The Effects Of Ultrasound-guided Adductor Canal Block Versus Formal Nerve Block On Analgesiaand Rehabilitation After Total Knee Arthroplasty

Objective: To investigate the comparison of the effect of adductor canal block(ACB)and femoral nerve block(FNB)on analgesia and rehabilitation after total knee arthroplasty(TKA).Methods: Eighty patients who underwent unilateral total knee arthroplasty in the orthopedics Department of Central Hospital from October 2020 to October 2021 were selected as the research objects,and were divided into ultrasound-guided adductor canal block group(group A)and femoral nerve block group(group F)according to random number table method,with 40 cases each.Intravenous anesthesia was used in both groups.Group A was given 0.25% Ropivacaine hydrochloride 20 ml before induction of general anesthesia for the affected adductor canal block under ultrasound,group F was given 0.25% Ropivacaine hydrochloride 20 ml for the affected femoral nerve block under ultrasound before induction of general anesthesia.An electric inflatable tourniquet was used to apply pressure on the upper third of the thigh before the operation,and the tourniquet was relaxed after the operation.At the end of anesthesia,sufentanil(2μg/kg)combined with dexmedetomidine(1.5μg/kg)plus 0.9%sodium chloride solution to 100 ml was used for intravenous controlled analgesia(PCIA).The background infusion volume was 2m L/h,the PCA volume was 0.5m L/ time,and the locking time was 15 min.The intraoperative doses of sufentanil,remifentanil and propofol were recorded.Post-operative monitoring of sufentanil use in post anesthesia care unit(PACU)after anesthesia;Visual analog scores(VAS)at 6h,24 h,48h and72 h after surgery;Ramsay sedation score 24 h,48h,72 h after surgery;Alsens Insomnia Scale(AIS)scores were performed 24 h,48h and 72 h after surgery.Maximum flexion motion of knee 48 h and 72 h after surgery;Postoperative walking time and walking distance 48 hours after operation;The number of patients with effective self-controlled intravenous analgesia pump and the incidence of postoperative adverse reactions.Results: Comparison between groups: The maximum flexion motion of knee in group A was significantly higher than that in group F at 48 h and 72 h after surgery(P < 0.05).The postoperative time of group A was significantly shorter than that of group F(P <0.05).The walking distance of group A was longer than that of group F 48 hours after operation(P < 0.05).However,there were no significant differences between group A and group F in intraoperative analgesic and sedative drug dosage,the number of patients who needed to monitor post anesthesia care unit(PACU)for sufentanil use after anesthesia,visual simulation score(VAS),Ramsay sedation score,AIS sleep score and incidence of postoperative adverse reactions(P > 0.05).Intragroup comparison: Compared with 24 h after surgery,VAS scores in both groups were significantly decreased at 6h,48 h,72h after surgery(P < 0.05).Compared with 24 h after surgery,Ramsay score in both groups was significantly decreased at 48 h and 72 h after surgery(P< 0.05).Compared with 24 h after surgery,AIS scores in both groups were significantly decreased on 48 h and 72 h after surgery(P<0.05).Conclusions : There is no significant difference in the analgesic effect and sleep quality of patients after knee replacement under ultrasound guidance of adductor canal block and femoral nerve block,but compared with femoral nerve block,adductor canal block has less effect on quadriceps muscle strength and is more beneficial to early activity and muscle strength recovery of patients.