Application Of General Anesthesia Combined With Adductor Block In Perioperative Period Of Knee Joint

ObjectiveTo analyze the effect and safety of hydromorphone mixed with ropivacaine for ultrasound-guidedACBduring the general anesthesia in perioperative period of knee arthroplasty.Methods90 patients of unilateral arthroscopic surgeriesare randomly sorted into three groups,namely,the general anesthesia group(Group A),the general anesthesia+ropivacaine for ACB group(Group B),and the general anesthesia+hydromorphone mixed with ropivacaine for ACB group(Group C),with 30 patients in each.All patients are supplied with routine monitoring(including ECG,NIBP and SPO2),invasive arterial blood pressure monitoring and BIS,with their upper extremity veins opened,and dexamethasone 10 mg,cisatracurium 0.15～0.2mg/kg,etomidate 0.2～0.4mg/kg,together with sufentanil 0.3 μg/kg provided after preoxygenation through anesthesia induction.Ultrasound-guided ACBis conducted after the anesthesia induction in Group B and Group C,with 0.375%ropivacaine 20ml and 0.0lmg/kgropivacainemixedwith hydromorphone20ml injected.Mechanical ventilation is applied to the tracheal intubation through general anesthesiainduction among the three groups,volatile sevoflurane and propofol are pumped into the body to sustain the anesthesia,whose dosage is consecutively adjusted according to the BIS value,which is maintained between 45～55.Dosage of propofol and volatile sevoflurane,recovery time of autonomous respiration(T1),time of palinesthesia,and time of removal of the tracheal intubation(T2)are recorded.Preoperative and postoperativeVAS scores are recorded respectively4h(T3),8h(T4),12h(T5)and 24 h(T6);the usage of analgesic,average Hospitalization day,adverse events of ACB and of cardiovascular,overdose of sedative,nausea and vomiting are also recorded.Result The differences in gender,length and weight do not lead to statistical significances(P>0.05).The dosage of propofol in Group A is 4.41(3.92 5.27)mg/kg.h;the dosage of volatile sevoflurane is 28.27(26.68 31.88)ml/h;recovery time of autonomous respiration(Tal)is 12(10.25 14.47)min;time of palinesthesia and time of removal of the tracheal intubation(Ta2)is 15(12 23.5)min;postoperative VAS scores at 4h(Ta3),8h(Ta4),12h(Ta5),and 24h(Ta6)are respectively 1.8±0.79,3.13 ±0.81,3.8 ± 0.75,and 2.5 ± 0.5;preoperative and postoperative HSS scores are respectively 48(46 51)and 69(65.25 72.75);the usage of analgesic is 4(3 4.75)second;and the average HLOS is 3(2 3)day.The dosage of propofol in Group B is 3.98(3.674.43)mg/kg.h;the dosage of volatile sevoflurane is 20.84(17.62 23.84)ml/h;recovery time of autonomous respiration(Tbl)is 4.54(1.75 6.75)min;time of palinesthesia and time of removal of the tracheal intubation(Tb2)is 8.15(6.2510)min;postoperative VAS scores at 4h(Tb3),8h(Tb4),12h(Tb5),and 24h(Tb6)are respectively 1.97±0.84,1.77 ± 0.67,2.3 ± 0.86,and 2.07 ± 0.51;preoperative and postoperative HSS scores are respectively 48.5(46 54.5)and 72.5(66.25 76);the usage of analgesic is 1(1 2)second;and the average HLOS is 2(1 2)day.The dosage of propofol in Group C is 3.765(3.334.29)mg/kg.h;the dosage of volatile sevoflurane is 17.48(14.4 18.6)ml/h;recovery time of autonomous respiration(Tc1)is 3.67(3 5)min;time of palinesthesia and time of removal of the tracheal intubation(Tc2)7.445(5 10)min;postoperative VAS scores at 4h(Tc3),8h(Tc4),12h(Tc5),and 24h(Tc6)are respectively 1.67 ± 0.70,1.4 ±0.55,1.73±0.63,and 1.73 ± 0.68;preoperative and postoperative HSS scores are respectively 50(47 54)and 78(68.580);the usage of analgesic is 1(0 1)second;and the average HLOS is 2(1 2)day.The dosage of anesthesia maintenance medicines of propofol and volatile sevoflurane,recovery time of autonomous respiration,time of palinesthesia and removal of the tracheal intubation,postoperative VAS scores,usage of analgesic and average HLOS in Group C are less than those in Group A and B,and those in Group B are less than in Group A.Hence,it can be analyzed that Group C was the lowest,followed by group B and group A was the highest.;preoperative and postoperative HSS scores in Group C are better than those in Group A and B,and those in Group B are better than in Group A.Hence,it can be analyzed that Group C was the highest,group B was the second,and group A was the lowest.ConclusionIn knee surgeries,a general anesthesia combined with ACB calls for less anesthesia maintenance medicines than that in a mere general anesthesia,leading to a betteranalgesia and recovery and shorter Hospitalization day.Moreover,hydromorphone mixed with ropivacaine for ACB is betterthan mere ropivacaine.