| Objective: To investigate the clinical efficacy of femoral nerve block(FNB),adductor canal block(ACB)and local infiltration anesthesia(LIA)on short-term postoperative analgesia,clinical outcomes and complications in patients who underwent unicompartmental knee arthroplasty(UKA).Methods: 75 cases underwent UKA were selected between July 2019 and July 2020.They were randomly divided into three groups: Group A(with FNB),Group B(with ACB),Group C(with LIA).The primary outcome was the VAS score at each time point after operation.Meanwhile,the consumption of opioids,quadriceps muscle strength(QMS),operation time,first walking time,length of stay(LOS),the range of motion(ROM),postoperative satisfaction were analyzed.Results: All patients completed regular follow-ups;all patients met the standards of this study,no cases were withdrawn,and no data was missing.(1)No significant differences in age(P = 0.683),gender(P = 0.717),body mass index(BMI)(P = 0.762),ASA grade(P = 0.854)and K-L grade of osteoarthritis(P = 0.743)among the three groups;(2)The postoperative VAS scores of the three groups were significantly improved compared with those before operation,and no significant difference of VAS scores was found at each time point after operation(P > 0.05).(3)The QMS of group B(4.5 ± 0.2)and group C(4.5 ± 0.3)were significantly better than those of group A(3.6 ± 0.6)within 24 hours after operation;(4)The ROM of group A(93.7 ± 12.9 °)was significantly lower than those of group B(100.8 ± 10.8 °)and group C(103.6 ± 11.8 °)one week after operation;(5)No significant difference in opioid consumption among the three groups(P > 0.05);The operation time of group C(59.8 ± 6.8 min)was shorter than that of group A(77.2 ± 5.3 min)and group B(78.0 ± 6.6 min)(P < 0.05);The first walking time of Group A(6.7 ± 2.5 h)was significantly later than group B(5.0 ± 1.4 h)and group C(5.2 ± 1.3 h)(P < 0.05)(P > 0.05);As for satisfaction score,group C(8.4 ± 0.9)was slightly higher than that of group A(7.2 ± 1.0)(P < 0.05);The LOS of group C(3.2 ± 1.9 d)was slightly lower than group A(3.7 ± 1.1 d)and group B(3.4 ± 1.2 d),but the difference was not statistically significant(P > 0.05);(6)Among 43 UKA patients who failed to meet the discharge standard within 24 hours after operation,lack of mobilization(44%),pain(17%)and wound issue(11%)were the main reasons for patients not meeting the discharge standard;patients in group A(n = 15,60%)with lack of mobilization were more than group B(n = 9,36%)and group C(n = 9,36%)(P < 0.05),showing that FNB had adverse effects on QMS after UKA;a total of 4 patients were readmitted: 1 patient in group A was readmitted due to periprosthetic infection(PJI)seven months after operation,and this patient was healed and discharged from our hospital after two-stage revision of total knee arthroplasty;3 patients were readmitted due to limited knee flexion,which seriously affected the quality of life.After readmission,these patients were treated with manual release under anesthesia and functional exercise assisted by equipment,and the normal activity function was restored;no other complications were found in all patients until the last follow-up.Conclusion: 1.Local infiltration anesthesia,adductor block and femoral nerve block can effectively relieve the early pain after UKA and reduce the consumption of opioids.2.Compared with ACB and LIA,FNB has a significantly negative effect on quadriceps muscle strength,which could delay the postoperative recovery.3.Compared with FNB and ACB,LIA can attain satisfactory postoperative analgesia without compromising QSR.Moreover,LIA is easier and cost-effective,and more suitable for postoperative analgesia after UKA. |
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