Clinical Study Of Obturator Nerve Block Combined With Tibial Nerve Block In Early Postoperative Rehabilitation Flowing Total Knee Arthroplasty

Objective:On the basis of local invasive anesthesia by "cocktail" method and adductor tube block to compare the analgesic effect among obturator nerve block,tibial nerve block and obturator nerve block combined with tibial nerve block on postoperative rehabilitation following total knee arthroplasty(TKA).Methods:From July 2017 to December 2018,ninety patients who underwent unilateral total knee arthroplasty in our hospital(Weihai municipal hospital)at the age of 60-75 and with a BMI of 18-28kg/m2 ASA grade Ⅰ-Ⅲ were selected.And the patients were randomly divided into three groups.The informed consent was signed by the consent of the patients and their family members who fully received the indications and complications of anesthesia.All the surgeons in the three groups were a four-person group led by the same director.Nerve block operations after surgeries were performed by the same senior anesthesiologist.In each group patients in the ward received oral celecoxib 0.2g twice daily at least two days before the surgery operation and continued eating after the surgeries follow the doctor’s orders.Three groups of patients were undergoing general anesthesia,after injected the drugs via the vein,we assisted ventilation and rapid inducted the laryngeal mask,inhalation and intravenous general anesthesia using propofol,remifentanil and sevoflurane to maintain,to ensure the vital signs stable of patients undergoing the operation.After the prosthesis implantation,we operated local infiltration anesthesia(local infiltration analgesia,LIA)using "cocktail" therapy,and then suture wound at last.After surgery,ultrasound-guided adductor canal block(ACB),tibial nerve block(TNB),obturator nerve block(ONB)were performed in accordance with the requirements for grouping using 0.375%ropivacaine hydrochloride injection and 1:200000 epinephrine injection mixture(15ml).Patients were immediately connected to an Patient-controlled anesthesia(PCA)pump(using sufentanil2.5ug/kg+ondansetronl 6mg+dexmedetomidine0.8μg/kg,100ml.Infusion speed was 2ml/h,automatic control volume:was 2ml/time,automatic control time locked for 30min).The analgesic pump was pressed to relieve pain when the NRS score was greater than or equal to 4 points.Among them,local invasive anesthesia(LIA)and adductor canal block(ACB)were performed in the X,Y and Z groups.group X(n=30)received obturator nerve block(ONB),groupY(n=30)received tibial nerve block(TNB),patients in group Z(n=30)were given obturator nerve block(ONB)combined with tibial nerve block(TNB).1.Evaluated pain scores using the standard(NRS)scores at 2h,12h,24h,48h after surgery at rest and passive flexion 90°.2.Evaluated sedation scores(Ramsay score)were recorded at 2h,12h,24h,48h after surgery at rest.3.Record the number of control times of disposable infusion pump in each group and additional taking the dose of tramadol in total 24h.4.Record the incidence of nausea and vomiting,foot drop due to the peroneal nerve paralysis complications in every group 5.Measured the time of the test of the up and go(TUG)during the first 12 and 48 hours postoperatively 6.Evaluated patient satisfaction scores(gross satisfaction scales,GSS).Results:1.NRS scores of resting and exercise:At 6h,12h and 24h after surgery,group X were higher than in the groups of Y and Z,P<0.05,The difference was statistically significant.NRS scores at 2h,6h,12h,24h after surgery,there was no difference between group Y and group Z,P>0.05,the difference was not statistically significant.At 48h,there was no obvious significance among three groups,P>0.05,the difference was not statistically significant.2.Ramsay scores:At 2h,6h,12h after surgery,group X was lower than group Y and Z,P<0.05,and the difference was statistically significant.At 2h,6h,12h and 24h after surgery,P>0.05 was compared between the Y and Z groups,and the difference was not statistically significant.Among three groups at 48h after surgery showed no significant difference,P>0.05,the difference was not statistically significant.3.Times of the drug delivery of PC A pump and the supplemental dose of tramadol within 24h after surgery:Group X was significantly higher than group Y and group Z,P<0.05,and the difference was statistically significant.Compared group Y with group Z,P>0.05,the difference was not statistically significant.4.Postoperative incidence of nausea and vomiting:Compared the three groups via χ2 test,χ2=4.47,P=0.11>0.05,the difference was not statistically significant.The number of people who foot ptosis:Compared the three groups viayχ2 test,χ=3.31,P=0.19>0.05,the difference was not significant.5.The TUG test:The time of TUG test among three groups are similar before surgery P>0.05,and the difference was not statistically significant.The time of the postoperative TUG tests in group X was greater than that of the group Y and group Z at 24h,P<0.05,the difference was statistically significant,there was no difference between group Y and group Z,P>0.05,the difference was not statistically significant.The time of TUG test in three groups at 48 hours after surgery,group X was greater than that of the group Z,P<0.05,the difference was statistically significant.6.The patients’ satisfaction scores:Among groups X,Y and Z showed no significant differences,P>0.05,the difference was not statistically significant.There was no significant difference among three groups,P>0.05,the difference was not statistically significant.Conclusion:Tibial nerve block and obturator nerve block combined with tibial nerve block had better analgesic effect than obturator nerve block alone after total knee joint replacement,and the patients who carried out obturator nerve block combined with tibial nerve block had better walking ability,it could promot early postoperative rehabilitation,patients were satisfied with it.