| Objective:To evaluate the analgesic effect of intermittent multiple interspace between the popliteal artery and the capsule of the posterior knee block combined with adductor canal block and simple adductor canal block in patients with flexion contracture knee arthritis undergoing total knee arthroplasty.Methods:Forty-six American Society of Anesthesiologists physical statusⅠ-Ⅲpatients of both sexes,age≥18 years old,selected for unilateral total knee arthroplasty in the Bethune First Hospital of Jilin University from December 2021 to October 2022 were divided into 2 groups(n=23 each)using a random number stable: Group IA:Ultrasound-guided IPACK block combined with adductor canal block(n=23);Group A: Ultrasound-guided adductor canal block(n=23).Adductor canal block was performed in pre-anesthesia room under ultrasound guidance before induction of anesthesia in both groups,and 0.375%ropivacaine 20 ml was injected in both groups,and IPACK block was then performed under ultrasound guidance,and 0.25%ropivacaine 20 ml was injected in group IA.After confirming the blocking effect,all the patients were ventilated through the laryngeal mask airway under general anesthesia.Intermittent nerve block were used for postoperative analgesia(IPACK block combined with adductor canal block was performed in Group IA and adductor canal block was performed in Group A at 24 h and 48 h after operation).When visual analogue scale(VAS)scores > 4,5mg morphine was injected intravenously as rescue analgesia.VAS scores at rest were recorded at 2h,8h,24 h,36h,48 h and 60 h after operation.VAS scores of leg pressing,walking on level ground,and knee flexion of 45°,as well as knee joint extension angle,maximum flexion angle,leg raising angle,walking distance on level ground and consumption of opioid were recorded at 24 h and 48 h after operation.The time of first meal,first landing time,length of hospital,and the postoperative complications(such as nausea,vomiting and postoperative delirium,etc.)were recorded.Results:The general data of the two groups of patients were comparable(P>0.05).Compared with group A,VAS scores of knee flexion 45° and leg pressing at 24 h and 48h after operation were decreased in group IA(P<0.05),knee joint extension angle was smaller in group IA(P<0.05),The walking distance on level ground was significantly prolonged in group IA(P<0.05);The consumption of opioid was significantly decreased in group IA(P<0.05).There was no significant difference between the two groups in resting VAS scores at any time after operation,VAS scores at 24 h and 48 h after operation of walking on level ground,maximum knee flexion angle,leg raising angle,length of hospital,postoperative complications,The time of the first meal and first landing after surgery(P>0.05).Conclusion:Intermittent multiple IPACK block combined with adductor canal block produces better efficacy and less opioid consumption than adductor canal block alone for postoperative analgesia in patients with flexion contracture knee arthritis undergoing total knee arthroplasty. |
