Effect Of Different Analgesic Methods On Pain In Total Knee Arthroplasty In Elderly Patients

Objective: The research was comparing the effects of different methods of lower extremity nerve block combined with hemodynamics and postoperative analgesia in elderly patients undergoing knee arthroplasty.Aiming to explore the analgesic scheme suitable for knee arthroplasty in elderly patients.Methods: We selected 90 patients who needed unilateral total knee arthroplasty were randomly divided into three groups with 30 patients in each group.ASAII-III grade,age65-85 years old,average age is 75 years old,BMI 13.89-37.26.Among them,Group F and Group S were both experimental groups: Group F was treated with femoral nerve combined with obturator nerve and lateral femoral cutaneous nerve block and laryngeal mask general anesthesia add local infiltration analgesia in articular cavity;Group S was treated with saphenous nerve combined with obturator nerve and lateral femoral cutaneous nerve block and laryngeal mask general anesthesia add local infiltration analgesia in articular cavity;Group C was the control group: laryngeal mask general anesthesia alone was treated with local infiltration analgesia as postoperative analgesia.Electrocardiogram(ECG),blood pressure(SBP/DBP),mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SpO2)and end-expiratory carbon dioxide(PETCO2)were continuously monitored by multifunctional monitor.Heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)were recorded before anesthesia induction(T0),before tourniquet(T1)and after upper tourniquet(T2),before and after tourniquet withdrawal(T4).The intraoperative use of sufentanil was recorded in the three groups.the VAS pain scores in rest and exercise within 24 hours(2 hours,8 hours,12 hours,24 hours)after operation in the three groups were followed up,and the possible adverse reactions in the three groups were observed.Results: There was no significant difference in sex,age,body weight,ASA grade,operation time and tourniquet time among the three groups(p> 0.05).The intraoperative dosage of sufentanil in the two nerve block groups was less than that in the control group,the difference was statistically significant(p < 0.05).SBP,DBP,MAP,HR decreasedafter anesthesia induction,SBP,DBP,MAP,HR increased after tourniquet application,SBP,DBP decreased and HR increased after tourniquet loosening.The fluctuation of vital signs in the three groups was different.There were no significant changes in vital signs in group F after tourniquet application compared with group C(p < 0.05).Vas Scores in group F and Group S were significantly lower than that in group C(p < 0.05),and that in Group F was slightly lower than that in group S,but there was no significant difference.There was no significant difference between the three groups in VAS scores at each time point after operation at rest(p > 0.05).The incidence of postoperative nausea and vomiting was 13.4%,10% and 16.7%,and the incidence of dysphoria was 6.7%,6.7% and 10%,respectively.There was no significant difference between the three groups(p > 0.05).Conclusion: Nerve block analgesia is safe and effective in elderly patients undergoing total knee arthroplasty.Compared with local infiltration analgesia,nerve block technique can significantly reduce the use of narcotic drugs during operation.Compared with saphenous nerve combined with obturator nerve and lateral femoral cutaneous nerve block,femoral nerve combined with obturator nerve and lateral femoral cutaneous nerve block can effectively improve the blood zone reaction and the vital signs are relatively stable.Compared with local infiltration Analgesia,nerve block technique is more suitable for elderly patients undergoing total knee arthroplasty because of its accurate analgesia and low VAS score.