Observastion on effect of continuous femoral nerve block guided by ultrasound in postoperative analgesia in total knee arthroplasty / 重庆医学

ABSTRACT

Objective To observe the effect and adverse reactions of ultrasound guided continuous femoral nerve block in postoperative analgesia after total knee arthroplasty(TKA) and to conduct the comparative study with traditional patient-controlled intravenous analgesia. Methods Forty patients undergoing elective unilateral knee replacement in this hospital from August 2015 to March 2016 were selected and divided into the group A and B, 20 cases in each group. The group A adopted ultrasound guided continuous femoral nerve block analgesia, while the group B adopted patient-controlled intravenous analgesia(PCA). The VAS score on postoperative 4,8,12,24,48 h were compared between the two groups, the VAS score of continuous passive motion on postoperative 24,48,72 h were compared between the two groups, the muscle strength grade and knee joint maximum passive flexion and extension on postoperative 2-6 d were compared between the two groups. Postoperative adverse reactions were observed. The levels of C-reactive protein(CRP) and interleukin- 6 (IL-6) were tested. The ultrasound monitoring of lower extremity deep vein thrombosis occurrence was performed and the changes of serum D -dimer was observed. Results The rest state VAS score at each time point in the group A was significantly lower that in the group B (P<0.05). The VAS score of continuous passive function exercise at postoperative 24,48,72 h in the group A was significantly lower than that in the group B (P<0.05). The passive flexion and extension mobility on postoperative 2,3,4 d in the group A was significantly higher than that in the group B(P<0.05). There was no signifi cant difference in muscle strength at each time point between the two groups (P>0.05). The number of PCA pressing times in the group A was less than that in the group B (P<0.05). The CRP level at postoperative 6 h in the group the A was lower than that in the group B (P<0.05). The IL-6 level after operation in the two group was higher than that before operation, but the intergroup had no significant difference (P>0.05). The lower extremity deep venous thrombosis formation detected by ultrasound had no significant difference between the two groups. The D-dimer level during perioperative period in the group A was lower than that in the group B (P<0.05). Conclusion Ultrasound guided continuous femoral nerve block used in postoperative analgesia in the patients undergoing knee arthroplasty has definite analgesic effect, can alleviate postoperative stress damage and incidence of postoperative complications, and is conducive to consolidate the operative curative effect.