Clinical Study On Femoral Nerve Block Anesthesia Combined With Cocktail Therapy For Early Postoperative Analgesia After TKA

Objective:To compare the clinical effects of single analgesia of femoral nerve block combined with intraoperative cocktail therapy versus single femoral nerve block anesthesia and simple intraoperative cocktail therapy for early postoperative analgesia and knee functional rehabilitation in total knee arthroplasty.Methods:From January 2017 to October 2017 in the First Affiliated Hospital of Qiingdao University joint surgery for unilateral total knee replacement(total knee,arthroplasty,TKA)in 60 cases of patients were randomly divided into three groups.The experimental group: single femoral nerve block combined with cocktail therapy group(A group,n = 20 cases);control group: simple single femoral nerve block anesthesia group(B group,n = 20 cases);control group: Simple cocktail therapy group(C group,n=20 cases).The general data of all patients’ age(y),gender,body mass index(BMI),preoperative KSS score and intraoperative tourniquet use time were recorded.Observe and compare the visual analog scale(VAS)to the patient’s postoperative static and visual effects at different time points at 4h,8h,12 h,24h,48 h,72h,96 h,and 120 h after surgery in the experimental group and the two control groups.Allodynia scores;compare postoperative pain scores at 48 hours,72 hours,96 hours,and 120 hours at different time points;compare continuous passive exercise(CPM)at 48 hours,72 hours,96 hours,and 120 hours at different time points.The maximum number of degrees of activity was compared;the maximum degree of patient’s active buckling was also compared at different time points(48h,72 h,96h,120h).The time required for the surgical leg to lift the active leg from the bed more than 10 cm after surgery was compared between the experimental group and the two control groups.The number of additional pethidine hydrochloride injections was compared between the experimental group and the two control groups.The complications of dizziness,headache,nausea,vomiting,lung infection,and poor healing of surgical incision in the experimental group and the two control groups were recorded and compared.Results:The resting state of the experimental group in A group after 8h,12 h,24h under the pain score was 2.95 + 0.686,2.85 + 0.366,2.55 + 0.510,significantly lower than the control group B(4.80 + 0.523,3.90 + 0.447,3.20 + 0.696)and control group(C group,3.60 + 0.681 3.45 + 0.759,3.20 + 0.616),the difference was statistically significant(P<0.05).The experimental group A group in the state of motion after operation of 48 h,72h,96 h pain score(3.80 + 0.696,3.40 + 0.681,2.95 + 0.686)is lower than that of control group and B group(4.50 + 0.889,4.20 + 0.768,3.60 + 0.503)and C group(4.55 + 0.686,4.10 + 0.553,3.65 + 0.489),the difference was statistically significant.The experimental group after surgery in A 48 h,72h,96 h time point CPM maximum exercise degree(69.40 + 2.981,87.80 + 2.308,99.90 + 2.634)is higher than that of the control group and B group(57.50 + 1.638,78.05 + 2.911,92.35 + 2.207),the difference was statistically significant(P<0.05).The experimental group in the A group,48 h,72h,maximum degree 96 h active flexion of(51.70 + 7.519,66.80 + 7.016,79.75 + 5.270)higher than that in group B(37.80 + 4.948,50.30 + 4.975,64.95 + 4.019)and C group(56.90 + 4.103,79.15 + 3.528,91.15 + 3.924),the difference was statistically significant(P<0.05).The time required for the experimental group A group in the operation side of the active straight leg lift high heel lift off the bed more than 10 cm H(46.35 + 9.201)was significantly lower than the control group in B group(53.20 + 8.971)and C group(52.10 + 6.052),the difference was statistically significant(P<0.05).The experimental group A group in knee arthroplasty: adverse reactions such as dizziness,headache,nausea,vomiting,pulmonary infection,incision healing and other adverse reactions with the control group,B group and control group C group compared the difference was not statistically significant(P>0.05).Conclusion: Femoral nerve block combined with cocktail therapy can ensure smooth operation.Femoral nerve block combined with cocktail therapy can obtain better early postoperative analgesia than mere application of femoral nerve block anesthesia and simple application of cocktail therapy.Femoral nerve block combined with cocktail therapy is more conducive to early knee exercise after TKA.Femoral nerve block anesthesia combined with cocktail therapy does not increase the occurrence of adverse reactions,and the operation is simple,safe and reliable,it is worthy of clinical application and promotion.