| Objective:Total knee arthroplasty(TKA)is an efficient method to cure severe knee joint disease,recover joint activities and enhance patients' quality of life.TKA has serious surgical trauma and disturbance to body physiology,which makes reasonable Anaesthesia Management during peri operation period quite important for patients' early after-operation rehabilitation and rebuilding of joint function.Continuous femoral nerve block(CFNB)has been already broadly applied for the pain killer of TKA,but there are still some disputes of the point in time of implementing block.This research has the purpose of observing clinical effects of continuous femoral nerve block at different points in time on total knee arthroplasty(TKA)for the elderly.Method:A total of 90 elderly patients undergoing TKA were selected from Ja nuary 2017 to January 2019 at the People's Hospital of Sihong County..According to different points in time of implementing CFNB,those patients were randomly d ivided into control group(I group,n=30),preoperative block group(? group,n=30)and postoperative block group(? group,n=30).All of the patients were carried o ut intravenous general anaesthesia.The control group' patients weren't implemented any nerve block,the preoperative block group' patients underwent ultrasound guided femoral nerve puncture drug delivery and indwelling catheters before induction of anaesthesia and the postoperative block group' patients,after anaesthesia and operat ion,if their were fully conscious,ultrasound guided femoral nerve puncture drug de livery and indwelling catheters would be implemented.General anaesthesia induction drugs were selected from etomidate 0.1-0.2mg/kg,midazolam 0.05-0.1mg/kg,cistret racurium 0.2mg/kg,sufentanil 0.2-0.3?g/kg.Anaesthesia maintenance:continuous intr avenous pumping of propofol 4-8 mg/kg/h,cistracurium 1.5-2?g/kg/min and remife ntanil 0.1-0.3 ug/kg/min,BIS value maintained between 40 and 60.Remifentanil inf usion rate adjustment and sufentanil supplementation should be proceeded based on BIS monitoring and patients' pain response.Cistracurium should be stopped injectin g 30 mins before the end of the operation and 10 mins as the same for propofol.Remifentanil should be stopped injecting at the end of the operation and neosmin s hould be applied for antagonistic effects of muscle relaxation according to patients'muscle recovery situation.CFNB:Femoral nerve block guided by ultrasound with i ndwelling sterile catheter connected with disposable PCA Analgesic Pump and confi gured with 20ml 0.75%ropivacaine+normal saline to 100ml analgesic solution as subsequent continuous dosing.Control group should receive PCIA analgesia after o peration:Sufentanil 1.5?g/ml+normal saline to 100 ml.Other analgesic management during the peri operation period:All of the patients should take orally two times a day 200mg celecoxib after the hospitalisation.During the operation,the orthopedist should do "cocktail therapy",which is multi-point injection of 75mg/10ml ropivacaine+betamethasone 1ml for joint cavity.collateral ligament starting and end point,subcondylar fat pad and subcutaneous tissue.200 mg of celecoxib should be given after operation to be taken two times a day orally.Observation indicators:Anesthesia dose,anesthesia time,operation time and tourniquet time,resting VAS and exercise VAS rating,mini-mental state examination(MMSE)rating,C-reactive protein and cortisol,out-of-bed time and satisfaction of analgesia,rate of occurrence of hypotension and bradycardia during anaesthesia and operation,rate of occurrence of postoperative adverse reactions(nausea,vomiting,itching,drowsiness,etc.).Observation points in time:Peripheral blood specimen should be kept for CRP and Cor inspection one day before the operation and 1 hour,24 hours and 48 hours after operation.VAS rating should be followed-up and recorded after operation at above points in time.MMSE scores should be done at 1day before operation and the seventh day after operation.Results:There were no statistical differences in general information,anaesthesia time,operation time,tourniquet time,anaesthesia BIS value,rate of occurrence of bradycardia and hypotension and other targets in the three group,P>0.05.There was no statistical difference in the dosage of propofol,midazolam,etomidate,cistracurium,etc.during the operation,P>0.05.The dosages of remifentanil and sufentanil in ? group were significantly lower than those in ? group and ? group,P<0.05.Pain score:There was no statistical difference in resting VAS rating at each point in time of 1 hour,24 hours,and 48 hours among the three group of patients and the VAS ratings of the patients in the ? and ? group at 1 hour,24 hours,and 48 hours after operation were significantly lower than those in ?group,P<0.05.There was no statistically significant difference in the VAS ratings between the ? and ? group at the same point in time after operation,P>0.05.CRP and Cor content:The contents of the three group of patients at 1 hour,24 hours,and 48 hours were all higher than before operation,P<0.05.The CRP and Cor contents of the patients in ? and ? group at each points in time after operation were lower than those in ? group,P<0.05.There was no significant difference in CRP and Cor between ? and ? group,P>0.05.There was no significant difference in the MMSE rating among the three group of patients on the seventh day after operation,P>0.05.The rate of occurrence of ? nausea and vomiting of ? group was significantly higher than ? and ? groups,P<0.05.The analgesia satisfaction of patients in the ? and ? group was better than that in ? group,P<0.05.And out-of-bed time of ? group was longer than that of ? and ? groups,P<0.05.Conclusion:This research results show that the combination of CFNB and other analgesic methods can effectively ease the pain after TKA.Comparing CFNB began before and after operation,with its preoperative application the amount of anaesthesia and peri operation period CRP and Cor can be reduced to minimise adverse reactions after operation and increase patient satisfaction. |
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