep venous thrombosis of lower limbs,and the pulmonary embolism,bring physical and psychological injuries of patients;on the other hand,postoperative pain affects rehabilitation exercise and reduces knee joint functional activity.Therefore,postoperative analgesia of the knee is essential.Single drug or analgesia pattern has various problems.Multi-modal analgesia promotes the complementary effect of each drug or method to achieve the purpose of additive or synergistic effect by using different analgesic drugs or analgesic methods with different mechanisms,it can aslo reduce the dosage of each drug,and adverse reactions to achieve the best analgesic effect.At present,there are many ways of applying multi-modal analgesia in orthopedics perioperative period.The multi-modal analgesia based on continuous femoral nerve block has few research,and its effect needs further clinical verification ObjectiveTo analyse the different clinical efficiency with the knee arthroplasty perioperatively between the multi-mode analgesia(Continueous Femoral Nerve Block,CFNB)and the multi-mode analgesia(Patient Control Anaesthesia,PCA).The results can provide a reference for the choice of analgesia after the knee arthroplasty.Methods60 patients underwent knee arthroplasty with a primary diagnosis of knee osteoarthritis,and were divided into two groups according to different analgesia methods.The observation Group(n=30),The control Group(n=30).The observation group will take NSAIDS + Tizanidine + Cocktail therapy + CFNB + opioids,The control group will take NSAIDS + Tizanidine + Cocktail therapy+ PCA + opioids,during the perioperative period.1?The degree of patients` pain were assessed by visual analogue scale(VAS)and the RVAS scores of 6h,12 h,24 h,48 h,72 h were recorded before and after the operation;and the PVAS scores of 24 h,48 h,72 h were recorded after the operation.2?The knee motion was recorded to compare observation group with control group,2d,7d,14 d,3rd month postoperatively.3?The walking meters in 2d,7d,14 d of the two groups were recorded.4?Record the consumption of morphine or other opioids postoperatively.Results1.The RVAS scores at 6h,12 h,24h,48 h and 72 h after operation were lower than those before operation [(4.79±1.28),(4.91±1.19)points](P<0.05).The RVAS scores in the observation group [(1.49 ± 0.28),(2.48 ± 0.87),(2.44 ± 0.73),(2.42 ± 0.80)points ] at 6h,12 h,24h,48 h were lower than those in the control group [(1.74 ± 0.44),(3.02 ± 1.09),(2.95 ± 1.04),(2.99 ± 0.90)points](P<0.05),at 24 h and 48 h,the PVAS scores [(3.37±0.68),(2.72±0.47)points] were lower than the control group [(3.79±0.64),(3.09±0.60)points](P<0.05);There was no significant difference in RVAS and PVAS scores between the observation group and the control group at 72 h after operation(P>0.05).2.The knee flexion activity [(30.22 ± 6.11)°,(93.70 ± 9.89)°,(100.84 ± 4.69)°,(110.91 ± 6.31)°] and the extension activity [(3.80 ± 1.14)°,(0.82 ± 0.70)°,(-2.19 ± 1.03)°,(-3.12 ± 1.11)°] at 2d,7d,14 d and 3rd month in the observation group were significantly higher than the control group [(26.82 ± 4.32)°,(87.63 ± 10.31)°,(97.96 ± 4.74)°,(105.45 ± 4.42)°,(4.48 ± 1.20)°,(1.27 ± 0.79)°,(-1.56 ± 0.82)°,(-1.78 ± 1.52)°](P <0.05),in the observation group the ROM of the knee at 14 d,3rd month were significantly higher than 2d,7d(P<0.05).3.The walking distances [(36.57 ± 18.16),(58.48 ± 12.00),(112.20 ± 12.27)m] of the observation group at 2d,7d,14 d were longer than that in the control group [(26.33 ± 15.72),(50.75 ± 11.43),(104.98 ± 11.41)m](P <0.05).4.The consumption of morphine [(14.46±7.20)tablets] in the observation group were significantly lower than that in the control group [(19.20±9.96)tablets ](P <0.05).5.The incidence of nausea,vomiting,dizziness,and lethargy in the observation group were lower than those in the control group(P<0.05).ConclusionThe multi-mode analgesia(mainly CFNB)can provide a better pain relief than the multi-mode analgesia(mainly PCA)perioperatively.The multi-mode analgesia(mainly CFNB)can effectively control the paina,lead to quick functional recovery,and can be a good choice for the clinical use. |
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