Efficacy of ultrasound-guided continuous fascia iliac compartment block versus neurostimulator-guided continuous femoral nerve block for postoperative analgesia in patients undergoing total knee arthroplasty / 中华麻醉学杂志

ABSTRACT

Objective To compare the efficacy of ultrasound-guided continuous fascia iliac compartment block (cFICB) and neurostimulator-guided continuous femoral nerve block (cFNB) for postoperative analgesia in patients undergoing total knee arthroplasty.Methods Sixty-six ASA Ⅰ or Ⅱ patients,aged 46-78 yr,weighing 45-88 kg,scheduled for unilateral total knee arthroplasty,were randomly divided into 2 groups (n =33 each)cFNB group (group Ⅰ) and cFICB group (group Ⅱ).At 30 min before surgery,the patients received FNB guided by neurostimulator in group Ⅰ and FICB guided by ultrasound in group Ⅱ.A bolus of 0.5％ ropivacaine 20 ml was injected and a catheter for continuous nerve block was inserted in both groups.At 0.5 h after surgery,the catheter was connected to a patient-controlled analgesia (PCA) pump.PCA with 0.2％ ropivaeaine was used for postoperative analgesia (48 h).The PCA pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤ 3.The distribution of sensory block was assessed at 10 min after the first administration,and at 0.5,4 and 24 h after surgery.The effective rate of sensory block was calculated.When VAS score ＞ 4,tramadol 50 mg was given intravenously or orally every 12 h as a rescue analgesic.When VAS score ＞ 5,pethidine 50 mg was injected intramuscularly as a rescue analgesic.The number of attempts was recorded during 0-4 h,4-12 h and 12-24 h after surgery.The consumption of tramadol and pethidine was also recorded during 0-24 h and 24-48 h after surgery.The sleep quality score during the nighttime was also recorded during 0-24 h and 24-48 h after surgery.Vascular puncture and parasthesia during nerve block were recorded.The toxic reaction,severe nausea and vomiting (lasting for more than 1 day) and nerve damage were recorded after surgery.Results Compared with group Ⅰ,the effective rate of sensory block in the medial aspect of the thigh was significantly decreased at 10 min after the first administration,and the effective rate of sensory block in the lateral aspect of the thigh was significantly increased at 0.5 h after surgery in group Ⅱ (P ＜0.05).There was no significant difference in the number of attempts,consumption of tramadol and pethidine,and sleep quality score during the nighttime during different time periods between the two groups (P ＞ 0.05).No vascular puncture or parasthesia was found during nerve block in the two groups.No toxic reaction,severe nausea and vomiting or nerve damage was found after surge,y in the two groups.Conclusion Ultrasound-guided cFICB has the similar analgesic efficacy with neurostimulator-guided cFNB after operation,but it can provide a wider distribution of sensory blockade in patients undergoing total knee arthroplasty.