The Effect Of Femoral Nerve Block Combined With PCIA On Analgesia And Inflammatory Factors After Arthroscopy Knee Surgery

Objective:Based on the conception of enhanced recovery after surgery(ERAS),the experiment explored the lowest effective concentration of ropivacaine for ultrasound-guided femoral nerve block,combined with patient-controlled intravenous analgesia(PCIA)on analgesia after arthroscopy knee surgery(AKS),and evaluated the efficacy and safety for analgesic effect and inflammatory cytokines,which providing a reference for clinical analgesia.Methods:Patients,unilateral arthroscopy knee surgery in Nanhua Hospital Affiliated University of South China of 83 cases,aged from 18to 70,ASA?to?,BMI from 18.5 to 24.9kg/m~2,were randomly divided into four groups,group A,group B,group C and group D,each group 20cases,22 cases,21 cases and 20 cases.All patients were subjected to unilateral arthroscopy knee surgery under combined spinal-epidural anesthesia.The control group(Group A)received PCIA(the sufentanil2?g/kg with normal saline were diluted to 100ml)after surgery,the experimental groups(Group B,C and D)received 30ml of ropivacaine at concentration of 0.15%,0.20%,0.30%respectively within 30 mins,with ultrasound-guided femoral nerve block combined with PICA.The four groups VAS of in resting state and dynamic state,Ramsay score,BCS were recorded.The serum level of IL-6?IL-10?TNF-?were tested,and the number of patients within 24h after pressing PCIA and adverse reactions(nausea and vomiting,pruritus,somenolence and respiratory depression)were recorded.Results:(1)Compared with four groups of VAS in resting state and dynamicc state after 6h,12h,24h,the experimental groups(B,C,D)were significantly lower than control group,there was statistically significant(p<0.05).VAS of group B was obviously higher than group C and group D,there was statistically significant(p<0.05).There was no significant difference in VAS between group C and D(p>0.05).(2)The Ramsay score of four groups had no significant difference after6h,12h,24h(p>0.05).(3)The BCS of experimental groups was higher than control group,and there was statistically significant(p<0.05).There was no significant difference in BCS of group B,C and D(p>0.05).(4)The serum level of IL-6 and TNF-?in experimental groups was significantly lower than control group after 12h and 24h,and there was statistically significant(p<0.05).The serum level of IL-6 in group C and D was lower than group B,and there was statistically significant(p<0.05).There was no significant difference in the serum level of IL-6 between group C and D(p>0.05).The experimental groups had no significant difference in the serum level of TNF-?(p>0.05).The control group had no significant difference in the serum level of IL-10(p>0.05).The serum level of IL-10 in experimental groups was significantly increased and was higher than control group,and there was statistically significant(p<0.05).The experimental groups had no significant difference in the serum level of IL-10(p>0.05).(5)The press number of PCIA in control group was significantly higher than experimental groups after 24h,and there was statistically significant(p<0.05).The press number of PCIA in group C and D was lower than group B,and there was statistically significant(p<0.05).There was no significant difference in the press number of PCIA between group C and D(p>0.05).(6)Compared with control group,the cases with adverse reactions(nausea and vomiting,pruritus,somenolence and respiratory depression)in experimental groups had significantly decreased,and there was statistically significant(p<0.05).Conclusion:Ultrasound-guided femoral nerve block with PCIA on analgesia after arthroscopy knee surgery is better than PCIA,which can reduce systemic inflammatory response and promote rapid recovery.0.2%ropivacaine 30ml can be safely and effectively used for femoral nerve block analgesia after arthroscopy knee surgery.