Effect Of IPACK Block Combined With Adductor Canal Block On Postoperative Analgesia And Early Motor Function Rehabilitation After Total Knee Arthroplasty:A Prospective Randomized Clinical Trial

Objective To evaluate the effect of IPACK block combined with adductor canal block on postoperative analgesia and early functional rehabilitation knee in patients undergoing Total Knee Arthroplasty.Methods Sixty patients scheduled to accept unilateral total knee arthroplasty,both sexes,aged 60-75yr,BMI18-30kg/m~2,of ASA physical status?or?,with total knee arthroplasty,were randomly divided into 2 groups(30 patients pear group)using a random number table method:IPACK block+adductor canal block group(group A);femoral nerve block+sciatic nerve block group(group F).Before anesthesia induction,15 ml of 0.375%ropivacaine was used for adductor block and 25 ml was used for IPACK block in group A under ultrasound guidance.Under ultrasonic guidance,The group F was given femoral nerve block and popliteal superior sciatic nerve block respectively,with 20ml 0.375%ropivacaine pear block.After the patient's skin in the blocked area is feeling dull,general anesthesia under laryngeal mask control ventilation is performed.Patient controlled intravenous analgesia(PCIA)were adopted after surgery:sufentanil 2?g/kg,ondansetron 8mg and normal saline were added to 100 ml.The background infusion volume was 2 ml/h and 2 ml bolus dose was controlled for 15 min.In order to maintain VAS?3,oral cailoxib capsules were used for remedial analgesia and the incidence of postoperative remedial analgesia with oral cailoxib capsules and the number of effective and ineffective compressions of the analgesic pump were recorded.The VAS score of rest and dynamic activity were recorded at the time when the patients left PACU and 24 h,48 h,72 h after surgery.The quadriceps muscle strength score and the bromage score were recorded at PACU and 24 h,48 h,72h after surgery.The walking distance were recorded at the time of48 h,72 h after the operation.The incidence of postoperative analgesia and nerve block adverse reaction were recorded.Results There was no statistically significant difference in general data between the two groups.VAS score at rest and dynamic activity at the time when the patients left PACU,postoperative 24 h,48 h,72 h showed no significant differences between the two groups,and compared with group F,there was no significant changes in group A were found in intraoperative sufentanil dosage,postoperative incidence of celecoxib analgesic relief,and postoperative effective and ineffective times of intravenous controlled analgesia.The quadriceps muscle strength score was significantly increased in group A and the bromage score was significantly decreased in group A at the time when the patients left PACU,postoperative 24 h,48 h,72 h.There was no significant difference between the two groups in the incidence of nerve block adverse reaction.Conclusion Compared with traditional femoral nerve block combined with sciatic nerve block,as a new technique,IPACK block combined with Adductor canal block is safe for postoperative analgesia and can provide a more satisfactory and comfortable analgesic effect for patients with Total Knee Arthroplasty without influencing the motor function and accelerating the postoperative rehabilitation process.