Comparison of the analgesic effect between local infiltration anesthesia and femoral nerve block after total knee arthroplasty / 中国基层医药

ABSTRACT

Objective To compare the analgesic effect of infiltration anesthesia and femoral nerve block after total knee arthroplasty .Methods Seventy patients with unilateral knee arthroplastywere selected , and they were divided into local anesthesia group (group A) and ultrasound guided femoral nerve block group(group B) by randomized digital method,35cases in each group .All of them were treated with laryngeal mask ventilation under general anesthesia and post-cold therapy.The visual analogue scale (VAS) at postoperative 6h,12h,1d,2d,3d,quadriceps muscle strength at 6h,12h,1d,2d,3d and 5d after operation,range of motion(ROM) at discharge,patients'satisfaction rate, postoperative morphine consumption , incidence of adverse reaction were observed and recorded in the two groups . Results Postoperative 2d,3d,5d,the VAS scores of group A were (3.41 ±0.9)points,(3.19 ±1.24)points,(2.71 ± 0.51)points,respectively,which of group B were (3.35 ±0.8)points,(3.26 ±1.95)points,(2.89 ±0.92)points, respectively,postoperative 2 days the VAS score began to decrease in the two groups (t=2.64,2.52,2.32,all P>0.05),and the pain was alleviated.Postoperative 3d,the femoral quadriceps muscle power of group A was (4.51 ± 0.24)grades,that of group B was (4.12 ±0.63)grades,the,quadriceps muscle strength had improved trend (t=3.82,P>0.05).At discharge from hospital,knee joint range of motion of group A was (92.74 ±15.61) °,which of group B was (90.82 ±12.43) °,the knee joint activity scope of the two groups expanded (t=23.64,P<0.01). Postoperative morphine consumption of group B[(7.4 ±0.8)mg]was lower than group A[(8.7 ±1.2)mg],and the difference between the two groups was statistically significant (t=6.32,P<0.05).Neither group showed any adverse effects of wound infection and respiratory inhibition.There were 8 cases of nausea and vomiting in group A ,9 cases of urinary retention ,10 cases of nausea and vomiting in group B , 10 cases with urinary retention , but there were no statistically significant differences between the two groups (all P>0.05).Conclusion Local infiltration anesthesia and femoral nerve block can achieve good analgesic effect in TKA surgery ,the effect is similar .The latter's satisfaction rate is higher ,and usage amount of morphine is less ,the latter is more suitable for TKA postoperative analgesia .